Prediction of Feeding Performance in Preterm Infants

Abstract

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.

Relationship of the First Suck Burst to Feeding Outcomes in Preterm Infants

“…These studies have shown that more experience generally results in improved feeding outcomes. 16,22 The findings of this analysis supports previous findings and suggest that knowledge of feeding experience coupled with observation of early-in-the-feeding sucking behaviors could be useful for predicting success at feeding.…”

“…13,15 However, other researchers have found that more active states, including all but those associated with agitation, result in improved feeding outcomes. 16 In this study, while behavior state was moderately associated with feeding outcomes, it did not predict a clinically significant amount of the variance in those outcomes.…”

Predictors of nutritive sucking in preterm infants

“…There is increasing evidence that both the quantity and quality of oral feeding experience may play a role in the feeding transition. 16,20,21 Further research is required to more completely explore the effect of experience on feeding skill development. A randomized clinical trial using the significant predictors reported here, morbidity, maturity and feeding experience as factors, is recommended, with infants randomly assigned to feeding experience groups stratified by morbidity and maturity.…”

“…The scale has been used in many feeding studies. 21,26 Consistent with other studies and numerous reports suggesting that a quiet alert state is optimal for preterm infant feeding, 26 the ABSS observations were treated as interval data. Moreover, the data indicated that modeling behavior state as a linear trend alone would be problematic from a theoretical perspective, thus, both the linear and quadratic effects of behavior state were modeled.…”

“…16,20 In other studies, infants who had more opportunities to bottle feed consumed more of their prescribed formula by bottle and did so more efficiently independent of their 'success' at previous feedings. 21 The underlying rationale for these latter findings may be related to the development of sucking activity that is associated with increased feeding opportunities. 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.…”