Oral Feeding in Infants

描述(申请人提供)：随着医学进步导致早产儿存活率增加，早产儿的口腔喂养困难已成为新生儿科医生主要关注的问题。早产儿的医院出院通常会因为他们无法摆脱管状喂养而延迟。人们也越来越意识到，喂养障碍可能会在这群婴儿中长期存在。口腔喂养的诊断和管理在很大程度上是经验性的，因为造成这种困难的原因尚不清楚。这一医疗困境给社会和家庭带来的社会经济负担正在以惊人的速度上升。喂养治疗师通常会使用一些干预措施来帮助这些婴儿。然而，由于缺乏支持其有效性的循证数据，临床医生对其益处存在争议，因为随后的任何进展可能只是正常成熟的结果。在这项建议的第一部分，我们假设在生命早期提供有效的干预将加快早产儿达到独立口服喂养的时间，并将提高特定的口腔喂养技能。我们将调查两个旨在改善吸吮和吞咽的锻炼方案和两个旨在确定奶瓶喂养时最佳喂养位置的直接支持方案对口腔喂养的影响。还将评估两种运动方案的综合效果以及确定的最佳喂养位置。这些干预措施的效果将在临床上通过监测婴儿的口腔喂养表现来衡量，并在功能上通过评估特定的口腔喂养技能来衡量。我们的主要成果将是从引入到独立口服喂养的几天。衡量口服喂养效果的次要指标将包括产后住院时间、总乳汁转移率、乳汁转移率以及心肺功能损害的发生情况，如氧减饱和、呼吸暂停、心动过缓、咳嗽/窒息和/或吸入。具体的口腔喂养技能评估将包括吸吮的发育阶段、吸吮幅度、吸吮-吞咽和燕子-呼吸的相互作用。我们预计，拟议的干预措施将改善所有上述结果，综合治疗将提供更大的好处。在这项建议的第二部分，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更好的口腔喂养技能。主要结果将是儿科胃肠病医生和/或喂养障碍诊所必须对喂养问题进行跟踪。次要结果是在校正年龄3、6、12、18和24个月时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.