What are the interventions to promote oral intake in preterm infants?"
Overview
An estimated fifteen million infants are prematurely born every year. According to the Center for Disease Control and Prevention (CDC), one in every ten children born in America is affected by preterm birth. The term preterm is used to refer to babies who are born before the normal thirty-seven weeks gestation period. Preterm births are classified based on the gestation age. Babies born less that twenty-seven weeks or the gestation period are categorized as extremely preterm. Very Preterm babies are those born between twenty seven weeks and thirty-two weeks while moderate to late preterms are born between thirty-two weeks and thirty-seven weeks. Preterm births have been identified as the leading cause of deaths among children under the age of five. Those who survive preterm births of develop lifetime complications like learning, physical, visual, and hearing disabilities. It is however important to note that preterm babies can be save by using feasible and cost effective care.
Preterm births happen because of a variety of reasons but most of them are spontaneous. Some preterm births happen because of early induction of labor or caesarean. Common causes of preterm infants include infections, multiple pregnancies, and chronic diseases. Preterm babies born before week thirty-four have been found not to have developed a more coordinated pattern with their oral movement that allows them to suck, swallow and breathe. Bache, Pizon, Jacobs, Vaillant, & Lecomte, (2014), argues that preterm babies who are yet to master this coordination should not be fed via a bottle or breast until they attain the age of thirty-four weeks. By understanding this aspect of feeding behaviour in preterms, it is critical for caregiver and parent to ensure that premature infant feeding programs are not only safe but also efficient. Multiple pieces of research suggest that there are numerous factors that influence the feeding behaviours of infants; however, it has been found that implementing oral simulation programs during the transition period positively impacts the feeding behaviour of the infant. The objective of this review is to critically analyse available research on the interventions that are used to promote oral intake in preterm infants. The review will seek to understand if oral support enhances the feeding behaviour of neonates.
Significance of the Problem
Every preterm baby struggles to stay alive as they are not fully developed to survive the harsh conditions of the world. The babies are physically underdeveloped with no proper feeding mechanism. However, with appropriate care, preterm babies can be saved and helped to transition to a state they are fully developed into an mature infant. The health of these preterm children lies on the care they receive after birth. Part of the care is ensuring that they are fed in a safe and secure manner as it is not right to feed them like normal babies. This review hopes to stem the interventions that have been proposed to promote oral intake in preterm infants (Hwang, Lin, Coster, Bigsby, & Vergara, 2010). It is important to find out ways that can be used to support premature babies feed as it is critical for their health. This review should be used as a basis to help caregivers of preterm’s understand the procedures available to help promote their feeding performance. The significance of understanding the interventions available for handling feeding behaviour of preterm babies is that it helps understand the appropriate ways that the neonates can be fed. This review will focus more on jaw support as a way to help promote the feeding behaviour of infants. Understanding this concept will go a long way in helping understand if oral support enhances the feeding behaviour of preterm infants.
Literature Search Strategy
While carrying out this research, there are some search strategies that were used. To begin with search terms such as preterm feeding, neonates feeding or sucking behaviour, oral intake, feeding methods, infant, and premature were used to search for the research article. The search terms ensured that they relate to the objective of the study specifically targeting the interventions necessary for promoting preterm infants. Apart from the search terms, the review into multiple library databases with focus kept on nursing. The databases reviewed and searched included published articles from the neonatal Society, the British Association of Perinatal Medicine, and the conference on feeding and eating in infancy and early childhood (Hwang, Lin, Coster, Bigsby, & Vergara, 2010). Other databases that were used included online searches from American Academy of Pediatrics, American Society for Parenteral and Enteral Nutrition, Canadian Pediatric Society, and the European Academy of Pediatrics. Armed with the mentioned databases the research was refined to consider only peer reviewed articles that were written within the last seven years were used. The research ensured that the article used had primary data and that it was not altered. With this in mind, the research found out that twenty-three articles from the available listed databases would be useful in helping answer the research question. However, the research settled on the effectiveness of cheek and jaw support in improving the feeding behaviour of neonates as it was more detailed and addressed the issue directly. The article settle on had no Meta-analysis and used the quantitative method in its study.
