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.

项目概要/摘要 早产儿（出生时胎龄≤ 37 周）仅占美国活产婴儿的 10%，但 占医院婴儿护理总成本的 43%。 早产儿是长期住院的主要原因之一，这增加了护理和治疗费用 延迟与家人团聚 早产儿常常由于其不成熟而经历经口喂养困难。 神经、心肺、胃肠道和口腔运动系统在进食过程中反复出现不适。 发育中的大脑中的感觉运动通路，导致高达 41% 的长期不适应的进食行为。 的早产儿经历喂养困难并持续到儿童期，这对长期 传统上，半高位仰卧位（以下简称“生长和神经发育”）。 仰卧位）已在新生儿重症监护室用于早产儿奶瓶喂养时使用。 近十年来，半高侧卧位（以下简称侧卧位）已被广泛采用。 被提议作为提高早产儿经口喂养技能和减少不良事件的潜在策略 喂养期间，但支持侧卧位作为喂养干预措施的证据质量尚不明确。 由于证据有限，战士们在早期、紧急阶段对侧卧位置的使用不一致， 让已经经历喂养挑战的婴儿暴露在不可预测和可变的喂养位置，这 可能会使它们的喂养技能发展进一步复杂化，因此需要进行更多研究来提供更明确的信息。 了解侧卧位是否可以提高早产儿的喂养技巧并产生所需的 为了解决这一差距，我们提出了一个单一的信息来提高这种干预措施的应用精度。 中心随机交叉试验，以全面了解副作用的生物行为功效 卧位与仰卧位对早产儿生理和行为反应的影响 管完全经口喂养，并确定与干预反应相关的婴儿特征。 具体目标是： 1) 比较早产儿侧卧奶瓶喂养时的生理反应 与仰卧位；2) 比较早产儿侧卧与侧卧奶瓶喂养时的行为反应。 仰卧位；3) 确定干预反应的调节因素，评估婴儿性别、成熟度水平，以及 共病情况包括连续测量心率、呼吸频率、 氧饱和度和自主神经系统调节（心率变异性和内脏大脑 喂养前、喂养期间和喂养后的行为反应将包括对婴儿的观察。 通过吸吮和呼吸波形数据的微分析以及喂食录像来记录喂食行为 （吸吮呼吸协调和早期喂养技能评估工具将使用线性混合分析数据）。 这项研究的结果将为指导基于证据的实践提供重要的知识。 支持和加强早产儿的经口喂养，同时还为关键功效试验提供所需的数据。