Preterm infants experience breathing irregularities that lead to significant and frequent episodes of hypoxemia during bottle feeding. Recurrent, transient hypoxemia may contribute to the development of dysfunctional oral-motor feeding patterns, increased expenditure of energy and poor growth, and neurologic injury. The goals of the proposed mentored research are to refine and test the effectiveness of an individualized, contingently-structured feeding intervention for hospitalized preterm infants designed to minimize hypoxemia during bottle feeding. The feeding intervention will begin with an assessment feeding during which the infant's feeding skills and regulatory problems are identified and an individual approach to feeding is designed. Then the infant will be fed once by a standard approach and once by the intervention approach. The intervention approach will consist of strategies that are applied to all infants, for example, preparing the infant to feed, and a contingently-structured component with specific strategies based on the type of feeding difficulties presented by the infant during the feeding. In addition, the efficacy of the addition of supplemental oxygen for the minimization of hypoxemia will be explored with infants who do not respond adequately to the intervention. The intervention will be compared to the standard feeding approach on measures of infant readiness at the outset of the feeding, the number and severity of hypoxemic events during the feeding, and post-feeding measures of feeding tolerance using multivariate repeated measures ANOVA. The investigator's educational aims for the K01 are: (a) to expand knowledge of the respiratory physiology of feeding for preterm infants; (b) to expand knowledge of the development of swallowing in preterm infants and the physiologic bases for supporting effective swallowing and breathing coordination during early preterm infant feeding; (c) to develop competence in the assessment and measurement of swallowing patterns, the identification of swallowing difficulties, and the design of appropriate interventions for swallowing dysregulation; (d) to develop skill in coding behavioral indicators of fatigue during feeding and identifying early behavioral indicators of fatigue, and to develop effective strategies to prevent or respond to fatigue during feeding, (e) to develop skills in designing and implementing longitudinal intervention studies and analyzing longitudinal data, in preparation for submitting an R01 grant proposal on prevention of hypoxemia during preterm infant bottle feeding. The R01 will propose testing the intervention throughout the period of learning to oral feed during hospitalization and examining outcomes of growth, development of feeding skills, and neurodevelopment. If the intervention is effective in improving these outcomes, it will be taught to nurses and parents, who are the primary feeders of preterm infants during hospitalization.
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