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

描述（由申请人提供）：拟议研究的目标是将一种创新和成功的针对极早产儿（VP）的护士喂养干预扩展到由母亲分娩的婴儿。高达三分之一的VP婴儿（30周孕龄）在幼儿期会出现明显的喂养问题。困难开始于婴儿学习如何口头喂养。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气道液体威胁的条件。这些反过来又会影响婴儿吮吸的质量和行为反应。因此，VP婴儿表现出较差的耐力和早期停止喂养，较差的液体管理，有误吸风险，行为困扰期，氧合和心率不稳定。她们的母亲应对这些挑战所需的技能往往出乎意料，比预期的要复杂得多。为了解决婴儿和母亲的喂养挑战，开发了共同调节喂养干预（CoReg）。CoReg包括护士指导母亲提供体位支持、婴儿喂食前的准备、基于婴儿准备的开始、喂奶和打嗝时运动的最小化、奶流和呼吸机会的调节，以及根据婴儿组织吸吮、吞咽、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)，将一个小麦克风放置在婴儿的喉部，使母亲对婴儿的呼吸和吞咽节奏敏感。提出的研究符合NINR的目标，即制定生物行为干预策略，以优化弱势群体的健康。指导母亲提供干预的CoReg干预方案将得到完善，并将采用顺序队列设计进行一项试点研究。试点研究的具体目的是评估干预对母亲的可行性和可接受性，研究护师与母亲一起执行干预的能力，以及数据收集程序的可行性。此外，还将确定干预对产妇喂养反应（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。我们将探讨母亲特征（受教育程度、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）对干预效果的影响。数据分析将包括定性和描述性分析、线性回归和线性混合建模。该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及其音频培训器(c)就可以整合到当前的新生儿护理环境中。

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.