Feeding Problems and Long-Term Outcomes in Preterm Infants—A Systematic Approach to Evaluation and Management

Abstract

Preterm infants are known to have long-term healthcare needs. With advances in neonatal medical care, younger and more preterm infants are surviving, placing a subset of the general population at risk of long-term healthcare needs. Oral feeding problems in this population often play a substantial yet under-appreciated role. Oral feeding competency in preterm infants is deemed an essential requirement for hospital discharge. Despite achieving discharge readiness, feeding problems persist into childhood and can have a residual impact into adulthood. The early diagnosis and management of feeding problems are essential requisites to mitigate any potential long-term challenges in preterm-born adults. This review provides an overview of the physiology of swallowing and oral feeding skills, disruptions to oral feeding in preterm infants, the outcomes of preterm infants with feeding problems, and an algorithmic approach to the evaluation and management of neonatal feeding problems.

Clinical effects of oral motor intervention combined with non-nutritive sucking on oral feeding in preterm infants with dysphagia

“… 22 In the present study, the infants were also on CPAP during oral feeding, however, delaying oral feeding until coming off nasal CPAP has been shown not to faster maturation of oral feeding ability, or decreased length of stay. 23 The reality, on the other hand, is more complicated, 24 necessitating a deliberate approach, 25 since aggressive early feeding may cause undue stress in these newborns, leading to further setbacks.…”

Human Breast Milk: The Key Role in the Maturation of Immune, Gastrointestinal and Central Nervous Systems: A Narrative Review

“…Up to 5% of these neonates and up to 10% of extremely preterm ones (born before 28 weeks of gestation) develop NEC, which has a mortality higher than 10% for these infants [ 55 ]. Infants that survive are also in risk of long-term gastrointestinal complications, such as short bowel syndrome with or without intestinal failure, cholestasis and liver disease, adhesions, dysmotility and feeding problems [ 56 , 57 ]. Immaturity of a VPI’s gastrointestinal (GI) tract in combination with a disturbance of normal enteric microbiome seems to contribute significantly to the pathophysiology of NEC [ 58 , 59 ].…”

A thickened formula reduces feeding-associated oxygen desaturation and bradycardia in preterm infants

“…[1][2][3]6,7) The mechanisms attributed to unstable cardiorespiratory vital signs during oral feeding include poor coordination of the suckswallow-breath cycle, immature sucking power, immature oral structures, gastroesophageal reflux, and associated lung or airway diseases. [8][9][10][11][12][13][14][15] Given the diversity of the underlying etiologies and clinical manifestations of feeding problems in neonates, the lack of standardized diagnostic definitions and therapeutic strategies is challenging.…”

“…With respect to various feeding problems, desaturation or bradycardia associated with oral feeding often delays the discharge of preterm infants from a neonatal intensive care unit (NICU), and repeated episodes may be harmful to the developing brain [ 1 - 3 , 6 , 7 ]. The mechanisms attributed to unstable cardiorespiratory vital signs during oral feeding include poor coordination of the suck-swallow-breath cycle, immature sucking power, immature oral structures, gastroesophageal reflux, and associated lung or airway diseases [ 8 - 15 ]. Given the diversity of the underlying etiologies and clinical manifestations of feeding problems in neonates, the lack of standardized diagnostic definitions and therapeutic strategies is challenging.…”