Feeding the Medically Fragile Infant: Effects of Feeding Method and Milk Flow on Physiology and Behavior

Pados, Britt

Feeding the Medically Fragile Infant: Effects of Feeding Method and Milk Flow on Physiology and Behavior

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March 19, 2019

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Pados, Britt
- Affiliation: School of Nursing

Abstract

Background: Oral feeding is a challenge for medically fragile infants, particularly those born preterm and with hypoplastic left heart syndrome (HLHS). Rate of milk flow from the bottle nipple affects physiologic stability during feeding in preterm infants, but little data is available on the flow rates of nipples used for feeding hospitalized infants. Changes in milk flow rate likely also affect physiologic stability of infants with HLHS during feeding, however no studies have evaluated responses of infant with HLHS to different feeding methods. Feeding interventions aim to reduce feeding stress in fragile infants to promote growth. Outcome measures that sensitively measure stress are needed. Purpose: This dissertation is composed of three studies. Chapter two presents milk flow rates of nipples used for feeding hospitalized infants. Chapter three examines the physiologic and behavioral responses of an infant with HLHS to variations in milk flow rate. Chapter four evaluates heart rate variability (HRV) as a feeding intervention outcome measure in the preterm infant. Methods: In chapter two, milk flow rates of ten each of 29 nipple types (n=290) were tested using a breast pump. In chapter three, a single-subject with HLHS was evaluated during feeding with either a slow-flow or standard-flow nipple. In chapter four, a secondary analysis of heart rate variability indices was conducted from a test of a co-regulated approach to feeding preterm infants (n=14). Results: In chapter two, flow rates varied widely between nipple types. Chapter three found that oral feeding was distressing for an infant with HLHS, regardless of flow condition. In chapter four, only SD12, a non-linear index of HRV, was found to significantly differentiate between feeding methods. Conclusions: Data on milk flow rates from nipples used in hospitals will guide clinicians in nipple selection. Information on flow rates of nipples used after discharge is needed. Further study of how infants with HLHS respond to oral feeding is necessary to identify supportive strategies. Research is also warranted to further evaluate the use of HRV, particularly non-linear indices, during feeding interventions.

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