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

项目摘要/摘要 早产儿(出生时的胎龄为37周)仅占美国活产儿的10%，然而 占医院婴儿护理总费用的43%。口腔喂养技能发展的延迟 早产儿是延长住院时间的主要原因之一，这增加了护理和医疗费用 推迟了与家人的团聚。早产儿经常因其发育不成熟而出现口腔喂养困难 神经学、心肺、胃肠和口腔运动系统。进食期间反复出现的痛苦会改变 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% 的早产儿会经历持续到童年的喂养困难，这对长期的 足月生长和神经发育。传统上，半抬高仰卧位(以下简称 当早产儿用奶瓶喂养时，已在新生儿重症监护室使用仰卧位。超过了 在过去的十年里，半高式侧卧姿势(以下简称侧卧姿势) 建议作为提高早产儿口腔喂养技能和减少不良事件的潜在策略 但支持侧卧姿势作为喂食干预的证据的质量 早期的、新兴的阶段。由于证据有限，临床医生对侧卧姿势的使用不一致， 使已经经历喂养困难的婴儿暴露在不可预测和可变的喂养位置，这 会进一步使它们的进食技能发展复杂化。进一步的研究是必要的，以提供更明确的结论 关于侧卧姿势是否能提高早产儿喂养技能并产生所需营养的知识 为了提高信息的精确度，对此进行了干预应用。为了解决这一差距，我们提出了一项单一的- 中心随机交叉试验，以透彻了解该药的生物行为疗效。 卧位与仰卧位对早产儿过渡时生理和行为反应的影响 从管子到全口喂养，并确定与干预反应相关的婴儿特征。这个 具体目的是：1)比较奶瓶侧卧喂养早产儿的生理反应 2)比较早产儿在侧卧与卧位喂奶时的行为反应。 仰卧位；以及3)确定干预反应的调节因素，评估婴儿性别、成熟度和 共同的病症。生理反应将包括连续测量心率、呼吸频率、 血氧饱和度和自主神经系统调节(心率变异性和内脏-脑 氧比)在喂食之前、期间和之后。行为反应将包括观察婴儿的 吸吮和呼吸波形数据及摄食录像的摄食行为分析 (吸气-呼吸协调和早期喂养技能评估工具)。数据将使用线性混合模型进行分析 效果模型。这项研究的结果将为指导循证实践提供至关重要的知识 支持和加强早产儿的口服喂养，同时也为关键的疗效试验提供必要的数据。

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.