Trajectory of Infant Problematic Feeding Symptoms: Study Protocol.

BACKGROUND: Infants with developmental risk factors are more likely to have feeding problems and develop chronic feeding disorders. Early detection and understanding of the progression of problematic feeding and its relationship with a child's biological functioning and the family feeding environment will enhance effective symptom management and development of interventions to prevent pediatric feeding disorders. OBJECTIVES: The New Through Two (NewThru2) feeding study protocol is described. Study aims are to (a) characterize symptoms of problematic feeding and trajectories of symptoms from pre-discharge from neonatal intensive care through age 24 months; (b) determine the relationship of child biological function at discharge with symptom characteristics and trajectories; (c) describe the child's feeding environment and its relationship to symptoms from discharge through 24 months; and (d) determine the relationship between problematic feeding symptoms and growth and developmental outcomes. METHODS: NewThru2 is a prospective, longitudinal, mixed method study following over 200 infants who received care in a neonatal intensive care unit and were identified as at risk for compromised development. The study follows enrolled infants through 24 months of age. Symptoms of problematic feeding are measured pre-discharge by clinical observation and medical record review and post-discharge by parent report. Biological function is measured by medical history and cardiorespiratory and autonomic nervous system function during feeding prior to discharge. Child feeding environment is measured by strategies parents use to manage feeding, the effect of feeding on the parent and family, and the use of feeding services. A subset of parents is interviewed to achieve a contextual understanding of the family feeding environment. Child outcome measures include parent-reported feeding skills and clinician-reported growth and neurodevelopment. DISCUSSION: The results of this study will improve understanding of pediatric feeding disorders during a time of development sensitive to adequate nutrition and with infants at risk for developmental delays or impairments.

Biobehavioral Efficacy of the Elevated Side-Lying Position for Feeding Preterm Infants: Study Protocol.

AIM: Present a study protocol investigating the biobehavioral efficacy of side-lying vs. supine positions on physiologic and behavioural responses of preterm infants during their transition from tube to full oral feeding, and identify associated infant characteristics. DESIGN: Within-subject cross-over design. METHODS: Sixty preterm infants born at ≤35 weeks gestational age (GA) from a level 3 NICU are observed during their transition to full oral feeding. Each undergoes two feedings within 24 h: One in the supine position and one in the side-lying position. Continuous physiologic and video data are collected 30 min before and after feeding. Physiologic measures include heart rate, respiratory rate, oxygen saturation, and autonomic nervous system regulation (heart rate variability and splanchnic-cerebral oxygen ratio). Behavioural responses are assessed via microanalysis of the sucking and breathing waveforms and videotaped feedings (Suck-breathe coordination and Early Feeding Skills assessment tool). Data are analysed using linear mixed-effects models. IRB was obtained in September 2021, with funding awarded by the National Institute of Nursing Research in July 2021. CONCLUSION: This study will enhance our understanding of the effects of the side-lying position on preterm infant feeding, providing guidance for its clinical use as a feeding strategy. IMPLICATIONS: Provides vital knowledge to guide evidence-based practices in enhancing oral feeding in preterm infants and inform future pivotal efficacy trials. IMPACT: If effective, this intervention could significantly enhance the management of feeding challenges in preterm infants across neonatal care settings. REPORTING METHOD: Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013. PATIENT OR PUBLIC CONTRIBUTION: While direct parent involvement was not documented in our protocol, informal feedback on data collection procedures from parents was incorporated. Additionally, extensive engagement with healthcare professionals during study design addressed patient safety, logistical challenges, and ethical standards in NICU settings. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04942106; registered on 28 June 2021. Available at: https://clinicaltrials.gov/ct2/show/NCT04942106.

Parental Decision-Making Around Introducing Complementary Foods: An Integrative Review.

A primary role in infant parenting is feeding, and this role undergoes a significant transition when introducing complementary foods (CF), with important long-term health implications. Understanding the influences on parental decision-making around timing the introduction to CF can help health care providers provide parents with effective support for feeding; however, the factors that influence parental decision-making have not been recently reviewed in the United States. To determine influences and information sources, this integrative review examined the literature from 2012 to 2022. Results indicated that parents are confused and distrustful of inconsistent and changing guidelines around CF introduction. Instead, developmental readiness signs may be a more appropriate way for practitioners and researchers to support parents in appropriate CF introduction. Future work is needed to evaluate interpersonal and societal influences on parental decision-making, as well as to develop culturally sensitive practices to support healthful parental decisions.

