15

Journal of Neonatal-Perinatal Medicine 8 (2015) 15–21 DOI 10.3233/NPM-15814045 IOS Press

Original Research

Factors influencing independent oral feeding in preterm infants S.M. Van Nostranda , L.N. Bennetta , V.J. Coraglioa , R. Guob and J.K. Muraskasa,∗ a Division b Office

of Neonatology, Loyola University Medical Center, Maywood, IL, USA of Research Services, Stritch School of Medicine Rm 433, Loyola University, Maywood, IL, USA

Received 15 May 2014 Revised 17 December 2014 Accepted 6 January 2015

Abstract. OBJECTIVE: Determine the mean post-menstrual age when preterm infants attain independent oral feeding skills and whether gestational age, common neonatal morbidities, gender, race, delivery route, or birth year affects this reflex. METHODS: A retrospective chart review of 2700 preterm infants, born before 37 weeks gestational age admitted to a level III NICU between January 1978 and July 2013, to determine the post-menstrual age when independent oral feedings occur. RESULTS: Mean post-menstrual age at achievement of independent oral feeding was 36 + 4/7 weeks ± 14 days. Gestational age under 29 weeks correlated with delayed post-menstrual age at achievement of independent oral feeding at 37 + 3/7 weeks versus 36 + 1/7 weeks for gestational age 29–33 weeks and 36 + 3/7 weeks for late preterm infants (p < 0.0001). Preterm infants with certain morbidities experienced a delay in independent oral feeding: necrotizing enterocolitis at 38 + 6/7 weeks (p < 0.0001), bronchopulmonary dysplasia at 38 + 1/7 weeks (p < 0.0001), severe intraventricular hemorrhage at 37 + 6/7 weeks (p < 0.001). Preterm infants born before the year 2000 achieved independent oral feeding two days later than preterm infants born since the year 2000 (p < 0.0001). Preterm infants delivered vaginally achieved independent oral feeding three days sooner than infants delivered via c-section (p < 0.0001). Female infants orally fed one day sooner than male preterm infants (p = 0.0008). CONCLUSIONS: Preterm infants achieve independent oral feeding at 36 + 4/7 weeks. Factors negatively influencing when the preterm infant will achieve independent oral feeding include gestational age under 29 weeks and major morbidities, whereas vaginal delivery and ongoing advances in neonatal care may accelerate the transition to independent oral feeding. Keywords: Oral, feeding, preterm infant

1. Introduction Preterm infants are neurologically immature in their ability to coordinate sucking, swallowing, and breathing until they approach term gestation. The ability of ∗ Corresponding

author: Dr. Jonathon K. Muraskas, Division of Neonatology,LoyolaUniversityMedicalCenter,Maywood,IL,USA. Tel.: +1 708 216 1067; Fax: +1 708 216 5602; E-mail: jmurask@ lumc.edu.

the preterm infant to orally feed independently from a bottle or breast (PO ad lib), without significant apnea, bradycardia, and desaturations is a primary criteria for safe discharge from the neonatal intensive care unit (NICU) [1, 2]. From nine weeks of fetal development to term gestation the fetus acquires the abilities of sucking, swallowing, and sensorimotor function [3]. Fetal breathing begins by 10 weeks gestation, swallowing

1934-5798/15/$35.00 © 2015 – IOS Press and the authors. All rights reserved

16

S.M. Van Nostrand et al. / Oral feeding in preterm infants

of amniotic fluid by 12–14 weeks gestation, and fetal sucking by 15 weeks gestation [4]. From 34 to 42 weeks post-menstrual age (PMA), the premature infant undergoes the neurologic maturation needed to coordinate sucking, swallowing, and breathing that allows for independent oral feeding [5]. When preterm infants independently oral feed successfully they must consume sufficient calories and volume for adequate growth while also maintaining cardiorespiratory stability. There are many internal and external factors that influence the preterm infant’s success at oral feeding including: milk flow, nipple size, caregiver skill, alertness, rooting, sucking pressure, sucking length, and sucking frequency [5]. The preterm infant transitions from gavage feeding to oral feeding as the suck, swallow, and breathing reflex matures. Since 1981, the preterm birth rate in the United States has increased by more than 33%, and in 2012, 11.5% of all births were preterm (

Factors influencing independent oral feeding in preterm infants.

Determine the mean post-menstrual age when preterm infants attain independent oral feeding skills and whether gestational age, common neonatal morbidi...
64KB Sizes 2 Downloads 9 Views