Prevalence of problematic feeding in young children born prematurely: a meta-analysis

Abstract

Background Difficulties related to eating are often reported in children born preterm. The objective of this study was to quantitatively synthesize available data on the prevalence of problematic feeding in children under 4 years of age who were born preterm. Methods Literature was identified from PubMed, CINAHL, and PsycInfo. The search was limited to English language and publication years 2000–2020. To be included in the meta-analysis, the article had to report the prevalence of problematic oral feeding within a population of children born prematurely (< 37 weeks’ gestation), and the child age at the time of study had to be between full-term corrected age and 48 months. For studies meeting inclusion criteria, the following data were extracted: sample size and subsamples by gestational age and/or child age at time of study; definition of problematic feeding; measures used for assessment of feeding; gestational age at time of birth of sample; child age at time of study; exclusion criteria for the study; and prevalence of problematic feeding. Random-effects meta-analyses were performed to estimate the prevalence of problematic feeding across all studies, by gestational age at birth, and by child age at time of study. Results There were 22 studies that met inclusion criteria. Overall prevalence of problematic feeding (N = 4381) was 42% (95% CI 33–51%). Prevalence was neither significantly different across categories of gestational age nor by child age at the time of study. Few studies used psychometrically-sound assessments of feeding. Conclusion Problematic feeding is highly prevalent in prematurely-born children in the first 4 years of life regardless of degree of prematurity. Healthcare providers of children born preterm should consider screening for problematic feeding throughout early childhood as a potential complication of preterm birth. Systematic review registration number Not applicable.

Perfil alimentar de crianças nascidas prematuras e alterações no sistema estomatognático no período dos 24 aos 36 meses de idade corrigida

“…Mesmo assim, em recente revisão sistemática da literatura, os autores pautados nas evidências encontradas afirmam que os problemas com a alimentação são altamente prevalentes entre crianças nascidas prematuramente nos primeiros quatro anos de vida, independentemente do grau de prematuridade. Dessa forma, esses resultados indicam que os profissionais de saúde durante o acompanhamento de crianças PT devem fazer a triagem para problemas com a alimentação desde a primeira infância, considerando que esta é uma complicação potencial do nascimento prematuro (Pados et al, 2021).…”

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

“…Figure 2 shows the phases of swallowing, normal actions in each phase, disruptions to swallowing, and their clinical presentation. In the neonatal period, feeding problems can present with diverse clinical manifestations, as shown below, leading to inadequate nutritional intake, increased length of hospitalization, and compromised airway safety [ 9 , 10 , 16 ].…”

“…While previous studies have suggested that up to 1% of the pediatric population can present with feeding problems, the prevalence is likely to be significantly higher in preterm infants, proportional to the degree of prematurity [ 15 ]. Residual feeding problems in growing preterm infants span a broad spectrum of phenotypes, including feeding tube dependency [ 30 ], non-specific feeding difficulties, oral aversion [ 9 , 31 , 32 ], feeding aversion, poor progression to solid foods, challenges with eating specific food types (e.g., solids), and subtle swallowing difficulties.…”

“…As the feeding skills mature into childhood with more voluntary control, it is only plausible that feeding problems become more apparent in infants with neurological injury and impaired cortical function. In a recently published meta-analysis by Pados et al, including 22 studies, the prevalence of feeding problems was 42% in the first four years of life amongst preterm-born infants [ 9 ]. In a subgroup of 11 studies including almost 2500 extreme preterm infants <28 weeks, the prevalence of feeding problems was 46%, with significant variation among studies.…”

“…While the evidence for the adult outcomes of preterm infants is increasing, the long-term impact of the altered development of oral neuromotor skills and abnormal oral feeding remains unclear, primarily due to a paucity of studies on adults born preterm. Given the diversity of underlying etiologies and clinical presentations of feeding problems, the lack of standardized definitions and assessments by which to identify and document oral feeding problems adequately is frustrating [ 9 ]. There is an urgent need for a two-pronged approach to feeding problems in infants born preterm in order to standardize diagnostic criteria and to develop individualized therapeutic strategies using a comprehensive multidisciplinary approach.…”