Guiding Mothers to Co-Regulate Oral Feeding with Very Preterm Infants

描述(申请人提供)：拟议研究的目标是将针对极早产儿(VP)的创新和成功的护士分娩喂养干预扩展到由母亲分娩的干预措施。多达三分之一的VP婴儿(胎龄30周)会在儿童早期出现严重的喂养问题。当婴儿学习如何口服喂养时，困难就开始了。肺功能受损限制了VP婴儿持续协调呼吸和吞咽的能力，从而造成呼吸中断和呼吸道液体威胁的条件。这些反过来又会影响婴儿的吮吸质量和行为反应。因此，VP婴儿表现出耐力差和过早停止喂养，液体管理不善，有吸入风险，行为窘迫，以及不稳定的氧合和心率。他们的母亲应对这些挑战所需要的技能往往是出乎意料的，也比预期的更复杂。为了应对婴儿和母亲的喂养挑战，共同调节喂养干预(COREG)应运而生。COREG包括母亲提供体位支持的护士指导，婴儿喂养前的准备，基于婴儿准备的启动，在喂养和打嗝期间最大限度地减少运动，调节乳汁流动和呼吸机会，以及根据婴儿组织吸吮、吞咽和呼吸顺序的技能提供休息时间。干预的一个创新部分是使用音频训练器(C)，即放置在婴儿喉咙上的一个小麦克风，以使母亲对婴儿的呼吸和吞咽节奏敏感。这项拟议的研究符合NINR的目标，即开发生物行为干预策略，以优化弱势人群的健康。指导母亲提供干预的Coreg干预方案将得到完善，并将使用序贯队列设计进行试点研究。试点研究的具体目的是评估对母亲进行干预的可行性和可接受性，评估研究护士指导对母亲进行干预的能力，以及数据收集程序的可行性。此外，还将确定干预对母亲喂养反应(共同调节喂养策略)、婴儿喂养调节(行为组织、液体管理、呼吸功、生理稳定性)和婴儿喂养结果(喂养技能发展、生长和住院时间)的影响程度。我们将探讨母亲的特征(教育、年龄、喂养经验、对孩子健康的担忧、疾病相关的压力和抑郁症状)和婴儿的特征(胎龄、肺部疾病的严重程度和神经发育风险)对干预效果的贡献。数据分析将包括定性和描述性分析以及线性回归和线性混合建模。拟议的研究将为指导母亲在新生儿护理中喂养最难喂养的婴儿提供必要的证据基础。一旦经过全面测试，Coreg凭借其音频训练器(C)的使用，可以整合到当前的新生儿护理环境中。 公共卫生相关性：早产儿的护理费用占所有婴儿护理费用的24%；每年在他们的护理上花费约30亿美元。由于喂养问题而延长住院时间是很常见的，约33%的人在出院后会出现严重的喂养问题。该项目使用一种新的创新技术和护士的指导，帮助早产儿的母亲了解他们婴儿的喂养困难，并选择有效的喂养策略，帮助他们的婴儿在喂养过程中保持冷静，更安全地喂养，更早地发展喂养技能，促进生长，并使婴儿更快地出院回家。这项拟议的研究将为指导母亲在新生儿护理中喂养最难喂养的婴儿提供必要的证据基础，并推动目前极早产儿基于线索的新生儿喂养护理的实践。

DESCRIPTION (provided by applicant): The goal of the proposed research is to extend an innovative and successful nurse-delivered feeding intervention for very preterm infants (VP) to one delivered by mothers. Up to one-third of VP infants (d30 weeks gestational age) will develop significant feeding problems during early childhood. Difficulties begin when the infant is learning how to feed orally. Impaired pulmonary functioning limits the ability of the VP infant to consistently coordinate breathing and swallowing, thus creating the conditions for disrupted breathing and fluid threats to the airway. These in turn, affect the infant's quality of sucking and behavioral responses. As a consequence, VP infants demonstrate poor endurance and early cessation of feeding, poor fluid management with aspiration risk, periods of behavioral distress, and unstable oxygenation and heart rate. The skills their mothers need to deal with these challenges are often unexpected and more complex than anticipated. To address feeding challenges for both infants and mothers, the Co-Regulated Feeding Intervention (CoReg) was developed. CoReg includes nurse guidance of the mother to provide postural support, preparation of the infant pre-feeding, initiation based on infant readiness, minimization of movement during feeding and burping, regulation of milk flow and breathing opportunities, and providing rest periods in response to infant skill at organizing the suck, swallow, breathe sequence. An innovative component of the intervention is use of the audio trainer(c), a small microphone placed over the infant's larynx to sensitize the mother to the infant's breathing and swallowing rhythms. The proposed study meets NINR's goal to develop biobehavioral intervention strategies to optimize health of vulnerable populations. The CoReg intervention protocol for guiding mothers to provide the intervention will be refined and a pilot study will be conducted using a sequential cohort design. The specific aims of the pilot study are to evaluate the feasibility and acceptability of the intervention for mothers, the research nurse-guide's ability to execute the intervention with mothers, and the feasibility of the data collection procedures. In addition, the magnitude of the effect of the intervention on maternal feeding response (co-regulation feeding strategies), infant feeding regulation (behavioral organization, fluid management, work of breathing, physiologic stability), and infant feeding outcomes (feeding skill development, growth, and length of hospitalization) will be determined. We will explore the contributions of maternal characteristics (education, age, experience in feeding, worry about the child's health, illness-related stress, and depressive symptoms) and infant characteristics (gestational age, severity of lung disease, and neurodevelopment risk) on the efficacy of the intervention. Data analyses will include qualitative and descriptive analyses and linear regression and linear mixed modeling. The proposed study will provide a needed evidence base for guiding mothers to feed the most difficult-to-feed infants in neonatal care. Once fully tested, CoReg, with its use of the audio trainer(c), can be integrated into current neonatal care settings. PUBLIC HEALTH RELEVANCE: Cost of care for very preterm infants represents 24% of all infant care costs; about $3 billion is spent on their care each year. Prolonged hospitalization due to feeding problems is common and about 33% will develop significant feeding problems after discharge. This project uses a new innovative technology and the guidance of a nurse to assist mothers of very preterm infants learn about their infant's feeding difficulties and select effective feeding strategies that will help their infants remain calm during feeding, feed more safely, develop feeding skills earlier, improve growth, and allow the infant to be discharged to their home sooner. The proposed research will provide a needed evidence base for guiding mothers to feed the most difficult-to-feed infants in neonatal care and advance the current practice of cue-based neonatal feeding care for very preterm infants.