Infants treated with Infasurf have a modest benefit in the acute phase of RDS. Infasurf seems to produce a longer duration of effect than Survanta.

Prematurely born, low birth weight infants are abnormal by their very existence ex utero. Thus, the well-documented finding in such infants of low plasma vitamin E concentrations when compared to the adult poses philosophical and pragmatic difficulties as to whether or not a true deficiency state exists: do these low levels represent age-adjusted reference values or do they in fact represent a deficiency state, warranting treatment? We examined multiple measures of vitamin E status in 62 prematurely born, low birth weight infants in order to address this issue. Mathematical and statistical modeling of these measures during the first 21 days of life lead us to conclude that the ex utero antioxidant protective role of vitamin E is best achieved at plasma concentrations of tocopherol very close to those observed in the adult; specifically, when total tocopherol is greater than 0.64 mg/dl and alpha-tocopherol is greater than 0.50 mg/dl. Thus, at birth, a true deficiency in vitamin E exists for most preterm, low birth weight infants and early treatment is warranted.

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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.