The specific aim of this study is to test the effect of a patterned feeding experience (PFE) from birth to discharge from the neonatal intensive care unit (NICU) and beyond for infants born before 30 weeks gestation. The primary aim of this study is to test the effect of a PFE on neurobehavioral organization at three time points;the transition to oral feedings, NICU discharge, and 2 months corrected age (48 weeks PMA). The secondary aims are to test the effects of a PFE on cognitive function at 6 months corrected age, neurobehavioral development;and clinical outcomes. The study's exploratory aim is to describe the potential effects of demographic factors and biobehavioral cofactors on the outcome variables (neurobehavioral organization, cognitive function, neurobehavioral development, and clinical outcomes). It is hypothesized that infants who receive the PFE will have improved neurobehavioral organization, cognitive function, neurobehavioral development, and clinical outcomes in comparison to those who receive usual feeding care. A longitudinal, randomized control trial is proposed with two groups, one receiving a patterned feeding experience from the first gavage feeding through full oral feedings to discharge and one receiving usual feeding care experience. The intervention planned for this project is based on principles of neural plasticity and neuroprotection and is designed to take advantage of neuronal synaptic development and both experience-expectant and experience-dependent characteristics of the developing brain. In addition, the intervention is designed to take advantage of a regularly occurring caregiving and life sustaining event in the life of an infant, feeding. The intervention takes advantage of what we have learned about oral feeding experience in our previous studies, as well as what we have theoretically hypothesized is occurring in relation to the effect of patterned feeding. Thus, the patterned feeding experience intervention designed for this study involves a continuity of tactile experiences associated with feeding to train and build neuronal networks. This intervention provided a critical time in neurologic system development and associated with a recurring event (feeding) should enhance neural connections that may be important for later development, particularly language and other cognitive and neurobehavioral organization skills. The proposed study addresses the National Institute of Nursing Research's focus on the interplay of biology and behavior in an effort to promote health and limit disease. Consistent with NINR's goals, the intervention is based on well-defined underlying mechanisms and includes examination of genetic cofactors and other biomarkers implicated in poor neurobehavioral outcomes. Specifically the proposed study will investigate ways to ameliorate the long-term consequences of prematurity using a unique intervention that will easily adapt to caregiving the NICU.

Public Health Relevance

The number of infants born preterm has not declined and these infants are at risk for poor long-term outcomes. This study will test an intervention involving touch and patterned experience that is administered during infant feedings and that is designed to improve developmental outcomes.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Nursing and Related Clinical Sciences Study Section (NRCS)
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Roary, Mary
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Cincinnati Children's Hospital Medical Center
United States
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Moore, Tiffany A; Pickler, Rita H (2017) Feeding intolerance, inflammation, and neurobehaviors in preterm infants. J Neonatal Nurs 23:134-141
Pickler, Rita; Sealschott, Stephanie; Moore, Margo et al. (2017) Using Functional Connectivity Magnetic Resonance Imaging to Measure Brain Connectivity in Preterm Infants. Nurs Res 66:490-495
Blair, Lisa M; Pickler, Rita H; Anderson, Cindy (2016) Integrative Review of Genetic Factors Influencing Neurodevelopmental Outcomes in Preterm Infants. Biol Res Nurs 18:127-37
Pickler, Rita H; Wetzel, Paul A; Meinzen-Derr, Jareen et al. (2015) Patterned feeding experience for preterm infants: study protocol for a randomized controlled trial. Trials 16:255
Pickier, Rita H; McGrath, Jacqueline M; Reyna, Barbara A et al. (2013) A model of neurodevelopmental risk and protection for preterm infants. Adv Neonatal Care 13 Suppl 5:S11-20
Alberts, Jeffrey R; Pickler, Rita H (2012) Evolution and development of dual ingestion systems in mammals: notes on a new thesis and its clinical implications. Int J Pediatr 2012:730673
Pickler, Rita H; McGrath, Jacqueline M; Reyna, Barbara A et al. (2010) A model of neurodevelopmental risk and protection for preterm infants. J Perinat Neonatal Nurs 24:356-65