Preterm infants (gestational birth age < 34 weeks) with bronchopulmonary dysplasia (BPD) are hospitalized longer and at greater expense than other preterm infants, and the incidence of BPD is rising. Generally the last criterion to be met for hospital discharge by these infants is the accomplishment of nipple feeding. How to make the transition from gavage to nipple feeding for preterm infants with BPD varies from nursery to nursery based more on custom than on the use of existing knowledge of neuro-development for the preterm infant. This proposed randomized clinical trial is an expansion of MR 8043 to preterm infants with BPD. The objective is to compare the effectiveness of an experimental feeding intervention that considers the infant's neurologic development and signs of chronic respiratory distress, to the standard care practice for making the transition from gavage to nipple feeding. Preterm infants with BPD will be randomized to either an experimental group (n=43) or to the hospital's standard practice for the transition to nipple feeding (n=43). Previously, the experimental feeding intervention was successful in helping healthy preterm infants transition from gavage to nipple feeding an average of 5 days sooner (50% improvement), and with less bradycardia and better behavioral responses during feeding than control infants given the standard care. The hypotheses are that experimental infants will attain nipple feeding and be ready for hospital discharge sooner with cost effectiveness, has less bradycardia and better behavioral responses with feeding compared to control infants. The experimental feeding intervention includes behavioral assessment to identify readiness for nipple feeding, nonnutritive sucking to promote awake behavior for feeding, and use of infant behavioral and cardiorespiratory responses to regulate frequency, length, and volume of nipple feedings. Data analysis will include generalized linear analysis of variance for days to nipple feeing and days to hospital discharge; mixed models analysis of variance for nipple feeding proficiency, behavioral responses, heart rate variability, apnea, and bradycardia during nipple feeding; and calculation of an incremental cost effectiveness ratio comparing the experimental and control feeding conditions. Parental reports about their infants' feeding problems at 3 months post hospital discharge will be content analyzed. ? ? ?
| McCain, Gail C; Del Moral, Teresa; Duncan, Robert C et al. (2012) Transition from gavage to nipple feeding for preterm infants with bronchopulmonary dysplasia. Nurs Res 61:380-7 |
| McCain, Gail C; Knupp, Amy M; Fontaine, Jessica Loucas et al. (2010) Heart rate variability responses to nipple feeding for preterm infants with bronchopulmonary dysplasia: three case studies. J Pediatr Nurs 25:215-20 |
| McCain, Gail C (2003) An evidence-based guideline for introducing oral feeding to healthy preterm infants. Neonatal Netw 22:45-50 |
| McCain, G C; Gartside, P S; Greenberg, J M et al. (2001) A feeding protocol for healthy preterm infants that shortens time to oral feeding. J Pediatr 139:374-9 |