Gut-Brain Axis Perspective on Negative Symptoms and Their Neighbors in Early Adolescence: Can We Move Care Upstream?

The current study investigated symptom network patterns in adolescents from a gut-brain-axis (GBA) biopsychosocial perspective. Our secondary analysis of data from the Adolescent Brain Cognitive Development Study assessed symptom relationships using network analysis to provide information about multivariate structural dependencies among 41 signs and symptoms. Cross-sectional EBICglasso symptom networks were evaluated to assess patterns associated with anhedonia and depressed mood. Significant differences were identified between symptom neighbors of anhedonia compared with depressed mood based on stratification by age. The GBA perspective revealed several symptom neighbors that could expand clinical assessment, diagnosing criteria, education, and interventions for adolescents at risk for, or with, anhedonia or depressed mood. Results speak to the unique impact of symptoms on health that are not interchangeable with other symptoms and do not have equal effects. Mental health nurses should consider a holistic and proactive precision health approach to improving health and well-being through evidence-based assessment of symptom associations. [Journal of Psychosocial Nursing and Mental Health Services, 61(7), 29-38.].

Inquiry into women's pathways to diagnosis of endometriosis: A qualitative study protocol.

AIMS: This protocol describes a study aiming to: (1) describe pathways and experiences of women's symptom recognition, appraisal and management of endometriosis; and (2) identify differences in pathways and experiences among a socioeconomically and racially diverse group of women. DESIGN: Descriptive qualitative study with stratified purposeful sampling. METHODS: Data will be collected from a minimum of 24 women with provider-presumed or surgically confirmed diagnoses across two time points. The study will recruit across socioeconomic status (SES) and race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic/Latina) to ensure diversity of the sample. Recruitment will occur at a large public hospital in the southeastern United States (US). Participants will be interviewed using semi-structured interview guides informed by Elder and Giele's Life Course perspective approaching women as active beings in dynamic systems shaped by: 1) their location in time and space; 2) linked lives; and 3) human agency, and 4) the time of their lives. Each woman's experiences, symptoms, and contacts with health-care systems will be mapped to trace their diagnostic pathways. Coded interviews and data will undergo within- and across-case analysis to identify similarities and differences in their experiences. Institutional review board approval was obtained June 2019. DISCUSSION: The participants' diagnostic maps will enable us to distinguish the differences in pathways and experiences between and across groups. Findings will inform the development of interventions aimed at shortening the time to diagnosis. IMPACT: This will be the first study to compare pathways to diagnosis of endometriosis in a socioeconomically and racially diverse sample of US women using the life course perspective. The results from this research stand to inform future interventions aimed at helping women achieve more timely diagnoses.

Model Integration: Can Understanding Biopsychosocial Gut-Brain Axis Mechanistic Pathways Improve our Clinical Reasoning in Primary Care?

INTRODUCTION: Most NPs practice in primary care settings. Cognitive tools to inform and advance NP understanding of biopsychosocial mechanisms can support early recognition, interdisciplinary collaboration, interventions, and prevention of negative outcomes. THEORY AND METHODS: We describe the development of a model to support NP consideration of gut-brain axis (GBA) evidence-based pathways, contributing variables, and related health outcomes. RESULTS: The model's outcomes are factors associated with homeostasis or disruption of biological, psychological, and social systems. DISCUSSION/CONCLUSION: This cognitive tool aims to support NP awareness of multi-domain GBA relationships to consider with differential diagnoses and clinical treatment of the "whole body system".

Sleep-Wake States and Feeding Progression in Preterm Infants.

