Feeding outcomes in very preterm infants: preliminary effects of positioning

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  • March 22, 2019
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  • Park, Jinhee
    • Affiliation: School of Nursing
Abstract
  • Background/Significance: Oral feeding emerges during a dynamic process of the organization of inputs from subsystems within the infant and the environment. Very preterm infants (VP, ≤ 30 weeks gestational age) are at risk for impaired lung function, which significantly limits their organizational capacity and contributes to feeding difficulties. A head-elevated side-lying (HEL) position has recently been proposed as a strategy that may improve oral feeding in VP infants by supporting breathing during feeding. Purpose: The primary purpose of this study is to test the preliminary effects of the HEL position on the physiologic stability and feeding performance of VP infants when bottle-fed, compared to the head-elevated supine (HES) position. In addition, methods for measuring changes in physiologic stability across the feeding period are examined. Methods: Using a within-subject cross-over design, six VP infants were bottle-fed twice on one day, in both the HEL and HES positions. The following variables were measured before and/or during feeding: physiological stability (heart rate [HR], oxygen saturation [SpO2], respiratory characteristics) and feeding performance (overall milk transfer, proficiency, efficiency, and duration of feeding). Three methods were used to examine changes in physiologic stability across the feeding period. Results: Compared to the HES position, VP infants fed in the HEL position show significantly less variation in HR, less severe and fewer decreases in HR, shorter and more regular intervals between breaths, breathing frequency that is closer to the pre-feeding state, and more variation in breath duration. VP infants also demonstrate a more stable HR over time, especially during the early minutes of feeding, and improved regulated breathing over time by demonstrating shorter and more regular intervals between breaths and more variation in breath duration across the feeding period. In addition, the method using the first 6 minutes of bottle-in period is suggested as the most effective for examining significant changes in physiologic stability over time. No significant findings for SpO2 and feeding performance are found. Conclusions: The findings indicate that the HEL position may be a feeding strategy to support better regulation of breathing during feeding that allows VP infants to better maintain physiologic stability throughout the feeding.
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  • ... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the School of Nursing.
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  • Thoyre, Suzanne
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