Contingent Feeding of Preterms to Reduce Hypoxemia

早产儿在奶瓶喂养期间会出现呼吸不规律，导致严重和频繁的低氧血症发作。反复的、短暂的低氧血症可能导致功能失调的口腔运动进食模式的发展，能量消耗增加和生长不良，以及神经损伤。提出的指导研究的目标是完善和测试针对住院早产儿的个性化，随机结构的喂养干预的有效性，旨在最大限度地减少瓶喂期间的低氧血症。喂养干预将从评估喂养开始，在此期间确定婴儿的喂养技巧和调节问题，并设计个体喂养方法。然后用标准方法喂养一次，用干预方法喂养一次。干预方法将包括适用于所有婴儿的策略，例如，让婴儿做好喂养准备，以及基于婴儿在喂养过程中出现的喂养困难类型的特定策略的偶然结构组成部分。此外，对于对干预反应不充分的婴儿，将探讨添加补充氧以尽量减少低氧血症的功效。该干预措施将与标准喂养方法进行比较，包括喂养开始时婴儿准备程度、喂养期间低氧血症事件的数量和严重程度，以及喂养后喂养耐受性的测量，使用多变量重复测量方差分析。研究者对K01的教育目标是：(a)扩展早产儿喂养呼吸生理学的知识；(b)扩大对早产儿吞咽发育的认识，以及在早产儿早期喂养过程中支持有效吞咽和呼吸协调的生理基础；(c)培养评估和测量吞咽模式、识别吞咽困难以及设计适当的吞咽失调干预措施的能力；(d)培养对喂养过程中疲劳行为指标进行编码和识别早期疲劳行为指标的技能，并制定有效的策略来预防或应对喂养过程中的疲劳；(e)培养设计和实施纵向干预研究和分析纵向数据的技能，为提交关于预防早产儿奶瓶喂养期间低氧血症的R01资助提案做准备。R01将提出在住院期间学习口服喂养的整个过程中测试干预措施，并检查生长、喂养技能发展和神经发育的结果。如果干预措施在改善这些结果方面是有效的，它将被教给护士和父母，他们是早产儿住院期间的主要喂养者。

Preterm infants experience breathing irregularities that lead to significant and frequent episodes of hypoxemia during bottle feeding. Recurrent, transient hypoxemia may contribute to the development of dysfunctional oral-motor feeding patterns, increased expenditure of energy and poor growth, and neurologic injury. The goals of the proposed mentored research are to refine and test the effectiveness of an individualized, contingently-structured feeding intervention for hospitalized preterm infants designed to minimize hypoxemia during bottle feeding. The feeding intervention will begin with an assessment feeding during which the infant's feeding skills and regulatory problems are identified and an individual approach to feeding is designed. Then the infant will be fed once by a standard approach and once by the intervention approach. The intervention approach will consist of strategies that are applied to all infants, for example, preparing the infant to feed, and a contingently-structured component with specific strategies based on the type of feeding difficulties presented by the infant during the feeding. In addition, the efficacy of the addition of supplemental oxygen for the minimization of hypoxemia will be explored with infants who do not respond adequately to the intervention. The intervention will be compared to the standard feeding approach on measures of infant readiness at the outset of the feeding, the number and severity of hypoxemic events during the feeding, and post-feeding measures of feeding tolerance using multivariate repeated measures ANOVA. The investigator's educational aims for the K01 are: (a) to expand knowledge of the respiratory physiology of feeding for preterm infants; (b) to expand knowledge of the development of swallowing in preterm infants and the physiologic bases for supporting effective swallowing and breathing coordination during early preterm infant feeding; (c) to develop competence in the assessment and measurement of swallowing patterns, the identification of swallowing difficulties, and the design of appropriate interventions for swallowing dysregulation; (d) to develop skill in coding behavioral indicators of fatigue during feeding and identifying early behavioral indicators of fatigue, and to develop effective strategies to prevent or respond to fatigue during feeding, (e) to develop skills in designing and implementing longitudinal intervention studies and analyzing longitudinal data, in preparation for submitting an R01 grant proposal on prevention of hypoxemia during preterm infant bottle feeding. The R01 will propose testing the intervention throughout the period of learning to oral feed during hospitalization and examining outcomes of growth, development of feeding skills, and neurodevelopment. If the intervention is effective in improving these outcomes, it will be taught to nurses and parents, who are the primary feeders of preterm infants during hospitalization.