BACKGROUND: Previous studies demonstrated a short-term relationship between infant sleep-wake states and oral feeding performance, with state being an indication of infants' neurobehavioral readiness for feeding. However, the relationship between sleep-wake states and feeding skills has not been evaluated longitudinally during hospitalization. OBJECTIVES: The purpose of this study was to examine preterm infants' sleep-wake state developmental trajectories and their associations with feeding progression during hospitalization. METHODS: This descriptive and exploratory study was a secondary analysis using data from a longitudinal two-group, randomized controlled trial evaluating the effects of early and late cycled light on health and developmental outcomes among extremely preterm infants who were born ≤28 weeks of gestational age. Sleep-wake states were assessed for two 2-hour interfeeding periods per day (day and night hours), 30 weeks postmenstrual age, and every 3 weeks until discharge. Occurrences of active sleep, quiet sleep, and waking were recorded every 10 seconds. Feeding progression was assessed based on an infant's postmenstrual age at five milestones: first enteral feeding, full enteral feeding, first oral feeding, half oral feeding, and full oral feeding. Trajectory analyses were used to describe developmental changes in sleep-wake states, feeding progression patterns, and associations between feeding progression and sleep-wake trajectories. RESULTS: Active sleep decreased while waking, and quiet sleep increased during hospitalization. Two distinct feeding groups were identified: typical and delayed feeding progression. In infants with delayed feeding progression, rates of active and quiet sleep development during the day were delayed compared to those with typical feeding progression. We also found that infants with delayed feeding progression were more likely to be awake more often during the night compared to infants with typical feeding progression. DISCUSSIONS: Findings suggest that delays in sleep-wake state development may be associated with delays in feeding progression during hospitalization. Infants with delayed feeding skill development may require more environmental protection to further support their sleep development.

Adaptive Leadership in Parents Caring for their Children Born with Life-Threatening Conditions.

PURPOSE: The purpose of this study was to chronicle the adaptive challenges and adaptive work, including emerging leadership behaviors, recounted over time by the parents of very young children diagnosed before birth with life threatening conditions. DESIGN AND METHODS: A descriptive, follow-up study design was used for the current study. Following the original grounded dimensional analysis study completed in 2012, the corpus for this analysis was collected in 2014. In-depth, audio-recorded interviews were conducted with 15 families (8 couples, 7 mothers). The 15 children, born with cardiac, abdominal, and cerebrospinal anomalies, were 14 - 37 months or deceased at follow-up. A directed content analysis of transcribed verbatim interviews was structured by the Adaptive Leadership framework. RESULTS: Parents described behaviors that indicated a non-linear development towards adaptive leadership as they accomplished the adaptive work within intra- and interpersonal domains that was necessary to address challenges over time. Not all parents described abilities and/or a willingness to mobilize others to do adaptive work, suggesting that adaptive leadership remained an unrealized potential. CONCLUSIONS: Understood as a complex adaptive system, parents of medically at-risk children hold potential for development towards adaptive leadership and collaborative partnership within the family and with healthcare providers. PRACTICE IMPLICATIONS: Due to improved survival rates, parents face ongoing challenges related to their children's unpredictable and often chronic health needs. Study findings illustrate parents' adaptive work and leadership behaviors, which can inform nursing assessments, as well as the type and timing for intervention.

Symptoms of Feeding Problems in Preterm-born Children at 6 Months to 7 Years Old.

OBJECTIVES: Describe symptoms of feeding problems in children born very preterm (<32 weeks gestation) and moderate to late preterm (32-37 weeks gestation) compared to children born full-term; explore the contribution of medical risk factors to problematic feeding symptoms. METHODS: The sample included 57 very preterm, 199 moderate to late preterm, and 979 full-term born children ages 6 months to 7 years. Symptoms of feeding problems were assessed using the Pediatric Eating Assessment Tool and compared between groups after accounting for the child's age and/or sex. With the sample of preterm children, we further analyzed 11 medical factors as potential risk factors affecting a child's feeding symptoms: feeding problems in early infancy and conditions of oxygen requirement past 40 weeks of postmenstrual age, congenital heart disease, structural anomaly, genetic disorder, cerebral palsy, developmental delay, speech-language delay, sensory processing disorder, vision impairment, or symptoms of gastroesophageal reflux. RESULTS: Compared to children born full-term, both very preterm and moderate to late preterm born children had significantly higher scores on the Pediatric Eating Assessment Tool total scale and all 4 subscales. More severe symptoms were noted in very preterm children, particularly in the areas of Physiologic Symptoms and Selective/Restrictive Eating. Among preterm children, all 11 medical factors were found to be associated significantly with increased symptoms of feeding problems. CONCLUSION: Compared to children born full-term, preterm born children demonstrated greater symptoms of feeding problems regardless of their current age, suggesting children born preterm may require more careful monitoring of feeding throughout childhood.

