Feeding,Medical Factors,and Developmental Outcome in Premature Infants

Abstract

This is a prospective, longitudinal study of premature infants investigating whether the length of time needed to reach full enteral feedings (F_EF) or full nipple feedings (F_NF) is related to medical complications and/or developmental outcome at 24 months corrected age. Premature infants (n=161) from three institutions with birth weights less than 1,600 grams were followed up from birth to 24 months corrected age. The infants were stratified into groups by the severity of medical complications. Bayley Scales of Infant Development were performed at 24 months corrected age. Multiple linear regression was used to analyze the association between feeding milestones, medical complications, and developmental outcomes. Our results show that when controlling for birth weight and gestational age (GA), the severity of respiratory complications was significantly related to reaching F_EF (p=0.024) and F_NF (p=0.0014). Furthermore, when controlling for the severity of respiratory complications, GA, and socioeconomic status, an increased length of time to F_NF was significantly associated with a poorer mental outcome (p=0.0013). We conclude that there is an association between the length of time to reach F_NF and mental developmental outcome at 24 months corrected age. Infants who reach full enteral feedings at an earlier age appear to have a better developmental outcome despite their GA and severity of respiratory complications.

Get full access to this article

View all access options for this article.

References

1. Drillien CM . Abnormal neurologic signs in the first year of life in low-birth weight infants: possible prognostic significance. Dev M ped Child Neurol. 1972;14:575-584.

2. Wildin SR , Anderson A , Woodside M , et al. Prediction of 12-month netrodevelopmental outcome from a 6-month neurologic examination in premature infants. Coin Pediatr. 1995;34:290-299.

3. D'Eugenio DB , Slagle TA , Mettelman BB , et al. Developmental outcome of preterm infants with transient neuromotor abnormalities. An j Dis Child. 1993;147:570-574.

4. Winick M , Rosso P . Head circumference and cellular growth of the brain in normal and marasmic children. Pediatics. 1969;74:774-778.

5. Hack M , Breslau N , Weissman B , et al. Effect of very-low-birth-weight and subnormal head size on cognitive abilities at school age. N Enogl J Med. 1991;325:231-237.

6. Lucas A , Morley R , Cole TJ , et al. Early diet in preterm babies and developmental status at 18 months. Lancet. 1990;335:1477-1478.

7. Lucas A , Fewtrell MS , Morley R , et al. Randomized outcome trial of human milk fortification and developmental outcome in preterm infants. Am J Clin Nutr. 1996;64:142-151.

8. Goldman HI , Liebman OB , Freudenthal R , et al. Effects of early dietary protein intake on low-birth-weight infants: evaluation at 3 years of age. Pediatrics. 1971;78:126-129.

9. Skidmore MD , Rivers A , Hack M . Increased risk of cerebral palsy among very-low-birth-weight infants with chronic lung disease. Dev Med Child Neurol. 1990;32:325-332.

10.

10. Vohr BR , Coll CG , Lobato D , et al. Neurodevelopmental and medical status of low-birth-weight survivors of bronchopulmonary dysplasia at 10 to 12 years of age. Dev Med Child Neurol. 1992;33:690-697.

11.

11. Gray PH , Burns YR , Mohay HA , et al. Neurodevelopmental outcome of preterm infants with bronchopulmonary dysplasia. Arch Dis Child. 1995; 73:F128-F134.

12.

12. Landry SH , Chapieski L , Fletcher JM , et al. Three-year outcomes for low-birth-weight infants: differential effects of early medical complications. J Pediatr Psychol. 1988;13:317-327.

13.

13. Low JA , Galbraith RS , Sauerbrei EL , et al. Motor and cognitive development of infants with intraventricular hemorrhage, ventriculomegaly, or periventricular parenchymal lesions. Am J Obstet Gynecol. 1986;155:750-756.

14.

14. Bendersky M , Lewis M . Effects of intraventricular hemorrhage and other medical and environmental risks on multiple outcomes at age three years. J Dev Behav Pediatr. 1995;16:89-96.

15.

15. Mathew OP . Science of bottle feeding. J Pediatr. 1991;119:511-519.

16.

16. Case-Smith J , Cooper P , Scala V . Feeding efficiency of premature neonates. Am J Occup Ther. 1989;43:245-250.

17.

17. Miller CL , Landry SH , Smith KE , et al. Developmental change in the neuropsychological functioning of verylow-birth-weight infants. J Child Neuropsychol. 1995;1:224-236.

18.

18. Landry SH , Smith KE , Miller-Loncar CL , et al. The relation of change in maternal interactive styles with preterm infants' developing social competence across the first three years of life. Child Dev. 1998;69:105-123.

19.

19. Hollingshead AB . Four Factor Index of Social Status. New Haven, CT: Department of Sociology, Yale University; 1975.

20.

20. Papile L , Burstein V , Burstein R , et al. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weight less than 1500 grams. J Pediatr. 1978;92:529-534.

21.

21. Bayley N . Bayley Scales of Infant Development. New York: Psychological Corporation; 1969.

22.

22. Wolff, PH . The serial organization of sucking in the young infant. Pediatrics. 1968;42:943-956.

23.

23. Dreier T , Wolff PH , Cross EE , Cochran WD . Patterns of breath intervals during non-nutritive sucking in full-term and 'at risk' preterm infants with normal neurological examinations. Early Hum Dev. 1979;3/2:187-199.

24.

24. Tsang RC , Lucas A , Uauy R , Zlotkin S . Nutritional Needs of the Preterm Infant. Pawling, NY: Williams and Wilkins/Caduceus Medical Publishers, Inc; 1993:209-209.

25.

25. Lucas A . Ontogeny of gut hormones and hormone related substances. Acta Paediatr Scand. 1989;351 (Suppl):80-87.

26.

26. Lucas A , Bloom SR , Aynsley-Green, A . Metabolic and endocrine consequences of depriving preterm infants of enteral nutrition. Acta Paediatr Scand. 1983;72:245-249.

27.

27. Lucas A , Bloom SR , Aynsley-Green A . Postnatal surges in plasma gut hormones in term and preterm infants. Biol Neonate. 1982;41:63-67.

28.

28. Medoff-Cooper B , Gennaro S . The correlation of sucking behaviors and Bayley Scales of Infant Development at six months of age in VLBW infants. Nursing Res. 1996;45:291-296.