Molly Grabill, OTD, OTR/L, is Occupational Therapist, Department of Therapy Services, St. Louis Children's Hospital, St. Louis, MO.
Joan Smith, PhD, RN, NNP-BC, FAAN, is Director, Department of Quality Safety, and Practice Excellence, St. Louis Children's Hospital, St. Louis, MO.
Am J Occup Ther. 2023 May 1;77(3). doi: 10.5014/ajot.2023.050123.
Feeding difficulties are common among preterm infants during neonatal intensive care unit (NICU) hospitalization. Although most preterm infants achieve full oral feeding by term-equivalent age, whether feeding difficulties persist despite the infant taking full volume and whether these difficulties may relate to other neurobehavioral challenges remain unclear.
To identify the prevalence of feeding problems among preterm infants and the relationships between infant feeding behaviors and neurobehavior at term-equivalent age.
Cohort study.
Level 4 NICU with 85 beds.
Thirty-nine very preterm infants born ≤32 wk gestation (range = 22-32 wk). Exclusion criteria were congenital anomalies, >32 wk gestation at birth, and lack of feeding or neurobehavioral assessment at term-equivalent age.
Standardized feeding assessments using the Neonatal Eating Outcome Assessment and standardized neurobehavioral evaluation using the NICU Network Neurobehavioral Scale.
Thirty-nine infants (21 female) were included in the final analysis. The mean Neonatal Eating Outcome Assessment score was 66.6 (SD = 13.3). At term-equivalent age, 10 infants (26%) demonstrated feeding challenges, 21 (54%) demonstrated questionable feeding issues, and 8 (21%) demonstrated normal feeding performance. Lower Neonatal Eating Outcome Assessment scores (poorer feeding performance) at term-equivalent age were associated with more suboptimal reflexes (p = .04) and hypotonia (p < .01).
Feeding challenges and questionable feeding performance were prevalent among preterm infants at term-equivalent age and appeared in conjunction with suboptimal reflexes and hypotonia. Understanding this finding enables therapists to take a holistic approach to addressing feeding difficulties. What This Article Adds: Elucidating the relationships between feeding performance and neurobehavior during the neonatal period allows for a better understanding of potential contributors to early feeding challenges and identifies targets for intervention.
在新生儿重症监护病房（NICU）住院期间，喂养困难在早产儿中很常见。尽管大多数早产儿在达到足月年龄时能够完全经口喂养，但仍不清楚是否存在尽管婴儿摄入了全量但仍存在喂养困难的情况，以及这些困难是否与其他神经行为挑战有关。
确定早产儿喂养问题的发生率，以及婴儿喂养行为与足月时神经行为的关系。
队列研究。
有 85 张床位的 4 级 NICU。
39 名胎龄≤32 周（范围=22-32 周）的极早产儿。排除标准为先天性异常、出生时胎龄>32 周以及在足月时缺乏喂养或神经行为评估。
39 名婴儿（21 名女性）最终纳入分析。新生儿摄食结局评估的平均评分是 66.6（SD=13.3）。在足月时，10 名婴儿（26%）存在喂养挑战，21 名（54%）存在可疑的喂养问题，8 名（21%）存在正常的喂养表现。足月时新生儿摄食结局评估得分较低（喂养表现较差）与反射较差（p=0.04）和低张力（p<0.01）相关。
在足月时，早产儿存在喂养挑战和可疑的喂养表现，并且与较差的反射和低张力同时出现。了解这一发现使治疗师能够采取整体方法来解决喂养困难。这篇文章增加了什么：阐明喂养表现与新生儿期神经行为之间的关系，有助于更好地理解早期喂养挑战的潜在原因，并确定干预的目标。
