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. 2015 Jun 1;21(3):121-126.
doi: 10.1016/j.jnn.2014.08.004.

A self-paced oral feeding system that enhances preterm infants' oral feeding skills

C Lau  1 , S Fucile  2 , R J Schanler  3
Affiliations

A self-paced oral feeding system that enhances preterm infants' oral feeding skills

C Lau et al. J Neonatal Nurs. .

Abstract

Aim: Very low birth weight (VLBW) infants have difficulty transitioning to independent oral feeding, be they breast- or bottle-feeding. We developed a 'self-paced' feeding system that eliminates the natural presence of the positive hydrostatic pressure and internal vacuum build-up within a bottle during feeding. Such system enhanced these infants' oral feeding performance as monitored by overall transfer (OT; % ml taken/ml prescribed), rate of transfer (RT; ml/min over an entire feeding). This study hypothesizes that the improvements observed in these infants resulted from their ability to use more mature oral feeding skills (OFS).

Methods: 'Feeders and growers' born between 26-29 weeks gestation were assigned to a control or experimental group fed with a standard or self-paced bottle, respectively. They were monitored when taking 1-2 and 6-8 oral feedings/day. OFS was monitored using our recently published non-invasive assessment scale that identifies 4 maturity levels based on infants' RT and proficiency (PRO; % ml taken during the first 5 min of a feeding/total ml prescribed) during bottle feeding.

Results: Infants oral feeding outcomes, i.e., OT, RT, PRO, and OFS maturity levels were enhanced in infants fed with the self-paced vs. standard bottle (p ≤ 0.007).

Conclusion: The improved oral feeding performance of VLBW infants correlated with enhanced OFS. This study is a first to recognize that VLBW infants' true OFS are more mature than recognized. We speculate that the physical properties inherent to standard bottles that are eliminated with the self-paced system interfere with the display of their true oral feeding potential thereby hindering their overall oral feeding performance.

Keywords: bottle feeding; newborn; prematurity.

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Conflict of interest statement

Potential conflict of interest: First author has financial interests relevant to the self-paced oral feeding system as per her receipt of a Phase 1 SBIR funding (R43HD072847).

Figures

Figure 1
Figure 1
Differing physical properties between a standard (STD) and self-paced (SP) feeding tool
Figure 2
Figure 2
Tracing of an internal vacuum build-up within a STD bottle during a feeding from a VLBW infant taking 8 oral feedings per day
Figure 3
Figure 3
Oral Feeding Scale (OFS) levels 1 to 4
Figure 4
Figure 4
OFS profiles of VLBW infants feeding with a standard vs. self-paced bottle when taking: a. 1 to 2 oral feedings per day; b. 6 to 8 oral feedings per day
See this image and copyright information in PMC

References

    1. American Academy of Pediatrics. Policy Statement, Hospital discharge of the high-risk neonate. Pediatrics. 2008 Nov;122(5):1119–1126. - PubMed
    1. Lau C, Schanler RJ. Oral feeding in premature infants: advantage of a self-paced milk flow. Acta Paediatr. 2000 Apr;89(4):453–459. - PubMed
    1. Fucile S, et al. A controlled-flow vacuum-free bottle system enhances preterm infants’ nutritive sucking skills. Dysphagia. 2009 Jun;24(2):145–151. - PMC - PubMed
    1. Lau C, Smith EO. A Novel Approach to Assess Oral Feeding Skills of Preterm Infants. Neonatology. 2011 Jan;100(1):64–70. - PMC - PubMed
    1. Lau C, et al. Oral feeding in low birth weight infants. J Pediatr. 1997 Apr;130(4):561–569. - PubMed