Oral feeding difficulties in preterm infants have become a major concern for neonatologists as medical advances have led to an increased survival of these infants. Hospital discharge of preterm infants often is delayed as a result of their inability to wean from tube feeding. There is also an increasing awareness that feeding impediments may persist on a long-term basis in this population of infants. Diagnoses and management of oral feedings are largely empiric because the reasons for such difficulties are unclear. The socioeconomic burden to society and family due to this medical predicament is rising at an alarming rate. Feeding therapists routinely use a number of interventions to assist these infants. However, due to a lack of evidence-based data to support their efficacy, clinicians debate their benefit as any ensuing progress may be simply the result of normal maturation. In the first part of this proposal, we hypothesize that efficacious interventions offered early on in life will accelerate the time at which preterm infants reach independent oral feeding and will improve specific oral feeding skills. We will investigate the effect on oral feeding of 2 exercise programs aimed at improving sucking and swallowing and 2 direct support programs aimed at identifying the optimal feeding position during bottle feeding. The combined effect of the 2 exercise programs along with the optimal feeding position identified will be evaluated as well. The efficacy of these interventions will be measured clinically by monitoring infant's oral feeding performance and functionally by assessing specific oral feeding skills. Our primary outcome will be days from introduction to independent oral feeding. Secondary measures of oral feeding performance will include duration of birthstay hospitalization, overall milk transfer, rate of milk transfer, and occurrence of cardiopulmonary compromises, i.e. oxygen desaturation, apnea, bradycardia, coughing/choking, and/or aspiration. Assessment of the specific oral feeding skills will include the developmental stage of sucking, sucking amplitude, suck-swallow and swallow-respiration interactions. We expect that the proposed interventions will improve all the above outcomes with the combined therapy providing greater benefits. In the second part of this proposal, we hypothesize that these interventions administered early on in infancy will decrease the incidence of long-term feeding problems as a result of the improved oral feeding skills these infants acquired during their birthstay hospitalization. The primary outcome will be the necessity of being followed for feeding problems by pediatric gastroenterologists and/or feeding disorder clinics. The secondary outcomes will be attainment of specific feeding milestones at 3, 6, 12, 18, and 24 months corrected age.
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