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Factors associated with feeding progression in extremely preterm infants
Jinhee Park1, George Knafl, Suzanne Thoyre
1Jinhee Park, PhD, RN, is Postdoctoral Associate, Duke University School of Nursing, Durham, North Carolina. George Knafl, PhD, is Professor, School of Nursing, University of North Carolina, Chapel Hill. Suzanne Thoyre, PhD, RN, FAAN, is Professor and Director of PhD and Postdoctoral Programs, School of Nursing, University of North Carolina, Chapel Hill. Debra Brandon, PhD, RN, CCNS, FAAN, is Associate Professor and Director of PhD and Postdoctoral Programs, School of Nursing, Duke University, Durham, North Carolina.
Insights
Extremely preterm infants achieve feeding milestones later if born with younger gestational age or medical complications. Breast milk also promotes earlier feeding milestone achievement in these vulnerable infants.
Area of Science:
- Neonatalogy
- Pediatric Gastroenterology
- Developmental Pediatrics
Background:
- Oral feeding competence is crucial for growth and discharge in premature infants.
- Extremely preterm (EP) infants (≤28 weeks gestational age) face challenges in developing oral feeding skills due to medical complications.
Purpose of the Study:
- To examine feeding progression by assessing the timing of five early feeding milestones in EP infants.
- To determine the impact of gestational age at birth and medical complications on feeding progression in EP infants.
Main Methods:
- A chart review of 94 EP infants was conducted.
- Feeding progression was measured by postmenstrual age at five milestones: first/full enteral feeding, first/half/full oral feeding.
- Linear mixed models analyzed the influence of gestational age, five medical complications, and milk type on feeding milestones.
Main Results:
- EP infants gradually achieved feeding milestones, but younger gestational age and complications (neurological risk, BPD, NEC, PDA) significantly slowed attainment.
- Gastroesophageal reflux disease did not significantly impact feeding milestone acquisition.
- Infants fed breast milk achieved milestones earlier than those fed formula.
Conclusions:
- Understanding feeding milestone timing in EP infants is key for targeted interventions.
- Specific medical conditions significantly affect feeding skill development in EP infants.
- Early identification of risk factors can optimize feeding support for EP infants.
Background:
Among infants born prematurely, competence at oral feeding is necessary for growth and hospital discharge. Extremely preterm (EP) infants (28 weeks of gestational age [GA]) are at risk for a variety of medical complications, which can limit the infant's capacity to develop oral feeding competence.
Objective:
This study examined feeding progression by assessing timing of acquisition of five early feeding milestones among EP infants and the impact of immaturity and medical complications.
Design:
A chart review was conducted for 94 EP infants who participated in a larger longitudinal randomized study. Feeding progression was defined as infants' postmenstrual age (PMA) at five milestones: first enteral feeding, full enteral feeding, first oral feeding, half oral feeding, and full oral feeding. GA at birth and five medical complications (neurological risk, bronchopulmonary dysplasia, necrotizing enterocolitis, patent ductus arteriosus, and gastroesophageal reflux disease) were used as potential factors influencing the feeding progression. Linear mixed models were used to examine feeding progression across the milestones and contributions of GA at birth and five medical complications on the progression, after controlling for milk type as a covariate.
Result:
EP infants gradually achieved feeding milestones; however, the attainment of the feeding milestones slowed significantly for infants with younger GA at birth and the presence of medical complications, including neurological risk, bronchopulmonary dysplasia, necrotizing enterocolitis, and patent ductus arteriosus but not gastroesophageal reflux disease. Milk type was a significant covariate for all analyses, suggesting that infants fed with breast milk achieved each of five milestones earlier than formula-fed infants.
Discussion:
Improved understanding of the timing of essential feeding milestones among EP infants and the contribution of specific medical conditions to the acquisition of these milestones may allow for more targeted care to support feeding skill development.
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