Oral Feeding in Infants

描述（由申请人提供）：随着医学的进步，早产儿的口服喂养困难已成为新生儿学家关注的主要问题，这些婴儿的存活率有所提高。早产儿的出院往往被推迟，因为他们无法从管饲断奶。人们也越来越认识到，喂养障碍可能会长期存在于这群婴儿中。口腔喂养的诊断和管理在很大程度上是经验性的，因为造成这些困难的原因尚不清楚。这种医疗困境给社会和家庭带来的社会经济负担正以惊人的速度增加。喂养治疗师通常使用一些干预措施来帮助这些婴儿。然而，由于缺乏基于证据的数据来支持其有效性，临床医生对其益处存在争议，因为任何随后的进展可能只是正常成熟的结果。在本建议的第一部分中，我们假设在生命早期提供有效的干预措施将加速早产儿达到独立口服喂养的时间，并将提高特定的口服喂养技能。我们将研究两种旨在改善吸吮和吞咽的运动方案和两种旨在确定奶瓶喂养时最佳喂养姿势的直接支持方案对口服喂养的影响。两种运动方案的综合效果以及确定的最佳喂食位置也将被评估。这些干预措施的效果将通过监测婴儿的口腔喂养表现和通过评估特定的口腔喂养技巧来功能性地进行临床测量。我们的主要结果将是引入独立口服喂养的天数。口腔喂养表现的次要指标包括出生住院时间、总泌乳量、泌乳率和心肺功能损害的发生，即氧饱和度过低、呼吸暂停、心动过缓、咳嗽/窒息和/或误吸。具体的口腔喂养技能的评估将包括吮吸的发育阶段、吮吸幅度、吮吸-吞咽和吞咽-呼吸的相互作用。我们期望建议的干预措施将改善上述所有结果，联合治疗提供更大的益处。在本建议的第二部分，我们假设在婴儿早期实施这些干预措施将减少长期喂养问题的发生率，因为这些婴儿在出生住院期间获得了改善的口腔喂养技巧。主要结果将是由儿科胃肠病学家和/或喂养障碍诊所跟踪喂养问题的必要性。次要结果将是在3、6、12、18和24月龄达到特定的喂养里程碑。

DESCRIPTION (provided by applicant): Oral feeding difficulties in preterm infants have become a major concern for neonatologists as medical advances have led to an increased survival of these infants. Hospital discharge of preterm infants often is delayed as a result of their inability to wean from tube feeding. There is also an increasing awareness that feeding impediments may persist on a long-term basis in this population of infants. Diagnoses and management of oral feedings are largely empiric because the reasons for such difficulties are unclear. The socioeconomic burden to society and family due to this medical predicament is rising at an alarming rate. Feeding therapists routinely use a number of interventions to assist these infants. However, due to a lack of evidence-based data to support their efficacy, clinicians debate their benefit as any ensuing progress may be simply the result of normal maturation. In the first part of this proposal, we hypothesize that efficacious interventions offered early on in life will accelerate the time at which preterm infants reach independent oral feeding and will improve specific oral feeding skills. We will investigate the effect on oral feeding of 2 exercise programs aimed at improving sucking and swallowing and 2 direct support programs aimed at identifying the optimal feeding position during bottle feeding. The combined effect of the 2 exercise programs along with the optimal feeding position identified will be evaluated as well. The efficacy of these interventions will be measured clinically by monitoring infant's oral feeding performance and functionally by assessing specific oral feeding skills. Our primary outcome will be days from introduction to independent oral feeding. Secondary measures of oral feeding performance will include duration of birthstay hospitalization, overall milk transfer, rate of milk transfer, and occurrence of cardiopulmonary compromises, i.e. oxygen desaturation, apnea, bradycardia, coughing/choking, and/or aspiration. Assessment of the specific oral feeding skills will include the developmental stage of sucking, sucking amplitude, suck-swallow and swallow-respiration interactions. We expect that the proposed interventions will improve all the above outcomes with the combined therapy providing greater benefits. In the second part of this proposal, we hypothesize that these interventions administered early on in infancy will decrease the incidence of long-term feeding problems as a result of the improved oral feeding skills these infants acquired during their birthstay hospitalization. The primary outcome will be the necessity of being followed for feeding problems by pediatric gastroenterologists and/or feeding disorder clinics. The secondary outcomes will be attainment of specific feeding milestones at 3, 6, 12, 18, and 24 months corrected age.