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Transition time to full nipple feeding for premature infants with a history of lung disease
1Clinical Science Center, University of Wisconsin-Madison School of Nursing and Family Medicine 53792, USA.
Insights
Infant, environmental, and historical factors significantly impact feeding transition times for premature infants with lung disease. Improved care practices have shortened these transition times over the years.
Area of Science:
- Neonatal care
- Pediatric pulmonology
- Clinical nursing research
Background:
- Premature infants with lung disease often face challenges achieving full nipple feeding.
- Transition time to full nipple feeding is a critical outcome in neonatal care.
- Understanding factors influencing this transition is vital for optimizing infant outcomes.
Purpose of the Study:
- To determine the influence of infant, environmental, and historical factors on feeding transition times in premature infants with lung disease.
- To examine how historical era (1980s vs. 1990s) affected these influences.
- To compare factor contributions for infants with respiratory distress syndrome (RDS) versus bronchopulmonary dysplasia (BPD).
Main Methods:
- Retrospective analysis of medical records from two midwestern hospitals.
- Inclusion criteria: premature infants (≤32 weeks gestational age) with RDS or BPD.
- Cox proportional hazards model used to assess factor contributions and era effects.
Main Results:
- Infant, environmental, and historical factors significantly affected transition times (p < .05).
- Bronchopulmonary dysplasia (BPD) prolonged transition time in the earlier era (1980s).
- Longer duration of tube feedings and younger postconceptional age at feeding initiation increased transition time.
Conclusions:
- The study confirms a theoretical model of transition time for premature infants with lung disease.
- Changes in care policies and practices appear to have shortened transition times.
- Neurodevelopmental factors, particularly respiratory control, may limit advancement to full nipple feeding in infants with BPD, presenting a challenge for nursing.
Objective:
To (a) explore the contribution of infant, environmental, and historical factors to the number of days from initiation to achievement of full nipple feeding (transition time) for premature infants with a history of lung disease; (b) examine differences in the contribution of infant and environmental factors to transition time made by historical era, either earlier (in the 1980s) or later (in the 1990s); and (c) compare, within eras, the contribution to transition time of infant and environmental factors for infants with each lung diagnosis, respiratory distress syndrome (RDS) without bronchopulmonary dysplasia (BPD) or BPD.
Design:
Data were collected at two midwestern hospitals from the records of premature infants with a diagnosis of either RDS without BPD or BPD. The influence on transition time of infant, environmental and historical factors was assessed with the Cox proportional hazards model. This analytic model, a form of regression analysis, also was used to explore how era influenced the contribution to transition time of infant and environmental factors. Finally, the contribution to transition time of infant and environmental factors was examined within diagnostic group for each era.
Sample:
The hospital records audited were for infants who were 32 weeks gestational age or less with weight appropriate for gestational age. The number in each diagnostic group for each era was (a) BPD--Early, n = 35; (b) RDS--Early, n = 21; (c) BPD--Late, n = 21; and (d) RDS--Late, n = 15).
Results:
All three types of factors (infant, environmental, and historical) contributed significantly (p < .05) to shortening or lengthening transition time. A diagnosis of BPD lengthened transition time only in the early era. Across both eras, the number of days on tube feedings significantly lengthened transition time, and the older the infant in postconceptional age (PCA) at initiation of nipple feeding, the shorter the transition time.
Conclusion:
The contribution of infant, environmental, and historical factors to transition time confirmed the basic structure of the theoretical model of transition time for premature infants with a history of lung disease. The influence of era on the contributions to transition time of infant and environmental factors suggests that care policy and practice have shortened the transition time. Although the current findings support the basic structure of the theoretical model for infants with either RDS or BPD, the marginally significant (p < .10) shortening effect of PCA on transition time for infants with BPD in both eras suggests that advancement to full nipple feeding may be limited by neurodevelopmental capacities, including respiratory control. How these capacities can be supported for advancement to full nipple feeding is a challenge for nursing practice and research.