Biobehavioral Efficacy of the Semi-Elevated Side-Lying Position for Feeding Preterm Infants

项目总结/摘要 早产儿（出生时胎龄≤ 37周）仅占美国活产婴儿的10%，但 占医院婴儿护理总成本的43%。儿童口服喂养技能发展迟缓 早产儿是住院时间延长的主要原因之一，这增加了护理费用， 延迟与家人团聚。早产儿经常由于其发育不成熟而经历经口喂养困难。 神经、心肺、胃肠和口腔运动系统。进食改变期间复发性窘迫 发育中的大脑中的感觉运动通路，导致长期的，不适应的进食行为。高达41% 的早产儿经历喂养困难，这种困难一直持续到童年，这对长期的 长期生长和神经发育。传统上，半抬高仰卧位（以下简称 仰卧位）已经用于新生儿重症监护室，当早产儿用奶瓶喂养时。来 在过去的十年中，半抬高的侧卧位（以下简称侧卧位）已经被 提出作为一种潜在的策略，以提高早产儿的口服喂养技能，减少不良事件 在喂养过程中，但支持侧卧位作为喂养干预措施的证据质量处于 早期的，紧急阶段。由于证据有限，临床医生对侧卧位的使用并不一致， 使已经经历喂养挑战的婴儿暴露于不可预测和可变的喂养位置， 会使它们进食技能的发展更加复杂。有必要进行更多的研究，以提供更明确的 了解侧卧位是否能提高早产儿的喂养技能， 信息，以提高这种干预的应用精度。为了弥补这一差距，我们提出了一个单一的- 中心随机交叉试验，以全面了解侧- 仰卧位与卧位对早产儿从早产儿的生理和行为反应的影响 管完全口服喂养，并确定与干预反应相关的婴儿特征。的 具体的目的是：1）比较早产儿在侧卧位奶瓶喂养时的生理反应， vs.仰卧位; 2）比较早产儿侧卧与仰卧位奶瓶喂养时的行为反应。 仰卧位; 3）确定干预反应的调节因子，评估婴儿性别、成熟度水平， 共病生理反应将包括心率、呼吸频率、 氧饱和度和自主神经系统调节（心率变异性和内脏-脑 氧比）。行为反应将包括观察婴儿的 通过对吸吮和呼吸波形数据的微观分析以及喂食录像， （呼吸协调和早期喂养技能评估工具）。将使用线性混合模型分析数据。 效应模型这项研究的结果将提供重要的知识，以指导循证实践， 支持和加强早产儿的经口喂养，同时也为关键疗效试验提供所需数据。

Project Summary/Abstract Preterm infants (≤ 37 weeks gestational age at birth) only represent 10% of live births in the United States, yet account for 43% of the total cost of infant care in hospitals. Delays in the development of oral feeding skills in preterm infants are one of the main reasons for prolonged hospitalization, which increases the cost of care and delays unification with family. Preterm infants often experience oral feeding difficulties due to immaturity of their neurologic, cardiorespiratory, gastrointestinal, and oral-motor systems. Recurrent distress during feeding alters sensory-motor pathways in the developing brain, leading to long-term, maladapted feeding behaviors. Up to 41% of preterm infants experience feeding difficulties that continue into childhood, which has implications for long- term growth and neurodevelopment. Traditionally, the semi-elevated supine position (hereafter referred to as supine position) has been used in neonatal intensive care units when preterm infants are bottle-fed. Over the past decade, the semi-elevated side-lying position (hereafter referred to as side-lying position) has been proposed as a potential strategy to improve preterm infants’ oral feeding skills and to reduce adverse events during feeding, but the quality of the evidence to support the side-lying position as a feeding intervention is in an early, emergent stage. Due to limited evidence, clinicians are inconsistent in their use of the side-lying position, exposing infants already experiencing feeding challenges to unpredictable and variable feeding positions, which can further complicate their feeding skill development. Additional research is necessary to provide more definitive knowledge on whether the side-lying position improves preterm infants’ feeding skills and to generate needed information to enhance precision to the application of this intervention. To address this gap, we propose a single- center randomized cross-over trial to gain a thorough understanding of the biobehavioral efficacy of the side- lying vs. the supine position on physiologic and behavioral responses of preterm infants while transitioning from tube to full oral feeding, and to identify infant characteristics associated with the intervention response. The specific aims are to: 1) compare physiologic responses in preterm infants while bottle feeding in the side-lying vs. supine position; 2) compare behavioral responses in preterm infants while bottle feeding in the side-lying vs. supine position; and 3) identify moderators of intervention response, evaluating infant sex, maturity level, and co-morbid conditions. Physiologic responses will include continuous measures of heart rate, respiratory rate, oxygen saturation, and autonomic nervous system regulation (heart rate variability and splanchnic-cerebral oxygen ratio) prior to, during and after feeding. Behavioral responses will include observations of the infant’s feeding behavior through microanalysis of the sucking and breathing waveform data and videotaped feedings (Suck-breathe coordination and Early Feeding Skills assessment tool). Data will be analyzed using a linear mixed effects model. The results of this study will provide vital knowledge to guide evidence-based practices that support and enhance oral feeding in preterm infants while also providing needed data for a pivotal efficacy trial.