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Effect of feeding in elevated side-lying and paced bottle feeding on swallow-breathe coordination in healthy preterm
Nicole Hübl1, Jasmin Hasmann1, Benjamin Riebold2
1Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Children's Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
Insights
Elevated side-lying positions and paced bottle feeding improve suck-swallow-breathe coordination in preterm infants. These methods reduce choking, coughing, and breathing pauses, supporting safer feeding for premature babies.
Area of Science:
- Neonatal physiology
- Pediatric feeding disorders
- Developmental neuroscience
Background:
- Preterm infants (born before 37 weeks gestation) exhibit immature suck-swallow-breathe (SSB) coordination, increasing aspiration risk.
- Swallowing components mature around 34-35 weeks postmenstrual age (PMA), but early fatigue in preterm infants impairs swallowing efficiency and prolongs breathing pauses.
- Effective feeding strategies are crucial to manage SSB coordination challenges in preterm infants.
Purpose of the Study:
- To objectively evaluate the impact of feeding position and paced bottle feeding on swallowing and breathing function in preterm infants.
- To compare elevated side-lying versus supine positioning during bottle feeding.
- To assess the effects of paced bottle feeding on SSB coordination.
Main Methods:
- Two groups of 20 preterm infants (34-35 weeks PMA) were studied using noninvasive bioimpedance, electromyography, and a breathing belt.
- Study 1 (S1) compared feeding in elevated side-lying vs. elevated supine positions for 2 minutes each.
- Study 2 (S2) compared 2 minutes of paced bottle feeding with 2 minutes of non-paced feeding.
Main Results:
- Elevated side-lying feeding (S1) significantly reduced choking, coughing, breathing pause duration, and swallowing variability compared to supine.
- Supine positioning showed greater pharyngeal closure at the start of feeding in S1.
- Paced bottle feeding (S2) significantly decreased the length of breathing pauses.
Conclusions:
- Elevated side-lying position and paced bottle feeding show promise in enhancing SSB coordination for healthy preterm infants at 34-35 weeks PMA.
- These feeding interventions may mitigate risks associated with immature SSB coordination in preterm neonates.
- Further research can explore long-term benefits and optimal implementation of these strategies.
Background:
Preterm infants face challenges in their suck-swallow-breathe coordination leading to an increased risk of aspiration. Key components of the swallowing process are present around 34 to 35 weeks postmenstrual age (PMA), but preterm infants fatigue early affecting timing, quality and efficiency in swallowing and prolonging breathing pauses. Feeding strategies need to address these specific challenges in suck-swallow-breathe coordination.
Aim:
To objectively measure the effect of positioning and applying "paced bottle feeding" on swallowing and breathing function in preterm infants.
Methods:
Two separate groups of each 20 preterm infants were measured during a single bottle feed at the age of 34 to 35 weeks PMA using a noninvasive measuring device combining bioimpedance, surface electromyography as well as a breathing belt. In the first study (S1) feeding in elevated side-lying was compared to elevated supine position for 2 min each. In the second study (S2) 2 min of paced bottle feeding was compared to 2 min without paced bottle feeding.
Results:
(S1): Feeding in elevated side-lying led to significantly fewer episodes of choking and coughing, significantly shorter breathing pauses and significantly less variation in swallowing movements than in elevated supine. Pharyngeal closure was significantly greater in supine at the start of the feed. (S2): The application of paced bottle feeding significantly reduced the length of breathing pauses.
Conclusions:
Feeding in elevated side-lying position and applying paced bottle feeding may support improved swallow-breathe coordination in healthy preterm infants at 34 to 35 weeks PMA.
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