Biobehavioral Efficacy of the Semi-Elevated Side-Lying Position for Feeding Preterm Infants

半抬高侧卧位喂养早产儿的生物行为功效

• 批准号: 10433858
• 负责人: Jinhee Park
• 金额: $ 20.78万
• 依托单位: BOSTON COLLEGE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-17 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10433858
• 关键词: 37 weeks gestation; Address; Adverse event; Assessment tool; Autonomic nervous system; Behavioral; Biological; Birth; Bolus Infusion; Bottle feeding; Brain; Breast Feeding; Breathing; Caregivers; Cerebrum; Characteristics; Chest; Childhood; Clinical; Cross-Over Trials; Data; Deglutition; Development; Distress; Environmental Risk Factor; Evidence based practice; Family; Fatigue; Feeding Methods; Feeding behaviors; Gestational Age; Goals; Gravitation; Growth; Health; Health Care Costs; Heart Rate; Hospitalization; Hospitals; Hydrostatic Pressure; Infant; Infant Care; Interruption; Intervention; Knowledge; Learning; Length of Stay; Liquid substance; Live Birth; Measures; Milk; Modeling; Motor Pathways; Neonatal; Neonatal Intensive Care Units; Neurologic; Oral; Oxygen; Pattern; Phase; Physiological; Pilot Projects; Positioning Attribute; Premature Infant; Public Health; Publishing; Randomized; Recommendation; Recurrence; Regulation; Research; Research Priority; Risk; Sampling; Sensory; Side; Subgroup; Supine Position; System; Time; Tube; United States; Variant; Videotape; Work; Work of Breathing; behavior measurement; behavioral response; biobehavior; care costs; comorbidity; cost; design; dosage; efficacy evaluation; efficacy trial; experience; feeding; gastrointestinal; heart rate variability; improved; intervention effect; neonatal care; neurodevelopment; oral motor; prevent; primary outcome; respiratory; response; risk minimization; sex; skill acquisition; skills; soft tissue; success; sucking

Project Summary/Abstract Preterm infants (≤ 37 weeks gestational age at birth) only represent 10% of live births in the United States, yet account for 43% of the total cost of infant care in hospitals. Delays in the development of oral feeding skills in preterm infants are one of the main reasons for prolonged hospitalization, which increases the cost of care and delays unification with family. Preterm infants often experience oral feeding difficulties due to immaturity of their neurologic, cardiorespiratory, gastrointestinal, and oral-motor systems. Recurrent distress during feeding alters sensory-motor pathways in the developing brain, leading to long-term, maladapted feeding behaviors. Up to 41% of preterm infants experience feeding difficulties that continue into childhood, which has implications for long- term growth and neurodevelopment. Traditionally, the semi-elevated supine position (hereafter referred to as supine position) has been used in neonatal intensive care units when preterm infants are bottle-fed. Over the past decade, the semi-elevated side-lying position (hereafter referred to as side-lying position) has been proposed as a potential strategy to improve preterm infants’ oral feeding skills and to reduce adverse events during feeding, but the quality of the evidence to support the side-lying position as a feeding intervention is in an early, emergent stage. Due to limited evidence, clinicians are inconsistent in their use of the side-lying position, exposing infants already experiencing feeding challenges to unpredictable and variable feeding positions, which can further complicate their feeding skill development. Additional research is necessary to provide more definitive knowledge on whether the side-lying position improves preterm infants’ feeding skills and to generate needed information to enhance precision to the application of this intervention. To address this gap, we propose a single- center randomized cross-over trial to gain a thorough understanding of the biobehavioral efficacy of the side- lying vs. the supine position on physiologic and behavioral responses of preterm infants while transitioning from tube to full oral feeding, and to identify infant characteristics associated with the intervention response. The specific aims are to: 1) compare physiologic responses in preterm infants while bottle feeding in the side-lying vs. supine position; 2) compare behavioral responses in preterm infants while bottle feeding in the side-lying vs. supine position; and 3) identify moderators of intervention response, evaluating infant sex, maturity level, and co-morbid conditions. Physiologic responses will include continuous measures of heart rate, respiratory rate, oxygen saturation, and autonomic nervous system regulation (heart rate variability and splanchnic-cerebral oxygen ratio) prior to, during and after feeding. Behavioral responses will include observations of the infant’s feeding behavior through microanalysis of the sucking and breathing waveform data and videotaped feedings (Suck-breathe coordination and Early Feeding Skills assessment tool). Data will be analyzed using a linear mixed effects model. The results of this study will provide vital knowledge to guide evidence-based practices that support and enhance oral feeding in preterm infants while also providing needed data for a pivotal efficacy trial.

项目摘要/摘要 早产儿（≤37周的胎龄出生时年龄）仅占美国活产的10％，但 占医院婴儿护理总成本的43％。延误了口服喂养技能的发展 早产是长期住院的主要原因之一，这增加了护理成本和 延迟与家人的统一。早产婴儿经常因其不成熟而遭受口服喂养困难 神经系统，心肺，胃肠道和口腔运动系统。喂养期间的反复遇险改变 发育中的大脑中的感觉运动途径，导致长期，不良的喂养行为。高达41％ 早产婴儿经历了喂养困难的养育困难，这对长期有影响 期限生长和神经发育。传统上，半高级的仰卧职位（以下称为 仰卧位）已在早产儿提供瓶装时已在新生儿重症监护病房中使用。在 过去的十年，半高度的侧面位置（以下称为侧面位置） 提议作为提高早产儿的口服喂养技能并减少不良事件的潜在策略 在喂食期间，但是支持侧倾角位置作为喂养干预措施的证据质量是 早期，紧急阶段。由于证据有限，临床医生在使用侧拓位方面不一致， 暴露婴儿已经面临喂养挑战的婴儿，以对不可预测和可变的喂养位置进行挑战，这 可以进一步使他们的喂养技能发展复杂化。需要进行其他研究以提供更确定的 了解侧倾姿是否提高早产儿的喂养技巧并产生所需的知识 信息以增强该干预措施的精度。为了解决这一差距，我们提出了一个单一的 中心随机交叉试验，以彻底了解侧面的生物行为效率 撒谎与早产儿的生理和行为反应的仰卧位 管完全喂食，并确定与干预反应相关的婴儿特征。这 具体目的是：1）比较早产婴儿的生理反应 与仰卧职位； 2）比较早产儿的行为反应，而在侧倾式vs中喂食的瓶子。 仰卧职位； 3）确定干预反应，评估婴儿性别，成熟度和 合并条件。生理反应将包括持续的心率，呼吸速度的措施， 氧饱和度和自主神经系统调节（心率变异性和模式性脑脑调节 氧比）在进食之前和之后。行为反应将包括对婴儿的观察 通过微分析吮吸和呼吸波形数据和录像喂食来喂养行为 （吮吸呼气协调和早期喂养技能评估工具）。数据将使用线性混合进行分析 效果模型。这项研究的结果将提供重要的知识，以指导基于证据的实践 在早产儿中支持和增强口服喂养，同时还为关键效率试验提供了所需的数据。