Guiding Mothers to Co-Regulate Oral Feeding with Very Preterm Infants

指导母亲与极早产儿共同调节经口喂养

基本信息

批准号：
8328603
负责人：
SUZANNE M THOYRE
金额：
$ 17.86万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-05 至 2014-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8328603
关键词：
Address Adopted Affect Age Behavior Behavioral Breathing Caregivers Caring Characteristics Child Child health care Cognition Complex Crossover Design Cues Data Analyses Data Collection Deglutition Development Diffusion Distress Education Eligibility Determination Enrollment Gestational Age Goals Growth Growth and Development function Health Heart Heart Rate Home environment Hospitalization Infant Infant Care Intervention Larynx Learning Length Linear Regressions Liquid substance Lung diseases Milk Modeling Mothers Movement Neonatal Neonatal Nursing Nurseries Nurses Nursing Research Oral Outcome Pattern Physiological Pilot Projects Premature Infant Preparation Problem Solving Procedures Property Protocols documentation Readiness Regulation Research Research Methodology Research Training Rest Risk Sampling Severities Shapes Site Stress Structure System Systems Theory Testing Time Translational Research Treatment Efficacy Vulnerable Populations Work Work of Breathing base biobehavior caregiving carvedilol cohort cost depressive symptoms design early childhood efficacy testing evidence base experience feeding improved innovation innovative technologies intervention effect meetings neurodevelopment new technology novel pulmonary function response satisfaction skills sucking theories therapy development treatment as usual

项目摘要

DESCRIPTION (provided by applicant): The goal of the proposed research is to extend an innovative and successful nurse-delivered feeding intervention for very preterm infants (VP) to one delivered by mothers. Up to one-third of VP infants (d30 weeks gestational age) will develop significant feeding problems during early childhood. Difficulties begin when the infant is learning how to feed orally. Impaired pulmonary functioning limits the ability of the VP infant to consistently coordinate breathing and swallowing, thus creating the conditions for disrupted breathing and fluid threats to the airway. These in turn, affect the infant's quality of sucking and behavioral responses. As a consequence, VP infants demonstrate poor endurance and early cessation of feeding, poor fluid management with aspiration risk, periods of behavioral distress, and unstable oxygenation and heart rate. The skills their mothers need to deal with these challenges are often unexpected and more complex than anticipated. To address feeding challenges for both infants and mothers, the Co-Regulated Feeding Intervention (CoReg) was developed. CoReg includes nurse guidance of the mother to provide postural support, preparation of the infant pre-feeding, initiation based on infant readiness, minimization of movement during feeding and burping, regulation of milk flow and breathing opportunities, and providing rest periods in response to infant skill at organizing the suck, swallow, breathe sequence. An innovative component of the intervention is use of the audio trainer(c), a small microphone placed over the infant's larynx to sensitize the mother to the infant's breathing and swallowing rhythms. The proposed study meets NINR's goal to develop biobehavioral intervention strategies to optimize health of vulnerable populations. The CoReg intervention protocol for guiding mothers to provide the intervention will be refined and a pilot study will be conducted using a sequential cohort design. The specific aims of the pilot study are to evaluate the feasibility and acceptability of the intervention for mothers, the research nurse-guide's ability to execute the intervention with mothers, and the feasibility of the data collection procedures. In addition, the magnitude of the effect of the intervention on maternal feeding response (co-regulation feeding strategies), infant feeding regulation (behavioral organization, fluid management, work of breathing, physiologic stability), and infant feeding outcomes (feeding skill development, growth, and length of hospitalization) will be determined. We will explore the contributions of maternal characteristics (education, age, experience in feeding, worry about the child's health, illness-related stress, and depressive symptoms) and infant characteristics (gestational age, severity of lung disease, and neurodevelopment risk) on the efficacy of the intervention. Data analyses will include qualitative and descriptive analyses and linear regression and linear mixed modeling. The proposed study will provide a needed evidence base for guiding mothers to feed the most difficult-to-feed infants in neonatal care. Once fully tested, CoReg, with its use of the audio trainer(c), can be integrated into current neonatal care settings.

描述（由申请人提供）：拟议的研究的目的是将非常早产儿（VP）（VP）的创新和成功的护士喂养干预扩展到母亲提供的喂养。在童年时期，多达三分之一的副总裁婴儿（D30周胎龄）将出现重大的喂养问题。当婴儿正在学习如何口头喂食时，困难就开始了。肺部功能受损限制了副总裁婴儿始终如一地协调呼吸和吞咽的能力，从而为呼吸中断和对气道的流体威胁创造了条件。反过来，这些会影响婴儿的吮吸和行为反应的质量。结果，副总裁婴儿表现出耐力不良和早期停止喂养，流体管理不佳，具有抽吸风险，行为困扰时期以及不稳定的氧合和心率不稳定。母亲需要应对这些挑战的技能通常是出乎意料的，比预期的要复杂。为了应对婴儿和母亲的喂养挑战，开发了共同调节的喂养干预措施（CoreG）。核心包括母亲提供姿势支持，婴儿预喂养的准备，基于婴儿准备就绪的启动，在进食和打pur时的运动最小化，牛奶流量调节和呼吸机会的启动以及为婴儿提供休息时间的响应，对婴儿组织的吮吸，吞咽，呼吸序列提供休息时间。干预的一个创新组成部分是使用音频教练（C），这是一个放在婴儿喉上的小麦克风，以使母亲对婴儿的呼吸和吞咽节奏敏感。拟议的研究符合宁尔的目标，以制定生物行为干预策略，以优化脆弱人群的健康。指导母亲提供干预措施的CoreG干预方案将进行完善，并使用顺序队列设计进行试点研究。试点研究的具体目的是评估母亲，研究护士指定与母亲执行干预的能力以及数据收集程序的可行性的能力。此外，将确定干预对孕产妇喂养反应（共同调节策略），婴儿喂养调节（行为组织，流体管理，呼吸工作，生理稳定性）和婴儿喂养结果（喂养技能的发展，住院和住院时间长度）的影响。我们将探讨产妇特征（教育，年龄，喂养方面的经验，担心儿童的健康，与疾病有关的压力和抑郁症状）以及婴儿特征（胎龄，肺部疾病的严重程度和神经发育风险）对干预效率的贡献。数据分析将包括定性和描述性分析以及线性回归以及线性混合建模。拟议的研究将为指导母亲提供新生儿护理中最难喂养的婴儿提供所需的证据基础。一旦经过全面测试，CoreG及其使用音频培训师（C）可以集成到当前的新生儿护理设置中。