Prevalence of Early Feeding Alterations Among Preterm Infants and Their Relationship to Early Neurobehavior.

IMPORTANCE

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.

OBJECTIVE

To identify the prevalence of feeding problems among preterm infants and the relationships between infant feeding behaviors and neurobehavior at term-equivalent age.

DESIGN

Cohort study.

SETTING

Level 4 NICU with 85 beds.

PARTICIPANTS

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.

OUTCOMES AND MEASURES: Standardized feeding assessments using the Neonatal Eating Outcome Assessment and standardized neurobehavioral evaluation using the NICU Network Neurobehavioral Scale.

RESULTS

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).

CONCLUSIONS AND RELEVANCE: 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.