Barbara A. Reyna

Effects of non-nutritive sucking on nutritive sucking, breathing, and behavior during bottle feedings of preterm infants.

PURPOSEThe purpose of this study was to examine the effect of prefeeding non-nutritive sucking (NNS) on breathing, nutritive sucking (NS), and behavioral characteristics of bottle feeding. SUBJECTSThe convenience sample was composed of 10 preterm infants who were 33 to 40 weeks postconceptual age (PCA) at the time of the observation. DESIGNRandomized, crossover; each infant was observed twice during the first 48 hours of bottle feeding. METHODSTen preterm infants received NNS before 1 bottle feeding and served as their own control at a second bottle feeding. Sucking was measured using a chin strain gauge and breathing was measured with a nasal thermistor. Behavioral characteristics included behavior state, measured using the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) behavior state scale, and feeding efficiency. MAIN OUTCOME MEASURESCharacteristics of NS (number of suck bursts, sucks/burst, suck burst length) and breathing (number of breath bursts, breaths/burst, breath burst length), as well as behavior state during bottle feedings and feeding efficiency (percent of prescribed formula consumed, formula consumed/minute of feeding). PRINCIPAL RESULTSNS waves were smoother and more regular than NNS waves. Time to onset and duration of the first non-nutritive suck burst were positively correlated with time to onset for the first nutritive suck burst. Prefeeding NNS had no statistically significant effect on characteristics of breathing or on any other characteristics of NS. Behavioral state during feedings and feeding efficiency were not affected by prefeeding NNS. CONCLUSIONSIn this sample, the use of prefeeding NNS did not affect NS, breathing during feeding, or select behavioral characteristics of feeding.

Mother-Infant Synchrony

Synchrony is an essential component of the interaction between a mother and her infant and is characterized by adaptive and reciprocal behaviors that promote a mutually rewarding interaction. It is an antecedent for the emergence of self-regulatory function in infants and influences current and future interactions. Understanding the dynamics of the mother-infant dyad and identifying synchronous patterns are important for promoting a healthy relationship. Approaches to measurement and challenges to model development are described.

Predictors of nutritive sucking in preterm infants

Objective:The purposes of this analysis were to determine how select characteristics of nutritive sucking (number of sucks, sucks/burst, and sucks/minute) change over time and to examine the effect of select factors (morbidity, maturity, prefeeding behavior state, and feeding experience) on those changes.Study design:A longitudinal, non-experimental study was conducted in a Level 3 neonatal intensive care unit using a convenience sample of 88 preterm infants. Statistical analyses were performed using a repeated-measures mixed-model in SAS.Results:Sucking activity (number of sucks, sucks/burst, and sucks/minute) was predicted by morbidity, maturity, feeding experience and prefeeding behavior state. Experience at oral feeding had the greatest effect on changes in the number of sucks, suck/burst and sucks/minute.Conclusion:Experience at feeding may result in more rapid maturation of sucking characteristics.

A model of neurodevelopmental risk and protection for preterm infants.

The purpose of this article is to introduce a model of neurodevelopmental risk and protection that may explain some of the relationships among biobehavioral risks, environmental risks, and caregiving behaviors that potentially contribute to neurobehavioral and cognitive outcomes. Infants born before 30 weeks of gestation have the poorest developmental prognosis of all infants. These infants have lengthy hospitalization periods in the neonatal intensive care unit (NICU,) an environment that is not always supportive of brain development and long-term developmental needs. The model supports the premise that interventions focused on neuroprotection during the neonatal period have the potential to positively affect long-term developmental outcomes for vulnerable very preterm infants. Finding ways to better understand the complex relationships among NICU-based interventions and long-term outcomes are important to guiding caregiving practices in the NICU.

A descriptive study of bottle-feeding opportunities in preterm infants.

