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The Relationship Between Behavioral States and Oral Feeding Efficiency in Preterm Infants

Thao Griffith¹, Kristin Rankin, Rosemary White-Traut

¹Children's Hospital of Wisconsin, Milwaukee (Ms Griffith and Dr White-Traut); and Women, Children and Family Health Science, College of Nursing (Ms Griffith and Dr White-Traut), and Division of Epidemiology and Biostatistics, School of Public Health (Dr Rankin), University of Illinois at Chicago.

Advances in Neonatal Care : Official Journal of the National Association of Neonatal Nurses

|September 21, 2016

Insights

Infant behavioral states significantly impact oral feeding efficiency. Alert states are best for feeding, while sleep or crying states require careful evaluation and potential intervention.

Area of Science:

Neonatal development
Infant feeding
Behavioral science

Background:

The link between preterm infant behavioral states and oral feeding efficiency remains unclear.
Understanding these states is vital for optimizing nutritional intake in vulnerable infants.

Purpose of the Study:

To investigate the association between various behavioral states (alert, sleep, drowsy, crying) and oral feeding efficiency in preterm infants.
To identify optimal behavioral states for successful oral feeding in this population.

Main Methods:

A correlational secondary analysis of data from a randomized controlled trial involving preterm infants (29-34 weeks gestational age).
Behavioral states were assessed 1 minute before feeding by blinded coders.
Oral feeding efficiency was quantified as milliliters per minute (mL/min) over the initial 10 minutes of feeding.

Main Results:

Data from 147 preterm infants were analyzed.
Time spent in alert states (positive association) and crying states (positive association) significantly predicted higher oral feeding efficiency.
Time spent in sleep states (negative association) significantly predicted lower oral feeding efficiency.

Conclusions:

Preterm infant behavioral state is a critical factor in oral feeding efficiency.
Alert states are optimal for oral feeding; feeding should be avoided during sleep.
Infants in drowsy or crying states require careful assessment and may benefit from interventions to promote alertness before feeding.

Read full analysis

Abstract

Background:

The relationship between behavioral states (alert, sleep, drowsy, and crying) and oral feeding efficiency in preterm infants is not well understood.

Purpose:

To determine the relationship between behavioral states and feeding efficiency in preterm infants.

Methods:

This correlational study was conducted as a secondary analysis from a randomized controlled trial. Medically stable preterm infants born between 29 and 34 weeks' gestational age participated. Baseline data from the randomized controlled trial (week 0), 1 minute prior to feeding, were used. Behavioral states were coded by 2 blinded coders. Oral feeding efficiency (mL/min) was calculated as the amount of intake over the first 10 minutes of feeding.

Results:

Data from 147 infants were included. The proportion of time spent in alert states (β = .76, F = 11.29, P ≤ .05), sleep states (β = -1.08, F = 25.26, P ≤ .05), and crying (β = 1.50, F = 12.51, P ≤ .05) uniquely predicted oral feeding efficiency.

Implications For Practice:

Comprehensive assessment of behavioral states and infant characteristics for oral feeding readiness is crucial. Alert states are optimal for oral feeding. Forced oral feeding when infants are sleeping should be avoided. Infants in crying or drowsy states prior to feeding should be closely evaluated. Sleeping or drowsy infants may benefit from interventions (eg, oral sensory stimulation, nonnutritive sucking, or multisensory intervention) to support transition to alert states prior to feeding.

Implications For Research:

Future research should evaluate behavioral states prior to and during feeding and their relationship to oral feeding efficiency.

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