Oral Feeding in Infants

描述（由申请人提供）：由于医学进步导致早产儿存活率增加，早产儿经口喂养困难已成为儿科医生的主要关注点。早产儿的出院时间往往因无法脱离管饲而延迟。人们也越来越认识到，喂养障碍可能会长期存在于这一婴儿群体中。经口喂养的诊断和管理在很大程度上是经验性的，因为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在以惊人的速度上升。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疗效，临床医生对其益处进行了辩论，因为任何随后的进展可能只是正常成熟的结果。在本提案的第一部分，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。我们将研究旨在改善吸吮和吞咽的2个运动计划和旨在确定奶瓶喂养期间最佳喂养位置的2个直接支持计划对经口喂养的影响。还将评价2个运动计划沿着以及确定的最佳喂食位置的组合效果。这些干预措施的有效性将通过监测婴儿的经口喂养表现进行临床评估，并通过评估特定的经口喂养技能进行功能评估。我们的主要结果将是从引入到独立口服喂养的天数。经口喂养性能的次要指标将包括分娩住院时间、总乳汁转移、乳汁转移率和心肺功能损害的发生率，即氧饱和度下降、呼吸暂停、心动过缓、咳嗽/窒息和/或误吸。对特定经口进食技能的评估将包括吸吮的发育阶段、吸吮幅度、吸吮-吞咽和吞咽-呼吸相互作用。我们预计，拟议的干预措施将改善所有上述结果与联合治疗提供更大的好处。在本建议的第二部分中，我们假设这些干预措施在婴儿期早期实施将降低长期喂养问题的发生率，这是由于这些婴儿在分娩住院期间获得了改善的经口喂养技能。主要结局是儿科胃肠病学家和/或喂养障碍诊所随访喂养问题的必要性。次要结局将是在3、6、12、18和24个月矫正年龄时达到特定喂养里程碑。

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.