Impact of Personalized Feeding Program in 100 NICU Infants

Jadcherla, Sudarshan R.; Peng, Juan; Moore, Rebecca; Saavedra, Jason; Shepherd, Edward G.; Fernández, Soledad; Erdman, Steven H.; DiLorenzo, Carlo

doi:10.1097/mpg.0b013e3182288766

Cited by 53 publications

(27 citation statements)

References 32 publications

(72 reference statements)

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“…Thus, patient-focused feeding programs may enhance decision-making and reduce economic and societal burden. (18, 26–28) We also found that PO-fed infants showed significant superior scores in all domains of BSID-III. It is likely that infants who require a g-tube for feeding at discharge are already predisposed to future neurological delay at the time of g-tube placement.…”

Section: Discussionmentioning

confidence: 56%

“…The feasibility of such an approach, validation of diagnostic methods and description of specific strategies has been reported earlier (17, 18, 20). In brief, neonatal nurses and nurse practitioners, neonatologists, pediatric surgeons, pediatric gastroenterologists, and parents requested referrals for evaluation of oropharyngeal dysphagia, gastroesophageal reflux disease (GERD), and for g-tube placement, and/or fundoplication.…”

Section: Methodsmentioning

confidence: 83%

“…Due to heterogeneity among preterm infants with aerodigestive disorders and FD, we have adopted assessments and feeding strategy development targeted to each individual infant. (7, 17, 18) Our hypothesis was that following evaluation and development of personalized feeding methods, PO feeding at first NICU discharge would be associated with less neurodevelopmental impairment and better feeding milestones at ~2-years age relative to g-tube requirement. In the current study, 40% of the infants referred for FD were g-tube dependent at discharge (n=77).…”

Section: Discussionmentioning

confidence: 99%

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Feeding Methods at Discharge Predict Long-Term Feeding and Neurodevelopmental Outcomes in Preterm Infants Referred for Gastrostomy Evaluation

Jadcherla

Khot

Moore

et al. 2017

The Journal of Pediatrics

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Objective To test the hypothesis that oral (PO) feeding at first neonatal intensive care unit (NICU) discharge is associated with less neurodevelopmental impairment and better feeding milestones, as compared with discharge with a gastrostomy tube (g-tube). Study design We studied outcomes for a retrospective cohort of 194 neonates < 37 weeks gestation referred for evaluation and management of feeding difficulties between July 2006–July 2012. Discharge milestones, length of hospitalization, and Bayley Scales of Infant Development scores at 18–24 months were examined. Chi-Square, Mann-Whitney U, or t-tests and multivariable logistic regression models were used. Results 60% (n=117) of infants were discharged on PO feedings; of these, 96% remained PO-fed at 1-year. The remaining 40% (n=77) were discharged on g-tube feedings; of these, 31 (40%) remained g-tube dependent, 17 (22%) became PO-fed, and 29 (38%) were on PO and g-tube feedings at one year. Infants discharged on a g-tube had lower cognitive (p<0.01), communication (p=0.03), and motor (p<0.01) composite scores. The presence of a g-tube, younger gestation, bronchopulmonary dysplasia, or intraventricular hemorrhage was significantly associated with neurodevelopmental delay. Conclusions For infants referred for feeding concerns, g-tube evaluations and feeding management, the majority did not require a g-tube. Full PO feeding at first NICU discharge was associated with superior feeding milestones and less long-term neurodevelopmental impairment, relative to full or partial g-tube feeding. Evaluation and feeding management before and after g-tube placement may improve long-term feeding and neurodevelopmental outcomes.

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Section: Discussionmentioning

confidence: 56%

Section: Methodsmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Feeding Methods at Discharge Predict Long-Term Feeding and Neurodevelopmental Outcomes in Preterm Infants Referred for Gastrostomy Evaluation

Jadcherla

Khot

Moore

et al. 2017

The Journal of Pediatrics

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“…Each of these concerns may contribute to delay in achieving aero-digestive milestones, thus prolonging transition from gavage feeding to full oral feeding. Therefore infants with BPD are at higher risk of prolonged hospital stays [18]. The stability of airway and breathing is essential for successful oral feeding.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Oral Feeding in Infants with BPD on Nasal CPAP

