Impact of prematurity and co-morbidities on feeding milestones in neonates: a retrospective study

Abstract

Objective:Feeding problems are an important area of neonatal morbidity that requires attention. We defined the feeding milestones related to transition to per oral feeding among premature infants based on gestational (GA) and postmenstrual ages (PMA), and elucidated the co-morbidity variables affecting with these skills.Study Design:Feeding progress was tracked during the first hospitalization in a retrospective study involving 186 infants. We measured the age at acquisition of first feedings, maximum gavage feedings and maximum oral feedings. Resource usage measures included the total length of hospital stay (LOS), duration of gavage tube and duration of respiratory support. Effects of perinatal and co-morbidity factors on the acquisition of feeding milestones were evaluated. ANOVA, t-test, Wilcoxon rank sum test, χ2 test, univariate and multivariate analysis, stepwise linear regression analysis and logistic regression analysis were applied as appropriate. Data were presented as mean±s.d., or as stated. P<0.05 was considered significant.Result:We stratified the data into three groups based on GA at birth: <28.0 weeks (group-1), 28.0 to 32.0 weeks (group-2) and 32.0 to 35.0 weeks (group-3). Compared with group-3, group-1 needed four-fold more ventilation and five-fold more continuous positive airway pressure (CPAP) duration (all P<0.001); whereas group-2 needed two-fold more CPAP duration. Age at first feed correlated with age at full gavage feedings and age at full oral feedings (r=0.53 and r=0.71, both P<0.0001). Age at full gavage feedings correlated with age at full oral feedings (r=0.81, P<0.0001). Univariate analysis was significant for GA age, hypotension, the effects of gastroesophageal reflux, and duration of ventilation and CPAP on the PMA at maximal oral feedings (all P<0.05); multivariate analysis for these variables was also significant (R 2=0.58, P<0.0001). The success rate for oral feedings at discharge accelerated with GA maturation and caffeine use; on the other hand, the need for respiratory support and management of positive blood culture were associated with failure rates (P<0.05).Conclusion:Infants < 28 weeks GA have significant feeding delays with respect to initiation and progression to maximal gavage and oral feedings, as well as prolonged LOS. Infants >28 weeks GA attained successful feeding milestones by similar PMA. Specific aero-digestive co-morbidities significantly affected maximal oral feeding milestone. Delays in achieving maximum gavage and maximum oral feeding milestones suggest delays with the development of control and regulation of foregut motility.

Dysphagia in the high-risk infant: potential factors and mechanisms

“…The prevalence of feeding problems in premature infants born at ,37 wk of gestation is w10.5%, and this frequency increases to w24.5% among those born with a very low birth weight (,1500 g) (1). On the other hand, among infants born at ,28 wk of gestation, oral feeding is significantly delayed and the length of hospitalization is prolonged in comparison to infants .28 wk of gestational age; however, in this study, a large majority of healthy premature infants did indeed achieve oral feeding skills by 36-38 wk of postmenstrual age (2). Neurodevelopmental problems are increasing among high-risk neonatal intensive care unit (NICU) 4 graduates; and overall, 20-80% of such infants have feeding concerns during infancy (3,4).…”

“…Attributable dysphagia symptoms are related to prefeeding, feeding, and postprandial 1 Presented at the meeting "Evaluating the Evidence to Support Guidelines for the Nutritional Care of Preterm Infants: The Pre-B Project" held at the USDA/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, 31 July-1 August 2014. 2 Supported by The National Institute of Diabetes and Digestive and Kidney Diseases of the NIH under award 2R01068158 (SJ) and 2P01068051 (SJ and Reza Shaker) and the Research Institute at the Nationwide Children's Hospital. 3 The contents of this publication are solely the responsibility of the author and do not necessarily represent the official views of the NIH.…”

Preterm newborn readiness for oral feeding: systematic review and meta-analysis

“…Most excluded articles did not evaluate the moment of transition to oral feeding or the NB participants in the researches had already received oral feeding. The final sample included 29 articles, with 12 articles published between 2003 and 2007 (10,20,21,23,(34)(35)(36)(37)(38)(39)(40)(41) and 17 published between 2008 and 2012 (8,22,(24)(25)(26)(27)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52) .…”

Application of Parenteral Nutrition in Premature Infants

“…Энтеральное питание начинают, когда новорожденные проявляют кардиоре-спираторную стабильность и гастроинтестинальную толе-рантность. Задержка назначения энтерального питания снижает функциональную адаптацию желудочно-кишеч-ного тракта и приводит к непереносимости питания позд-нее [22]. Важным условием становления нормальной функции желудочно-кишечного тракта является раннее начало энтерального питания.…”