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.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD044469-04
Application #
7440331
Study Section
Pregnancy and Neonatology Study Section (PN)
Program Officer
Grave, Gilman D
Project Start
2005-08-01
Project End
2010-05-31
Budget Start
2008-06-01
Budget End
2009-05-31
Support Year
4
Fiscal Year
2008
Total Cost
$325,505
Indirect Cost
Name
Baylor College of Medicine
Department
Pediatrics
Type
Schools of Medicine
DUNS #
051113330
City
Houston
State
TX
Country
United States
Zip Code
77030
Lau, Chantal (2018) Breastfeeding Challenges and the Preterm Mother-Infant Dyad: A Conceptual Model. Breastfeed Med 13:8-17
Zimmerman, Emily; Lau, Chantal (2017) The Development of the Mother-Infant Mutualistic Screening Scale. J Pediatr Mother Care 2:
Lau, Chantal (2016) Development of infant oral feeding skills: what do we know? Am J Clin Nutr 103:616S-21S
Lau, Chantal (2015) Development of Suck and Swallow Mechanisms in Infants. Ann Nutr Metab 66 Suppl 5:7-14
Lau, C; Fucile, S; Schanler, R J (2015) A self-paced oral feeding system that enhances preterm infants' oral feeding skills. J Neonatal Nurs 21:121-126
Lau, Chantal; Bhat, Kiran; Potak, Debra et al. (2015) Oral Feeding Assessment Predicts Length of Hospital Stay in Late Preterm Infants. J Pediatr Mother Care 1:
Lau, Chantal (2013) Is there an advantage for preterm infants to feed orally in an upright or sidelying position? J Neonatal Nurs 19:28-32
Lau, C; Smith, E O (2012) Interventions to improve the oral feeding performance of preterm infants. Acta Paediatr 101:e269-74
Fucile, Sandra; McFarland, David H; Gisel, Erika G et al. (2012) Oral and nonoral sensorimotor interventions facilitate suck-swallow-respiration functions and their coordination in preterm infants. Early Hum Dev 88:345-50
Lau, C; Smith, E O (2011) A novel approach to assess oral feeding skills of preterm infants. Neonatology 100:64-70

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