Occurrence of oxygen desaturation events during preterm infant bottle feeding near discharge

Abstract

Aims-The purpose of this study was to examine the occurrence, severity, pattern, and moderators of oxygen desaturation during preterm infant bottle feeding near the time of discharge from the neonatal intensive care unit (NICU) when fed by mothers.Study design-Twenty-two very low birthweight (VLBW) infants [birthweight 1155 ± 293 g, gestational age (GA) 28.1 ± 2.0, postconceptional age (PCA) 36.5 ± 1.6 weeks] were videotaped being bottle-fed by their mothers. Most infants (86%) were discharged within 6 days of the study. Oxygen saturation was continuously monitored and infant feeding behaviors were coded. Oxygen desaturation events (SpO 2 < 90%) were identified and analyzed.Results-Infants averaged 10.8 events during feeding (range 1-28, S.D. 8.9) and spent, on average, 20% of their feeding time (range 0-70%, S.D. 17.98%) with oxygen levels below 90%. One hundred forty of the desaturation events (59%) were classified as mild (SpO 2 85-89), 47 events (20%) were classified as moderate (SpO 2 81-84), and 51 events (21%) were classified as severe (SpO 2 ≤ 80). Events were evenly distributed across infants' feeding time. Receiving supplemental oxygen, beginning the feeding with a higher baseline SpO 2 , and being of older PCA predicted lower percentage of feeding time with SpO 2 below 90% (R 2 = 0.57). Receiving supplemental oxygen and beginning the feeding with a higher baseline SpO 2 predicted less number of desaturation events during the feeding (R 2 = 0.44). Despite similar baseline SpO 2 levels, infants who were on supplemental oxygen had 50% less oxygen desaturation events and spent 33% less time with SpO 2 less than 90%.Conclusion-VLBW infants continue to have desaturation events during feeding when fed by their mothers near the time of discharge. Further research is needed to understand the effect of hypoxemia on the preterm infant's development of oral feeding skills, to study the effects of supplemental oxygen during feeding, and to further develop interventions to minimize desaturation during feeding.

The Early Feeding Skills Assessment for Preterm Infants

“…36 It also reduces the risk of bradycardia and hypoxemia related to breathing irregularities common to preterm infants during bottle feeding. 11,12,[37][38][39][40][41][42] To prevent and/or minimize desaturation during feeding, Shiao and colleagues suggest a minimum baseline oxygen saturation of 95 percent prior to oral feeding. 12 To complete the first section of the EFS, the caregiver assesses the infant's readiness during preparation for feeding.…”

“…41,63 Oxygenation is more likely to drop during the first minute than during any other time throughout feeding. 11 The caregiver observes for a drop in oxygen saturation and for stress cues during the first 30 seconds after each nipple placement. Stress cues include pulling away from the nipple, swiping at the bottle or pushing it away, raising the eyebrows, and fluttering the eyes.…”

“…Typically during stressful episodes, breathing pauses precede oxygen desaturation, which precedes bradycardia. 11,12 …”

“…1 According to research, two factors affect progression in ability to feed orally: the infant's state of health 2-6 and oral feeding experience. [7][8][9][10][11] According to other research, neuromaturation of the following contributes to an individual infant's skill in feeding: the ability to regulate oxygen, 11,12 development of alertness, 13-15 and development of sucking strength and organization of the sucking pattern. 16,17 External influences can also change the nature of the task.…”

Mother–Infant Feeding Tool

“…Infant regulated feeding behaviors have been found to depend on the mother's ability to modify the environment when needed and to directly support the infant's feeding (Brown & Pridham, 2007). Infant behaviors regulate those of the mother and the mother's caregiving behaviors in turn regulate those of the infant (Barnard, Bee, & Hammond, 1984;Osofsky & O'Connell,1972).Premature infants' immature regulatory systems make it difficult to process stimulation, and their cues for support in regulating input may not be clear to their mothers (Barnard et al, 1984;Davis et al, 2003;Singer et al, 2003;Thoyre & Carlson, 2003a). Consequently, premature infants have been found to be less attentive, less expressive, and fussier than term ;Wolf et al, 2002).…”