| BackgroundSignificant advances in medical management of preterm infants who are actually ill have enabled an increase number of premature infants to survive. Clinical concerns are turning toward how to improve the quality of life for infants who survive. Successful oral feeding is considered the most complex task of infancy. Management of oral feedings in preterm infants is a key aspect of hospital care. However, comprehensive objective measurement of preterm infants'feeding readiness in the NICU does not yet exist. Consequently, already vulnerable infants are subject to a trial-and-error approach to this most complex and critical acticvity, increasing stress and detract from success. Few reported studies have examined the complex relationships among the neurologic, physiologic, and behavioral components of feeding readiness or the relathionship of feeding readiness and outcomes in preterm infants. Better understanding of feeding readiness and its relationship to feeding outcomes will provide useful information for the management for oral feeding of preterm infants. Identification of readiness criteria associated with the greatest likelihood of successful feeding can provide the basis for clinical guidelines that should reduce adverse physiological responses to oral feedings and result in a smoother, less traumatic, and potentially shorter transition time to all oral feeding.PurposeThe purpose of this study was to describe feeding milestones and feeding performa-nce, and to examine various factors related to feeding readines in preterm infants.Research DesignThis was an observational prospective-cohort study using a convenience sample of 70 preterm infants born less than 34 weeks gestational age. Data were collected from neonatal intensive unit of PUMCH between January 2009 and April 2010. This study examined feeding readiness and feeding outcomes at admission, initiation of oral feeding, and full feeding. NOMAS, NMI, and ABSS applied to assess feeding readiness. SPSS 18.0 statistical package was used for data analysis.Results1. Feeding milestoneA total of 70 preterm infants were studied in initiation of oral feeding. The postmenstrul age (PMA) at initiation of oral feeding ranged from 30.0 to 37.43 weeks (M±SD=33.34±1.26 weeks). Body weight when oral feeding was first introduced ranged from 1150 to 2250gm (M±SD=1763.24±226.35gm). Significant differences found between different birth weight groups and severity of illness groups for PMA at initiation of oral feeding. SGA infants had significant delay in initiaton of oral feeding(p<0.05).A total of 58 preterm infants were studied in milestone of full feeding. The PMA at full feeding ranged from 31.14 to 37.86 weeks (M±SD=34.90±1.37 weeks). Body weight achieving full feeding ranged from 1380 to 2420gm (M±SD= 1996.38±227.43 gm). Significant differences in PMA at full feeding were identified between different birth weight groups and severity of illness groups (p<0.05). SGA infants had significant delay in age at full feeding(p<0.05).2. Feeding performanceThe medians of efficiency, consumed, and proficiency at initiation of oral feeding were 3.00ml/min(IQR 2.00-4.00),64.85(IQR 47.00-100.00),60.00%(IQR 41.92-100.00), respectively. High-risk Infants and very low birth weight infants demonstrated poor feeding performance.Fourty-four preterm infants were classified as poor feeders. Most poor feeders were very low birth weight infants. Fifty-five infants needed feeding support and fourty-nine infants stopped feeding because of fatigue, distress, and sucking-swallowing disorders. Infants born less than 32 weeks gestational age and with birth weight less than 1500gm needed more feeding support at initiation of oral feeding.3. Factors related with feeding readinessCox propotional hazard model was performed to examine factors related with feeding milestones showed that birth weight and gestational age were significant predictors of PMA at initiation of oral feeding. There was no significant relationship between indictors of feeding readiness with PMA at full feeding. A logistic regression analysis applied to determine factors affecting feeding performance indicated that external pacing, oral motor skills (in normal and disorganized categories), and feeding readiness behaviors had statistically significant impact on feeding performance.Conclusions1,Most preterm infants born less than 34 weeks gestational age initiated oral feeding before 34 weeks PMA and achived full feeding before 35 weeks PMA. Infants in different gestational age groups attained feeding milestones by similar PMA.2,Most infants demonstrated poor feeding performance and needed feeding support at initiation of oral feeding. Early microamount oral feeding may be beneficial to transition from gavage to oral feeding.3,High-risk infants and infants with birth weight less than 1500gm had significant feeding delays with respect to initiation and progression to oral feeding, and demonstrated poor feeding performance. Feeding strategies were needed to support infants with birth weight less than 1500 gm and high-risk infants.4,Multiple factors play a role in determining feeding readiness. Arbitrary age (34 weeks gestational age) and weight criteria (1500gmor 1800gm) should not be the only indicators for feeding readiness. Assessment of feeding readiness may be individualized for preterm infants. Oral motor skills, severity of illness, and feeding readiness behaviors are important indicators of feeding readiness.
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