INTERVENTIONS FOR THE ENHANCEMENT OF ORAL FEEDING IN PRETERM INFANTS

加强早产儿经口喂养的干预措施

基本信息

批准号：
8356653
负责人：
CHANTAL LAU
金额：
$ 3.23万
依托单位：
BAYLOR COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-12-01 至 2011-11-30
项目状态：
已结题

项目摘要

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. Primary support for the subproject and the subproject's principal investigator may have been provided by other sources, including other NIH sources. The Total Cost listed for the subproject likely represents the estimated amount of Center infrastructure utilized by the subproject, not direct funding provided by the NCRR grant to the subproject or subproject staff. To evaluate the effect of the following 2 interventions on time to attainment of independent oral feeding in preterm infants born 30 weeks gestation: 1. Efficacy of a swallowing exercise 2. Efficacy of the prone position during oral feeding It is well recognized that preterm infants have difficulty transitioning from tube to oral feeding (bottle/breast), particularly those born 30 weeks gestation (6). Such difficulty frequently leads to prolonged hospitalization, delayed mother-infant reunion and increased medical cost. Poor oral feeding may result from immature oral-motor skills, disorganized or delayed swallowing, and/or in-coordination of sucking, swallowing, and respiration. The latter is essential if these infants are to feed safely, i.e., with no aspiration, and successfully, i.e., capable of finishing all their feedings by mouth with adequate daily weight gain. There is no understanding of when and how such coordination develops. Clinical signs of in-coordination typically include oxygen desaturation, episodes of apnea and bradycardia during feeding, and/or coughing/choking. We have recently developed a nipple device that allows for the simultaneous monitoring of sucking, swallowing, and breathing (3-6). With this tool, we have gained an understanding of the development of sucking in infants and established a 5-stage scale that assesses the level of infant sucking skills (4). From our studies, we have noted that non-nutritive sucking, e.g., on a pacifier, matures before nutritive sucking (3). Insofar as swallowing is minimal during non-nutritive as compared to nutritive sucking, we speculate that sucking skills mature before sucking, swallowing, and breathing are coordinated. The maturation of the swallowing process in preterm infants is not well understood. Oral feeding difficulties resulting from disorganized and delayed swallow usually are diagnosed by videofluoroscopy. Knowledge of pulmonary maturation in preterm infants has progressed significantly over the last decade as reflected by the increased survival of the preterm population. However, the adaptability of the respiratory system to regular interruption of airflow resulting from swallowing events during oral feeding is unclear. Infants are primarily abdominal breathers as a result of the immaturity of the rib cage effectors that restrict the mobility of the upper chest (1). It is uncertain to what extent such limitation may impair the swallow-breathe process during oral feeding when swallowing frequency is increased as it is the case during oral feeding. When bottle feeding, infants are held usually in a relatively supine position similar to that used when they are breastfeeding. However, infants with anatomical oral anomalies, e.g., Pierre Robin syndrome, or conditions such as meningocele have benefited from being fed in a prone position. In general, this approach has facilitated their respiration during oral feeding (8). Similar benefits have been observed when prone feeding was used for sick preterm and fullterm infants (7). Given that preterm infants 30 weeks gestation, during their prolonged hospitalization, receive minimal stimulation appropriate for the development of their immature anatomical structures and physiological functions, we hypothesize that interventions can be developed to compensate for such void. Inasmuch as oral feeding difficulty can arise from sucking, swallowing, and/or respiration, the present protocol will evaluate 2 interventions aimed at ameliorating swallowing, and the interaction of swallow-breathe during oral feeding. Interventions to improve sucking are being investigated under our protocol H# 7469/GCRC #523.

该子项目是利用资源的众多研究子项目之一由 NIH/NCRR 资助的中心拨款提供。子项目的主要支持并且子项目的主要研究者可能是由其他来源提供的，包括其他 NIH 来源。子项目可能列出的总成本代表子项目使用的中心基础设施的估计数量， NCRR 赠款不直接向子项目或子项目工作人员提供资金。评估以下 2 种干预措施对妊娠 30 周出生的早产儿实现独立经口喂养时间的影响： 1.吞咽练习的功效 2. 俯卧位经口喂养的功效众所周知，早产儿很难从管饲过渡到口服喂养（奶瓶/母乳），尤其是妊娠 30 周出生的早产儿 (6)。这种困难常常导致住院时间延长、母婴团聚延迟以及医疗费用增加。经口喂养不良可能是由于口腔运动技能不成熟、吞咽紊乱或延迟、和/或吸吮、吞咽和呼吸不协调造成的。如果这些婴儿要安全喂养（即无误吸）并成功喂养（即能够通过口腔完成所有喂养且每日体重增加充足），后者至关重要。目前尚不清楚这种协调何时以及如何发展。不协调的临床症状通常包括氧饱和度降低、喂食期间呼吸暂停和心动过缓发作和/或咳嗽/窒息。我们最近开发了一种乳头装置，可以同时监测吸吮、吞咽和呼吸 (3-6)。通过这个工具，我们了解了婴儿吸吮的发展情况，并建立了评估婴儿吸吮技能水平的 5 阶段量表 (4)。从我们的研究中，我们注意到非营养性吸吮，例如使用奶嘴，在营养性吸吮之前成熟 (3)。与营养性吸吮相比，非营养性吸吮期间的吞咽量最少，我们推测吸吮技能在吸吮、吞咽和呼吸协调之前就成熟了。早产儿吞咽过程的成熟尚不清楚。由于吞咽混乱和延迟而导致的口腔喂养困难通常可以通过电视荧光镜检查来诊断。过去十年，对早产儿肺成熟的认识有了显着进展，早产儿存活率的提高就反映了这一点。然而，呼吸系统对经口喂养期间吞咽事件导致的气流定期中断的适应性尚不清楚。由于胸腔效应器不成熟，限制了上胸部的活动性，婴儿主要采用腹式呼吸 (1)。当吞咽频率增加时，这种限制会在多大程度上损害经口喂养期间的吞咽呼吸过程，目前尚不确定，正如经口喂养期间的情况一样。当奶瓶喂养时，婴儿通常处于相对仰卧的位置，类似于母乳喂养时所使用的位置。然而，患有口腔解剖异常（例如皮埃尔·罗宾综合征）或脑膜膨出等疾病的婴儿可以从俯卧位喂养中受益。一般来说，这种方法促进了它们在口服喂养期间的呼吸（8）。当对患病的早产儿和足月儿采用俯卧喂养时，也观察到了类似的益处 (7)。鉴于妊娠 30 周的早产儿在长期住院期间接受适合其不成熟解剖结构和生理功能发育的最小刺激，我们假设可以开发干预措施来弥补这种空白。由于口腔喂养困难可能是由吸吮、吞咽和/或呼吸引起的，因此本方案将评估两种旨在改善吞咽的干预措施，以及口腔喂养期间吞咽-呼吸的相互作用。我们正在根据 H# 7469/GCRC #523 方案研究改善吸吮的干预措施。