Abstract
Objectives
Mastery of oral feeding independent of supplementary feeding tubes is crucial for safe discharge of very preterm infants (≤ 32 weeks of gestation). Qualitative assessments of suck-swallow-breathe coordination can be subjective and result in prolonged hospitalizations and delay discharges. Quantitative assessment of sucking activity during feeding (i.e., nutritive sucking) could improve determination of readiness for progression to independent oral feeding and facilitate discharge planning. To quantitively assess nutritive sucking patterns using an instrumented feeding bottle.
Methods
Preterm infants ≤ 32 weeks of gestation who attained independent oral feeding were prospectively evaluated after written informed consent was obtained. Infants with congenital anomalies and infants with major comorbidities were excluded. Nutritive sucking was assessed for a minimum of one feeding session in each participant by instrumenting a commercially available feeding bottle with a detachable pressure sensor configured to detect changes in the bottle enclosure. Speech pathologists administered the feeding using a standardized technique with infants under continuous cardiorespiratory monitoring. Type of feed, volume, and schedule was maintained consistently in accordance with each participant's defined regimen during his/her hospitalization.
Results
We analyzed 63 feeding sessions from 33 preterm infants. Mean birthweight of study participants was 1160 g (SD: 455) and median gestational age was 28 weeks (IQR: 27 – 31). Nutritive sucking patterns were assessed at term equivalent age (median corrected gestational age: 37 weeks; IQR: 35 – 39). During each feeding session, the median suck count was 784 (IQR: 550 – 1053), the median sucking rate was 0.6/s (IQR: 0.5 -0.9), the median number of brief feeding interruptions was 10 (IQR: 6–15), and the median value of sucking bursts was 52 (41-65) [Image]. Maximum suck strength strongly correlated with suck count (r = 0.68). A positive association between suck count and sucking bursts was found in unadjusted regression models (R2 = 0.35; P < 0.0001) and models adjusted for gestational age at birth, birthweight, feeding volume, transient events during feeding, and postnatal age (R2 = 0.50; P < 0.0001).
Conclusions
In stable very preterm infants, nutritive sucking patterns can be quantified by instrumentation of commercially available feeding bottles. Further analyses of sucking burst patterns may improve determination of readiness for progression to independent oral feeding in preterm infants.
Funding Sources
None.
Supporting Tables, Images and/or Graphs
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