ABSTRACT PURPOSE: The purposes of this study were to describe patterns of bottle feeding opportunities in preterm infants and to analyze the relationships between feeding opportunities and outcomes. SUBJECTS: The sample was composed of 25 preterm infants who were bottle fed. DESIGN: Retrospective, correlational. METHODS: Data were collected from medical records and analyzed descriptively. Correlation coefficients among variables were computed. MAIN OUTCOME MEASURES: Postconceptional age (PCA) at the time of full bottle feedings and transition time from the first to full bottle feedings. PRINCIPAL RESULTS: The number of bottle feedings received per day during the transition from first to full bottle feedings was inversely related to length of transition to full bottle feedings. There was no relationship between the number of bottle‐feeding opportunities and PCA at full bottle feedings. CONCLUSIONS: The achievement of full bottle feedings may be facilitated by increased bottle‐feeding opportunities. More research about the relationships among feeding readiness, outcomes, and opportunities is needed.

Relationship of the first suck burst to feeding outcomes in preterm infants.

Objective This study examined the relationship between the number of sucks in the first nutritive suck burst and feeding outcomes in preterm infants. The relationships of morbidity, maturity, and feeding experience to the number of sucks in the first suck burst were also examined. Methods A nonexperimental study of 95 preterm infants was used. Feeding outcomes included proficiency (percent consumed in first 5 min of feeding), efficiency (volume consumed over total feeding time), consumed (percent consumed over total feeding), and feeding success (proficiency ≥ 0.3, efficiency ≥ 1.5 mL/min, and consumed ≥ 0.8). Data were analyzed using correlation and regression analysis. Results and Conclusions There were statistically significant positive relationships between number of sucks in the first burst and all feeding outcomes—proficiency, efficiency, consumed, and success (r = 0.303, 0.365, 0.259, and τ = 0.229, P < .01, respectively). The number of sucks in the first burst was also positively correlated to behavior state and feeding experience (τ = 0.104 and r = 0.220, P < .01, respectively). Feeding experience was the best predictor of feeding outcomes; the number of sucks in the first suck burst also contributed significantly to all feeding outcomes. The findings suggest that as infants gain experience at feeding, the first suck burst could be a useful indicator for how successful a particular feeding might be.

Effects of the neonatal intensive care unit environment on preterm infant oral feeding.

OBJECTIVE To examine the effect of neonatal intensive care unit environmental characteristics (perceived levels of light and sound, and time of day) in open unit wards and single-family rooms (SFRs) on oral feeding outcomes in preterm infants. DESIGN Data were collected at each scheduled oral feeding for 87 preterm infants from the first oral feeding until discharge. Data included the prescribed volume of feeding and the volume consumed, the infants level of wakefulness before feeding, and the nurses perception of light and sound. RESULTS Data were collected on 5111 feedings in the ward unit and 5802 in the SFR unit from feedings involving 87 preterm infants. Light and sound were rated significantly lower in the SFR (χ2 = 139 and 1654.8, respectively). Feeding times of 9 am, 12 noon, and 3 pm were associated with the highest perceived levels of light and sound, regardless of unit design (P < 0.0001). Moderate light levels and feeding times of 12, 3, and 6 am were associated with improved feeding outcomes. Infants consumed a greater proportion of their prescribed feeding volume when fed in the open ward and when awake before feeding. CONCLUSION Further study on the clinical effects of unit design is needed, as is study on the effects of environmental stimuli, so that interventions can be appropriately developed and tailored for infants needing the most support for optimal development.

Advanced Practice Nursing in the Care of the High-Risk Infant

Advanced practice nursing encompasses a range of roles and services. Tertiary care settings such as neonatal intensive care units provide a variety of opportunities for the advanced practice nurse, including direct care, case management, and developmental care. Primary care and community settings may also provide opportunities for advanced practice nursing in the care of high-risk infants. Challenges related to role implementation, control of practice, and reimbursement also exist, however. The article examines the evolution of advanced practice nursing in the care of the high-risk infant as well as current opportunities and challenges.

Patterns of genetic inheritance.

Neonatal nurses need to understand the basic patterns of genetic transmission. This article, the first in a series, provides an overview of Mendel’s laws and discusses five types of transmission: single gene inheritance, chromosomal inheritance, multifactorial inheritance, cytoplasmic inheritance, and somatic cell mutations.