The purpose of this article is to introduce a model of neurodevelopmental risk and protection that may explain some of the relationships among biobehavioral risks, environmental risks, and caregiving behaviors that potentially contribute to neurobehavioral and cognitive outcomes. Infants born before 30 weeks of gestation have the poorest developmental prognosis of all infants. These infants have lengthy hospitalization periods in the neonatal intensive care unit (NICU,) an environment that is not always supportive of brain development and long-term developmental needs. The model supports the premise that interventions focused on neuroprotection during the neonatal period have the potential to positively affect long-term developmental outcomes for vulnerable very preterm infants. Finding ways to better understand the complex relationships among NICU-based interventions and long-term outcomes are important to guiding caregiving practices in the NICU.

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In this sample, the use of prefeeding NNS did not affect NS, breathing during feeding, or select behavioral characteristics of feeding.

A nonexperimental study with a sample of 95 preterm infants was used to develop a model of feeding performance outcomes (proficiency, percent of prescribed volume consumed, and efficiency) using feeding readiness indicators (morbidity, maturity, behavior state at feeding start, and feeding experience). All readiness indicators were related to each other. In particular, there was a strong relationship between maturity and feeding experience. Morbidity only had an effect on efficiency; the most ill infants were less efficient feeders. Behavior state affects all feeding outcomes in a linear fashion; more awake and alert infants had better feeding performance outcomes. The effect of experience and maturity on the outcomes is more complex because of the relationship between the two. Experience has a greater effect as the infant matures, and as the infant matures, the amount of experience increases. Successful feeding requires maturity as well as experience.Once physiological stability has been attained, a major challenge for preterm infants is achievement of oral feeding competence. Although breast-feeding may present fewer physiological challenges to the growing preterm infant, 1 , 2 many preterm infants are bottle-fed either formula or expressed breast milk. 3 For the bottle-fed infant, feeding competence is the achievement of total or complete oral feedings. The American Academy of Pediatrics has included competency at nipple-feeding, either breast or bottle, as a criterion for preterm infant readiness for hospital discharge. 4 Achieving competence at this important task takes time, with the transition from gavage to full bottle-feedings reported to last 10 to 14 days. 5 Longer transition to full bottle-feedings has been associated with increased length of hospital stay. 6Assisting the preterm infant achieve bottle-feeding competence is a primary responsibility of the nursing staff. 7 Despite this responsibility, there continues to be a paucity of information available to support nurses in their decision making regarding preterm infant feeding. In particular, although the mechanics of bottle-feeding have been studied extensively, 8 , 9 there is very little research on the predictors of feeding performance.

Objective: The purposes of this analysis were to determine how select characteristics of nutritive sucking (number of sucks, sucks/burst, and sucks/minute) change over time and to examine the effect of select factors (morbidity, maturity, prefeeding behavior state, and feeding experience) on those changes.Study design: A longitudinal, non-experimental study was conducted in a Level 3 neonatal intensive care unit using a convenience sample of 88 preterm infants. Statistical analyses were performed using a repeated-measures mixed-model in SAS.Results: Sucking activity (number of sucks, sucks/burst, and sucks/ minute) was predicted by morbidity, maturity, feeding experience and prefeeding behavior state. Experience at oral feeding had the greatest effect on changes in the number of sucks, suck/burst and sucks/minute. Conclusion:Experience at feeding may result in more rapid maturation of sucking characteristics.