Date Presented 04/06/19
The findings of a recent study highlight the importance of a comprehensive approach to rehabilitation that considers oral motor and neurobehavioral alterations to address feeding challenges associated with premature birth. This presentation will reveal these results and help to elucidate relationships between early feeding skills and key neurobehavioral components. Understanding such relationships can lead to early identification of adverse outcomes and optimize outcomes for preterm infants.
Primary Author and Speaker: Molly Grabill
Additional Authors and Speakers: Kylie VanRoekel
Contributing Authors: Roberta Pineda
PURPOSE: Preterm infants are at risk for altered brain structure and adverse neurodevelopmental outcomes, which can be exacerbated by medical complications associated with prematurity (Padilla, 2011; Pineda, 2013). Alterations in tone, reflexes and sensory development can impact the ability to orally feed, which is one of the most complex skills of infancy. Oral feeding requires contributions of the physiologic, sensory, and neuromotor systems (Jadcherla, 2016). Feeding problems are common in preterm infants due to their poorly developed central nervous systems. While research suggests a relationship between feeding behaviors and many neural mechanisms, it remains unclear what connections exist between key neurobehavioral components and feeding behaviors (Jadcherla, 2016). Continued investigation is necessary to understand this relationship and identify potential markers for neonatal brain injury and/or adverse developmental outcome. The purpose of this study is to identify relationships between neurobehavior and early feeding performance in preterm infants.
DESIGN: In this prospective cohort study, 44 preterm infants born ≤32 weeks gestation were consecutively enrolled within the first week of life at the Level IV NICU at St. Louis Children’s Hospital. Infants with an identified congenital anomaly were excluded.
METHOD: Oral feeding was evaluated with the Neonatal Eating Outcome (NEO) assessment at term-equivalent age (37–42 weeks postmenstrual age). Infant neurobehavior was also assessed at this time using the NICU Network Neurobehavioral Scale (NNNS). One-way ANOVA (p<0.05) was used to determine relationships between feeding and neurobehavior.
RESULTS: Of the 44 participants, 25% (n=11) displayed feeding challenges, 50% (n=22) had questionable feeding performance, and 25% (n=11) displayed normal feeding behavior. Preterm infants who exhibited normal feeding behavior had greater tolerance of handling (p= 0.040) and decreased hypertonia (p= .026) as compared to preterm infants with feeding challenges.
CONCLUSION: Preterm infants have a high risk of feeding problems. Alterations in neurobehavior appear to relate to alterations in feeding behaviors. Feeding-related abnormalities may indicate adverse neurodevelopmental outcomes. Feeding problems may not be in isolation, and a comprehensive approach to rehabilitation that considers oral motor and neurobehavioral alterations may enable interventions that can optimize outcomes.
References
Padilla, N., et al., Differential effects of intrauterine growth restriction on brain structure and development in preterm infants: a magnetic resonance imaging study. Brain Res, 2011. 1382: p. 98-108. doi:10.1016/j.brainres.2011.01.032
Pineda, R.G., et al., Patterns of altered neurobehavior in preterm infants within the neonatal intensive care unit. J Pediatr, 2013. 162(3) : p. 470-476 e1. doi:10.1016/j.jpeds.2012.08.011
Jadcherla, S., Dysphagia in the high-risk infant: potential factors and mechanisms. Am J Clin Nutr, 2016. 103(2): p. 622S-8S. doi:10.3945/ajcn.115.110106
