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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Prevalence of Early Feeding Alterations Among Preterm Infants and Their Relationship to Early Neurobehavior
Molly Grabill1, Joan Smith2, Carolyn Ibrahim3
1Molly Grabill, OTD, OTR/L, is Occupational Therapist, Department of Therapy Services, St. Louis Children's Hospital, St. Louis, MO.
Insights
Many preterm infants experience feeding difficulties and neurobehavioral challenges at term-equivalent age. These feeding issues are linked to suboptimal reflexes and hypotonia, suggesting a need for holistic interventions.
Area of Science:
- Neonatology
- Developmental Pediatrics
- Neuroscience
Background:
- Feeding difficulties are common in preterm infants during neonatal intensive care unit (NICU) hospitalization.
- While most achieve oral feeding by term-equivalent age, persistent issues and links to neurobehavior remain unclear.
Purpose of the Study:
- To determine the prevalence of feeding problems in preterm infants.
- To explore the relationship between infant feeding behaviors and neurobehavior at term-equivalent age.
Main Methods:
- A cohort study was conducted with 39 very preterm infants (born ≤32 weeks gestation).
- Feeding was assessed using the Neonatal Eating Outcome Assessment.
- Neurobehavior was evaluated using the NICU Network Neurobehavioral Scale.
Main Results:
- 26% of infants had feeding challenges, and 54% had questionable feeding issues at term-equivalent age.
- Poorer feeding performance (lower Neonatal Eating Outcome Assessment scores) correlated with suboptimal reflexes and hypotonia.
Conclusions:
- Feeding challenges and questionable performance are prevalent in preterm infants, co-occurring with suboptimal reflexes and hypotonia.
- Findings support a holistic approach for therapists addressing feeding difficulties in this population.
- Understanding these links aids in identifying targets for early intervention.
Importance:
Feeding difficulties are common among preterm infants during neonatal intensive care unit (NICU) hospitalization. Although most preterm infants achieve full oral feeding by term-equivalent age, whether feeding difficulties persist despite the infant taking full volume and whether these difficulties may relate to other neurobehavioral challenges remain unclear.
Objective:
To identify the prevalence of feeding problems among preterm infants and the relationships between infant feeding behaviors and neurobehavior at term-equivalent age.
Design:
Cohort study.
Setting:
Level 4 NICU with 85 beds.
Participants:
Thirty-nine very preterm infants born ≤32 wk gestation (range = 22-32 wk). Exclusion criteria were congenital anomalies, >32 wk gestation at birth, and lack of feeding or neurobehavioral assessment at term-equivalent age.
Outcomes And Measures:
Standardized feeding assessments using the Neonatal Eating Outcome Assessment and standardized neurobehavioral evaluation using the NICU Network Neurobehavioral Scale.
Results:
Thirty-nine infants (21 female) were included in the final analysis. The mean Neonatal Eating Outcome Assessment score was 66.6 (SD = 13.3). At term-equivalent age, 10 infants (26%) demonstrated feeding challenges, 21 (54%) demonstrated questionable feeding issues, and 8 (21%) demonstrated normal feeding performance. Lower Neonatal Eating Outcome Assessment scores (poorer feeding performance) at term-equivalent age were associated with more suboptimal reflexes (p = .04) and hypotonia (p < .01).
Conclusions And Relevance:
Feeding challenges and questionable feeding performance were prevalent among preterm infants at term-equivalent age and appeared in conjunction with suboptimal reflexes and hypotonia. Understanding this finding enables therapists to take a holistic approach to addressing feeding difficulties. What This Article Adds: Elucidating the relationships between feeding performance and neurobehavior during the neonatal period allows for a better understanding of potential contributors to early feeding challenges and identifies targets for intervention.
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