et al. 2014

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Objective Safety and efficacy of oral feeding was examined in infants with bronchopulmonary dysplasia (BPD) on nasal continuous positive airway pressure (NCPAP). We hypothesized that repetitive oral feeding enhances aerodigestive outcomes and reduces resource utilization. Methods Data from infants with BPD (37–42 weeks post menstrual age) that were orally fed while on NCPAP (n=26) were compared with those that were exclusively gavage fed on NCPAP (n=27). Subject assignment was random and physician practice based. Specifically, we compared the differences in aero-digestive milestones, resource utilization and safety metrics. Results Demographic characteristics such as gender distribution, gestational age and birth weight, clinical characteristics such as frequency of intraventricular hemorrhage and patent ductus arteriosus needing surgical ligation were similar in both groups (p > 0.05). Characteristics of respiratory support and airway milestones were similar in both groups (p > 0.05). However, infants in NCPAP-oral fed group had earlier acquisition of full oral feeding milestone by 17 days (median) vs. infants who were not orally fed during NCPAP (p < 0.05). Discharge weights and the frequency of gastrostomy tube placement were also similar in both groups (p > 0.05). There were no tracheostomies in either group. There was no incidence of clinically significant aspiration pneumonia in infants during the period of the oral feeding while on NCPAP. Conclusion Controlled introduction of oral feedings in infants with BPD during NCPAP is safe and may accelerate the acquisition of oral feeding milestones.

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“…Prior research is suggestive that cue-based protocols improve oral feeding intake, shorter oral feeding progression, and shorter hospitalization (Jadcherla et al, 2012; Kirk, Alder, & King, 2007; Puckett, Grover, Holt, & Sankaran, 2008; Saunders, Baker-Friedman, & Stramoski, 1990; Shaker, 2012). Behavioral cues that are often used for assessment of infant readiness to feed include but are not limited to rooting, hand to mouth, sucking on hand, alert states, and inability to settle after position change or diaper change (Jadcherla et al, 2012; Kirk et al, 2007; Puckett et al, 2008; Shaker, 2012). The ATVV and the new integrated H-HOPE intervention have demonstrated support of infant behavioral organization prior to feeding and with future research has the potential, in conjunction with cue-based feeding protocols, to improve oral feeding outcomes.…”

Section: Discussionmentioning

confidence: 99%

Preterm infants’ orally directed behaviors and behavioral state responses to the integrated H-HOPE intervention

White‐Traut

Rankin

Pham

et al. 2014

Infant Behavior and Development

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Preterm infants are challenged by immature infant behavioral organization which may negatively influence their ability to oral feed. The purpose of this study was to determine whether the integrated H-HOPE (Hospital to Home: Optimizing the Infant’s Environment) intervention would improve infant behavioral organization by increasing the frequency of orally directed behaviors and the proportion of time spent in an alert behavioral state when offered prior to oral feeding. Mother–infant dyads (n = 198) were randomly assigned to the H-HOPE intervention or the Attention Control groups. Infants were born at 29 to 34 weeks gestation and were clinically stable. Mothers had at least two social environmental risk factors such as minority status or less than high school education. H-HOPE is an integrated intervention that included (1) twice-daily infant directed stimulation using the ATVV intervention (auditory, tactile, visual, and vestibular stimuli) and (2) maternal participatory guidance sessions by a nurse-community advocate team. Orally directed behaviors and behavioral states were assessed weekly prior to feeding during hospitalization when infants were able to feed orally. There were no differences between the groups at baseline (Day 0, prior to the initiation of the integrated H-HOPE intervention). We observed a pattern of increased frequency of orally directed behaviors in the H-HOPE intervention group when compared to the Attention Control group, however, the proportion of time spent in an alert behavioral state remained stable in both groups over the course of the study. On Day 7, the H-HOPE intervention group exhibited a significantly higher mean frequency of orally directed behaviors than the Attention Control group (12.6 vs. 7.1 pre-intervention, 51.8 vs. 33.2 during intervention, 4.3 vs. 3.2 immediately after intervention, and 8.9 vs. 5.3 immediately prior to feeding). On Day 7, the H-HOPE intervention group exhibited a significantly higher proportion of time spent in an alert behavioral state only during intervention (0.26 vs. 0.11) and immediately after intervention (0.28 vs. 0.06). These findings are suggestive that the integrated H-HOPE intervention facilitated infant behavioral organization for clinically stable infants born between 29 and 34 weeks gestation. The orally directed behaviors appear to be an important indicator of the infant’s preparation for feeding, and when used in conjunction with assessment of behavioral states, are especially valuable to the clinician. Use of this combined assessment approach in practice would strengthen clinician assessment for initiation of (beginning the first oral feeding) and daily preparation for oral feeding in preterm infants.

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Impact of Personalized Feeding Program in 100 NICU Infants

Cited by 53 publications

References 32 publications

Feeding Methods at Discharge Predict Long-Term Feeding and Neurodevelopmental Outcomes in Preterm Infants Referred for Gastrostomy Evaluation

Feeding Methods at Discharge Predict Long-Term Feeding and Neurodevelopmental Outcomes in Preterm Infants Referred for Gastrostomy Evaluation

Safety and Efficacy of Oral Feeding in Infants with BPD on Nasal CPAP

Preterm infants’ orally directed behaviors and behavioral state responses to the integrated H-HOPE intervention

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