Background Preterm infants may be at risk to develop oral feeding difficulties secondary to immature development and comorbidities associated with prematurity. We have shown that the use of cue-based oral feeding guidelines enabled preterm infants to attain full volume oral feeding at an earlier postmenstrual age (PMA) when compared to historical controls, without compromising growth. By using the guidelines, we could identify infants whose oral feeding progressed much slower than average. These infants and those who failed to attain full oral feeding at hospital discharge may have certain characteristics that cause them to have problems with oral feeding.
Purpose To identify the risk factors that contributed to abnormal oral feeding progression.
Design Preterm infants (< 37 weeks' gestation) admitted from July 2004 to August 2005 to the University of Utah NICU who qualified for the cue-based feeding regimen were studied. The medical records of 131 preterm infants were reviewed to obtain demographics and medical history. Infants that were transferred during oral feeding advancement were excluded from analysis. PMA at full oral feeding (removal of NG tube) was recorded for each infant and the median PMA and interquartile range for the group were calculated. Three groups of feeders were identified: infants that failed oral feeding by hospital discharge (discharged home on NG feedings or had a gastrostomy tube placed), infants that were in the upper quartile (slow feeders), and infants that were in the lower quartile (fast feeders). Comparisons were done using the chi-square and one-way ANOVA tests.
Results No differences in sex, income, race, maternal education, or age were found between groups. A significant difference among the 3 groups was noted for RDS requiring surfactant (36%, 46%, 80%) and oxygen need at discharge (14%, 21%, 70%), with the lowest percent in the fast feeder group and the highest percent in the failed feeding group. Those that failed oral feedings also had a significantly higher incidence of maternal chorioamnionitis, bloodstream infection, grade 3 or 4 IVH, PVL, apnea, vocal cord paralysis following PDA ligation, and concern for severe GERD when compared to the other two groups (p < .05). These infants were also more premature, had lower birth weight, and required significantly longer mechanical ventilation than the other groups (p < .01). Additionally, the infants that failed were much older at hospital discharge (p < .01).
Conclusion There are multiple factors that may help predict which infants are at risk to fail oral feeding. Certain factors may be amenable to different management. We speculate that targeting interventions for infants with these factors will facilitate their oral feeding progression.
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