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Epigenetics Embedding of Oral Feeding Skill Development in Preterm Infants: A Study Protocol
Thao Griffith1, Rosemary White-Traut, Dina Tell
1Author Affiliations: Department of Family and Community Health Nursing, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois (Drs Griffith, Tell, and Janusek); Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, Wisconsin (Dr White-Traut); Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois (Dr White-Traut); and Department of Internal Medicine, Division of Infectious Disease, Rush University, Chicago, Illinois (Dr Green).
Insights
Early life stress in preterm infants may impair oral feeding skills, potentially through DNA methylation of stress-related genes. This study investigates this link to improve infant nutrition and health outcomes.
Area of Science:
- Neonatal research
- Developmental neuroscience
- Epigenetics
Background:
- Preterm infants often struggle with oral feeding, impacting growth and development.
- Neurobehavioral development is crucial for oral feeding skills.
- Early life stress can alter DNA methylation of stress-related genes (NR3C1, HSD11B2), potentially affecting neurobehavior.
Purpose of the Study:
- To investigate the impact of early life stress, indicated by NR3C1 and HSD11B2 promoter DNA methylation, on oral feeding skill development in preterm infants.
- To elucidate the biomechanisms linking early life stress to impaired oral feeding.
Main Methods:
- Longitudinal prospective cohort study design.
- Enrollment of preterm infants (26-34 weeks gestational age).
- Assessment of early life stress, DNA methylation, cortisol reactivity, neurobehaviors, and oral feeding skills during hospitalization and post-discharge.
Main Results:
- 70 infants enrolled; data collection completed.
- Study is currently in the data analysis phase.
- Findings are expected to be disseminated in 2025.
Conclusions:
- Study findings will inform interventions to support oral feeding and nutrition in preterm infants.
- Results may reduce post-discharge feeding difficulties and long-term health risks.
- This research supports strategies to mitigate stress in vulnerable preterm populations.
Background:
Preterm infants face challenges to feed orally, which may lead to failure to thrive. Oral feeding skill development requires intact neurobehaviors. Early life stress results in DNA methylation of NR3C1 and HSD11B2, which may disrupt neurobehaviors. Yet, the extent to which early life stress impairs oral feeding skill development and the biomechanism whereby this occurs remains unknown. Our team is conducting an NIH funded study (K23NR019847, 2022-2024) to address this knowledge gap.
Purpose:
To describe an ongoing study protocol to determine the extent to which early life stress, reflected by DNA methylation of NR3C1 and HSD11B2 promoter regions, compromises oral feeding skill development.
Methods:
This protocol employs a longitudinal prospective cohort study. Preterm infants born between 26 and 34 weeks gestational age have been enrolled. We evaluate early life stress, DNA methylation, cortisol reactivity, neurobehaviors, and oral feeding skill development during neonatal intensive care unit hospitalization and at 2-week post-discharge.
Results:
To date, we have enrolled 70 infants. We have completed the data collection. Currently, we are in the data analysis phase of the study, and expect to disseminate the findings in 2025.
Implications For Practice And Research:
The findings from this study will serve as a foundation for future clinical and scientific inquiries that support oral feeding and nutrition, reduce post-discharge feeding difficulties and lifelong risk of maladaptive feeding behaviors and poor health outcomes. Findings from this study will also provide further support for the implementation of interventions to minimize stress in the vulnerable preterm infant population.
