INTERVENTIONS FOR THE ENHANCEMENT OF ORAL FEEDING IN PRETERM INFANTS

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目及 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 评价以下2种干预措施对胎龄< 30周早产儿达到独立经口喂养时间的影响： 1. 吞咽练习的功效 2. 俯卧位在经口喂养中的有效性 众所周知，早产儿很难从管饲过渡到经口喂养（奶瓶/母乳），特别是那些出生时妊娠< 30周的早产儿（6）。这种困难往往导致住院时间延长、母婴团聚延迟和医疗费用增加。口腔喂养不良可能是由于口腔运动技能不成熟，吞咽混乱或延迟，和/或吸吮，吞咽和呼吸不协调。如果这些婴儿要安全喂养，后者是必不可少的，即，没有愿望，并且成功地，即，能够以足够的日增重完成所有的口饲。不了解这种协调何时以及如何发展。不协调的临床体征通常包括氧饱和度下降、进食期间呼吸暂停和心动过缓发作和/或咳嗽/窒息。 我们最近开发了一种乳头装置，可以同时监测吮吸、吞咽和呼吸（3-6）。有了这个工具，我们已经了解了婴儿吸吮的发展，并建立了一个5阶段的规模，评估婴儿吸吮技能的水平（4）。从我们的研究中，我们注意到非营养性吸吮，例如，在奶嘴上，在营养性吸吮之前成熟（3）。由于与营养性吸吮相比，非营养性吸吮时吞咽的影响最小，因此我们推测吸吮技能在吸吮、吞咽和呼吸协调之前就成熟了。 早产儿吞咽过程的成熟还不清楚。由吞咽紊乱和延迟引起的经口进食困难通常通过荧光透视诊断。早产儿肺成熟的知识在过去的十年中取得了显着进展，这反映在早产儿群体的生存率增加。然而，呼吸系统对经口进食期间吞咽事件导致的气流定期中断的适应性尚不清楚。由于胸廓效应器的不成熟限制了上胸部的活动，婴儿主要是腹式呼吸。目前还不确定这种限制在多大程度上可能会损害吞咽呼吸过程中，当吞咽频率增加，因为它是在口服喂养的情况下，口服喂养。 奶瓶喂养时，婴儿通常保持相对仰卧的姿势，类似于母乳喂养时使用的姿势。然而，患有口腔解剖异常的婴儿，例如，皮埃尔·罗宾综合征，或脑膜膨出等疾病，都可以从俯卧位进食中获益。一般来说，这种方法在口服期间促进了它们的呼吸（8）。 当患病早产儿和足月婴儿使用俯卧喂养时，也观察到了类似的益处（7）。 鉴于早产儿<30周妊娠，在他们的长期住院期间，接受最小的刺激适合其不成熟的解剖结构和生理功能的发展，我们假设，干预措施可以开发，以弥补这种空白。由于吸吮、吞咽和/或呼吸可能导致经口进食困难，本方案将评价2种旨在改善吞咽的干预措施以及经口进食期间吞咽-呼吸的相互作用。根据我们的方案H# 7469/GCRC #523，正在研究改善吸吮的干预措施。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. To evaluate the effect of the following 2 interventions on time to attainment of independent oral feeding in preterm infants born < 30 weeks gestation: 1. Efficacy of a swallowing exercise 2. Efficacy of the prone position during oral feeding It is well recognized that preterm infants have difficulty transitioning from tube to oral feeding (bottle/breast), particularly those born < 30 weeks gestation (6). Such difficulty frequently leads to prolonged hospitalization, delayed mother-infant reunion and increased medical cost. Poor oral feeding may result from immature oral-motor skills, disorganized or delayed swallowing, and/or in-coordination of sucking, swallowing, and respiration. The latter is essential if these infants are to feed safely, i.e., with no aspiration, and successfully, i.e., capable of finishing all their feedings by mouth with adequate daily weight gain. There is no understanding of when and how such coordination develops. Clinical signs of in-coordination typically include oxygen desaturation, episodes of apnea and bradycardia during feeding, and/or coughing/choking. We have recently developed a nipple device that allows for the simultaneous monitoring of sucking, swallowing, and breathing (3-6). With this tool, we have gained an understanding of the development of sucking in infants and established a 5-stage scale that assesses the level of infant sucking skills (4). From our studies, we have noted that non-nutritive sucking, e.g., on a pacifier, matures before nutritive sucking (3). Insofar as swallowing is minimal during non-nutritive as compared to nutritive sucking, we speculate that sucking skills mature before sucking, swallowing, and breathing are coordinated. The maturation of the swallowing process in preterm infants is not well understood. Oral feeding difficulties resulting from disorganized and delayed swallow usually are diagnosed by videofluoroscopy. Knowledge of pulmonary maturation in preterm infants has progressed significantly over the last decade as reflected by the increased survival of the preterm population. However, the adaptability of the respiratory system to regular interruption of airflow resulting from swallowing events during oral feeding is unclear. Infants are primarily abdominal breathers as a result of the immaturity of the rib cage effectors that restrict the mobility of the upper chest (1). It is uncertain to what extent such limitation may impair the swallow-breathe process during oral feeding when swallowing frequency is increased as it is the case during oral feeding. When bottle feeding, infants are held usually in a relatively supine position similar to that used when they are breastfeeding. However, infants with anatomical oral anomalies, e.g., Pierre Robin syndrome, or conditions such as meningocele have benefited from being fed in a prone position. In general, this approach has facilitated their respiration during oral feeding (8). Similar benefits have been observed when prone feeding was used for sick preterm and fullterm infants (7). Given that preterm infants <30 weeks gestation, during their prolonged hospitalization, receive minimal stimulation appropriate for the development of their immature anatomical structures and physiological functions, we hypothesize that interventions can be developed to compensate for such void. Inasmuch as oral feeding difficulty can arise from sucking, swallowing, and/or respiration, the present protocol will evaluate 2 interventions aimed at ameliorating swallowing, and the interaction of swallow-breathe during oral feeding. Interventions to improve sucking are being investigated under our protocol H# 7469/GCRC #523.