Contingent Feeding of Preterms to Reduce Hypoxemia

早产儿的应急喂养以减少低氧血症

• 批准号: 6434327
• 负责人: SUZANNE M THOYRE
• 金额: $ 8.73万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-02-01 至 2005-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6434327
• 关键词: clinical research; developmental nutrition; fatigue; human subject; hypoxia neonatorum; infant human (0-1 year); infant nutrition disorder; nutrition related tag; outcomes research; oxygen consumption; oxygen therapy; premature infant human; pulmonary respiration; respiratory airflow disorder; respiratory oxygenation; swallowing; videotape /videodisc

Preterm infants experience breathing irregularities that lead to significant and frequent episodes of hypoxemia during bottle feeding. Recurrent, transient hypoxemia may contribute to the development of dysfunctional oral-motor feeding patterns, increased expenditure of energy and poor growth, and neurologic injury. The goals of the proposed mentored research are to refine and test the effectiveness of an individualized, contingently-structured feeding intervention for hospitalized preterm infants designed to minimize hypoxemia during bottle feeding. The feeding intervention will begin with an assessment feeding during which the infant's feeding skills and regulatory problems are identified and an individual approach to feeding is designed. Then the infant will be fed once by a standard approach and once by the intervention approach. The intervention approach will consist of strategies that are applied to all infants, for example, preparing the infant to feed, and a contingently-structured component with specific strategies based on the type of feeding difficulties presented by the infant during the feeding. In addition, the efficacy of the addition of supplemental oxygen for the minimization of hypoxemia will be explored with infants who do not respond adequately to the intervention. The intervention will be compared to the standard feeding approach on measures of infant readiness at the outset of the feeding, the number and severity of hypoxemic events during the feeding, and post-feeding measures of feeding tolerance using multivariate repeated measures ANOVA. The investigator's educational aims for the K01 are: (a) to expand knowledge of the respiratory physiology of feeding for preterm infants; (b) to expand knowledge of the development of swallowing in preterm infants and the physiologic bases for supporting effective swallowing and breathing coordination during early preterm infant feeding; (c) to develop competence in the assessment and measurement of swallowing patterns, the identification of swallowing difficulties, and the design of appropriate interventions for swallowing dysregulation; (d) to develop skill in coding behavioral indicators of fatigue during feeding and identifying early behavioral indicators of fatigue, and to develop effective strategies to prevent or respond to fatigue during feeding, (e) to develop skills in designing and implementing longitudinal intervention studies and analyzing longitudinal data, in preparation for submitting an R01 grant proposal on prevention of hypoxemia during preterm infant bottle feeding. The R01 will propose testing the intervention throughout the period of learning to oral feed during hospitalization and examining outcomes of growth, development of feeding skills, and neurodevelopment. If the intervention is effective in improving these outcomes, it will be taught to nurses and parents, who are the primary feeders of preterm infants during hospitalization.

早产婴儿经历了呼吸不规则，导致奶瓶喂养过程中低氧血症的严重和频繁发作。经常性的短暂性低氧血症可能有助于发展功能失调的口腔运动喂养模式，增加能量和生长不良的消耗以及神经系统损伤。拟议的指导研究的目标是完善和测试个性化的，包括结构化的喂养干预措施的有效性，以供住院的早产婴儿，旨在最大程度地减少奶瓶喂养期间的低氧血症。喂养干预将从评估喂养开始，在此期间，确定了婴儿的喂养技能和调节问题，并设计了单独的喂养方法。然后，婴儿将通过标准方法和一次干预方法喂食一次。干预方法将包括适用于所有婴儿的策略，例如，准备婴儿喂食，以及基于婴儿在喂养过程中婴儿提出的喂养困难的类型，具有特定策略的结构性成分。此外，将与对干预措施做出充分反应的婴儿一起探索补充氧气最小化的补充氧气的功效。该干预措施将与喂养开始时对婴儿准备的度量的标准喂养方法进行比较，在喂养过程中低氧事件的数量和严重程度以及使用多变量重复测量方差分析的喂养耐受性的喂养后喂养度量。研究者对K01的教育目标是：（a）扩大对早产儿的喂养呼吸生理学的知识； （b）扩大对早产儿吞咽的发展的了解，以及支持早产婴儿喂养期间有效吞咽和呼吸协调的生理基础； （c）发展吞咽模式评估和测量的能力，吞咽困难的识别以及针对吞咽失调的适当干预措施的设计； （d）在进食和确定疲劳的早期行为指标方面的编码行为指标方面，要制定有效的策略，以防止或应对喂养过程中疲劳的有效策略，（e）以开发设计和实施纵向干预研究和实施纵向数据的技能，以准备提交R01授予疗法的预期疗法，以预先促进预期。 R01将提出在整个学习期间的干预措施，以期在住院期间口服饲料，并检查增长的结果，喂养技能的发展和神经发育。如果干预措施有效地改善了这些结果，将教给护士和父母，这些护士和父母是住院期间早产儿的主要饲养者。