Purpose of the Study
The objective of the study is to analyse the impact cheek, and jaw support has on the feeding behaviours of premature infants. The research hopes to explain whether oral support through cheeks and jaws support improves the feeding behaviours of preterm infants. The study also seeks to answer oral support helps improve mature sucking patterns in preterm infants, increase their alertness and reduce their leakage during feeding.
Study Variable
The initial study was carried out on two groups of preterm infants. One group consisted of preterm infants who were of the range of thirty-four to forty weeks while the other group consisted of preterm infants between the ages of thirty-two weeks to thirty-four weeks. The two groups were subjected to feeding programs where they received oral support against time when they had no oral support.
Participants
Data Collection Method and Procedures
The data from the research was collected by two research assistants who were not informed of the hypothesis of the study. The procedure of the study used a crossover design where the participants acted as their controls. The participants were fed every day using two feeding conditions. The feeding conditions included one with oral support and without oral support. Feeding without oral support acted as the control feeding for the study with its procedure being the same as that with oral support. To avoid confounding effects, the condition was changed randomly between the days of the study. Data from the research was collected through physiological data recording (Hwang, Lin, Coster, Bigsby, & Vergara, 2010). Video and voice recordings were also used to collect the data by the research assistants. The data was collected as the child was fed with some being fed at their bedside while others were fed inside their isolette. Data was collected at every stage of the feeding process which included intervals of five minutes per feeding period. This was continued until the infant finished the required amount as stipulated in the study.
Instruments
The data was collected using video recorders and voice recorders. The research assistants also used weight measurements to measure the weight of the tissue paper that had food leakage from the infants at every stage of the feeding period. A bottle with a nipple was used to feed the infants as it was deemed safe for the infants during feeding. Any remaining food was given to the infant using a nasogastric tube by the nurse assigned to the infant.
Data Analysis
Data from the research was analysed by pooling data from the same condition as they were deemed to be similar. The feeding performance of every infant was then measured using the identified feeding parameters. The parameters included the duration of feeding, volume ingested, intake rate, sucking frequency, the volume of leakage, and the mean volume ingested for every suck (Hwang, Lin, Coster, Bigsby, & Vergara, 2010). The feeding performance was then compared across the two feeding conditions to better understand the study. The level of the infant’s alertness was compared using sign tests. This was done before and after every feeding across the two feeding conditions. Post hoc effect size calculations were then used to determine the effectiveness of the intervention for every feeding factor using the Cohen d.
Results Finding
Limitation
One of the limitations of the study was that it is hard to blind the person administering the food and the research assistants from the study conditions. For this reason, unintentional bias while handling the infants was possible especially on the person feeding them. The research assistants could not also be blinded to the conditions of the study which might have allowed them to be unintentionally biased during their coding. Another limitation of the study relates to the methodological issues. During the intervention feeding, the person feeding the infant might have blocked the infant's jaws making it difficult for the research assistants record the sucking movements of the infants.
Conclusion
It is evident from the findings of this study that intervention improves the feeding behaviours of neonates. The results of the study show significant improvement regarding the rate of intake, leakage, and time taken by infants to eat when offered oral support. The data from the research goes on to support previous research that oral support is necessary for helping preterm infant feeding process. The decrease in leakage stands as a causative factor towards better feeding process for neonates. It is, however, important that more research is done with more reliable measurements to comprehend the mechanism that supports the benefits of oral support in helping feed preterm infants.
References
Bache, M., Pizon, E., Jacobs, J., Vaillant, M., & Lecomte, A. (2014). Effects of pre-feeding oral stimulation on oral feeding in preterm infants: A randomized clinical trial. Early Human Development, 90(3), 125–129. doi:10.1016/j.earlhumdev.2013.12.011
CDC (2016). Preterm birth. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm
Hwang, Y. ., Lin, C. ., Coster, W. J., Bigsby, R., & Vergara, E. (2010). Effectiveness of cheek and jaw support to improve feeding performance of Preterm infants. American Journal of Occupational Therapy, 64(6), 886–894. doi:10.5014/ajot.2010.09031
