Safe and effective oral feeding of preterm infants is an important goal in every NICU. Yet these weak infants often complete their first few bottle feedings with difficulty and become very tired. After each bottle feeding, the next few feedings are usually by gavage (tube). To compound the problem, alimentary canal function improves when swallows are well spaced, but this requires a firm bottle nipple with a small hole (slow feed). An apparent solution to this dilemma has been seen clinically, when each feeding is begun with a slow-feed bottle, and completed by gavage at onset of tiring. Also it is known that cost and health effective care results if preterm infants have a pacifier with gavage feedings, and self-regulate feeding frequency and amount. The purpose of this research is to determine the effect on clinical course of giving pre-term infants self-regulatory gavage to bottle feedings (SR). The sample will be 80 preterm infants (birth weight less than 2000 g; appropriate for gestation) who will be given their first bottle feeding. Infants will be randomly assigned with gender as a blocking variable to two groups: SR and nursery routine (NR). All infants will have indwelling oral gavage tubes, gastric residual measured before feedings, and activity monitored with an ankle actometer. All will be fed prescribed amounts for weight and age, and placed prone postfeeding. Each NR infant will have a full bottle feeding with a soft (fast-feed) nipple, finished by gavage only as a last resort. Subsequent feedings will be on schedule, and by gavage or bottle at the nurses' discretion. SR infants will be fed each time as follows: 1) gastric residual, 2) pacifier for 5 minutes, 3) gastric residual, 4) slow-feed bottle until onset of tiring, 5) feeding completed with gavage and pacifier, 6) pacifier postfeeding to satiety. Feeding frequency and amount will become increasingly self-regulated during progression to 100% bottle feeding. Pacifiers will be given to SR infants before and after all full bottle feedings, and on cue if feedings must be withheld. Hypotheses are that SR infants will have less restlessness, less gastric residual (and less after the pacifier than before) faster G.I. transit, earlier 100% bottle feeding, faster weight gain, lower blood pressure, fewer complications, earlier discharge home, lower hospital costs, and less returns to the hospital. If these hypotheses are upheld, nursery personnel may choose to adopt the self-regulatory feeding procedure to aid the transition from gavage to bottle feeding, and subsequent development.
