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Effect of Tactile Experience During Preterm Infant Feeding on Clinical Outcomes
Rita H Pickler1, Jareen Meinzen-Derr, Margo Moore
1Rita H. Pickler, PhD, RN, FAAN, is FloAnn Sours Easton Professor of Child and Adolescent Health, College of Nursing, The Ohio State University, Columbus. Jareen Meinzen-Derr, PhD, MPH, is Professor, Department of Pediatrics, University of Cincinnati College of Medicine, and Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Ohio. Margo Moore, MS, RN, is Research Nurse III, Division of Infectious Disease, Cincinnati Children's Hospital Medical Center, Ohio. Stephanie Sealschott, MS, RN, is PhD Candidate, College of Nursing, The Ohio State University, Columbus. Karin Tepe, BS, RN, is Research Nurse in Neonatology, Cincinnati Children's Hospital Medical Center, Ohio.
Insights
Providing touch during feedings helps preterm infants achieve full oral feeding faster. This patterned feeding experience, mimicking natural expectations, is crucial for neurodevelopmental outcomes in the neonatal intensive care unit.
Area of Science:
- Neonatal care
- Developmental neuroscience
- Pediatric nutrition
Background:
- High rates of neurodevelopmental disabilities persist in preterm infants despite improved survival.
- Inconsistent neonatal intensive care unit (NICU) caregiving and hospitalization negatively impact infant outcomes.
- Neuroprotective strategies are vital during sensitive neural plasticity periods (2-3 months before term age).
Purpose of the Study:
- To evaluate the impact of a patterned feeding experience with tactile input on preterm infants' clinical outcomes.
- To assess oral feeding progress as an early indicator of neurodevelopmental status.
- To investigate the effect of touch and holding during feedings on feeding progression.
Main Methods:
- Experimental, longitudinal, two-group randomized assignment design.
- 120 preterm infants enrolled within the first week of life.
- Infants randomized to a patterned feeding experience group or a usual care control group.
Main Results:
- Infants receiving touch in over 25% of early gavage feedings reached full oral feeding sooner.
- Increased touch exposure correlated with decreased time from first oral to full oral feeding.
- No significant association found between holding during gavage feedings or touch during transition feedings and time to full oral feeding.
Conclusions:
- Patterned feeding experiences, particularly touch, can accelerate oral feeding progression in preterm infants.
- This intervention models expected infant experiences, potentially enhancing neuronal development.
- Further research is recommended to explore the effects on broader neurodevelopmental outcomes.
Background:
Although the survival rate of very preterm infants has improved, rates of subsequent neurobehavioral disabilities remain high. One factor implicated in poor neurobehavioral and developmental outcomes is hospitalization and inconsistent caregiving patterns in the neonatal intensive care unit. Although much underlying brain damage occurs in utero or shortly after birth, neuroprotective strategies may stop progression of damage, particularly when these strategies are used during the most sensitive periods of neural plasticity 2-3 months before term age.
Objective:
The purpose of this analysis was to test the effect of a patterned feeding experience involving a tactile component (touch and/or holding) provided during feedings on preterm infants' clinical outcomes, measured by oral feeding progress, as an early indicator of neurodevelopment.
Methods:
We used an experimental, longitudinal, two-group random assignment design. Preterm infants (n = 120) were enrolled within the first week of life and randomized to an experimental group receiving a patterned feeding experience or to a control group receiving usual feeding care.
Results:
Analysis of data from 91 infants showed that infants receiving touch at more than 25% of early gavage feedings achieved full oral feeding more quickly; as touch exposure increased, time from first oral to full oral feeding decreased. There was no association between holding during early gavage feedings or touch during transition feedings and time to full oral feeding.
Discussion:
Neurological expectation during critical periods of development is important for infants. However, a preterm infant's environment is not predictable: Caregivers change regularly, medical procedures dictate touch and holding, and care provision based on infant cues is limited. Current knowledge supports caregiving that occurs with a naturally occurring sensation (i.e., hunger), is provided in a manner that is congruent with the expectation of the neurological system, and occurs with enough regularity to enhance neuronal and synaptic development. In this study, we modeled an experience infants would "expect" if they were not in the neonatal intensive care unit and demonstrated a shorter time from first oral feeding to full oral feeding, an important clinical outcome with neurodevelopmental implications. We recommend further research to determine the effect of patterned caregiving experiences on other areas of neurodevelopment, particularly those that may occur later in life.