Age-based norm-reference values for the Pediatric Eating Assessment Tool.

BACKGROUND AND OBJECTIVES: Differentiating problematic feeding from variations of typical behavior is a challenge for pediatric providers. The Pediatric Eating Assessment Tool (PediEAT) is a parent-report measure of symptoms of problematic feeding in children 6 months to 7 years old with evidence of reliability and validity. This study aimed to determine age-based, norm-referenced values for the PediEAT. METHODS: Parents of children between 6 months and 7 years old (n = 1110) completed the PediEAT. Descriptive statistics were calculated for subscale and total scores of the PediEAT within 11 age groups. RESULTS: The PediEAT total scores followed a general downward trajectory with increasing age. Physiologic Symptoms were relatively steady from 6 to 15 months, and then rapidly declined in 15-18 month olds and continued to decline thereafter. Problematic Mealtime Behaviors increased from 6 to 9 months to a peak in 24-30 month olds and then declined with increasing age. Selective/Restrictive Eating increased from 6 to 9 months to a peak at 12-15 months and then decreased over time thereafter. Symptoms of difficulty with Oral Processing were highest in 6-9 month olds and decreased with age. CONCLUSIONS: The PediEAT now has age-based norm-reference values to guide score interpretation and clinical decision-making.

The Pediatric Eating Assessment Tool: Factor Structure and Psychometric Properties.

OBJECTIVES: The Pediatric Eating Assessment Tool (PediEAT) is a parent-report instrument developed to assess symptoms of feeding problems in children aged 6 months to 7 years. The purpose of this study was to identify the factor structure of the PediEAT and test its psychometric properties, including internal consistency reliability, temporal stability, and construct validity. METHODS: Participants included 567 parents of children aged 6 months to 7 years. Fifty-four percent of the sample had parent report of a diagnosed feeding problem or feeding concerns. Exploratory factor-analysis techniques were used to remove redundant or non-endorsed items and identify the factor structure of the instrument. Construct validity was examined with 466 parents completing the Mealtime Behavior Questionnaire as a criterion standard. Known-groups validation was used to compare PediEAT scores between children with and without diagnosed feeding problems. Temporal stability of the PediEAT was examined with 97 parents repeating the PediEAT after 2 weeks. RESULTS: Principal components factor analysis with varimax rotation supported a 4-factor model accounting for 39.4% of the total variance. The 4 subscales (Physiologic Symptoms, Problematic Mealtime Behaviors, Selective/Restrictive Eating, Oral Processing) demonstrated acceptable internal consistencies (coefficient alphas: 0.92, 0.91, 0.83, 0.83; respectively). Construct validity was supported in 2 ways. The PediEAT correlated with the Mealtime Behavior Questionnaire (r = 0.77, P < 0.001) and total score and subscale scores were significantly different between children with and without diagnosed feeding problem (P < 0.001). Temporal stability was demonstrated through test-retest reliability (r = 0.95, P < 0.001). CONCLUSIONS: Strong psychometric properties support the use of the PediEAT in research and clinical practice.

Age-based norm-reference values for the Child Oral and Motor Proficiency Scale.

AIM: To determine reference values for the Child Oral and Motor Proficiency Scale (ChOMPS) based on healthy, typically developing and typically eating children between six months and seven years old. METHODS: Parents of children six months to seven years old (n = 1057) completed the 63-item ChOMPS. Median, range, 5th and 10th percentiles were calculated for scores on the four subscales of the ChOMPS as well as the total score in each of 11 age groups. RESULTS: Age-based norm-reference values are reported. By 24 months, 95% of children could perform all skills in the Basic Movement Patterns subscale. By four years, more than 95% of children could perform all of the skills in the Fundamental Oral-Motor Skills subscale. The Oral-Motor Coordination and Complex Movement Patterns skills developed later. By five years, 90% of children could perform all Oral-Motor Coordination skills. In six to seven year olds, 95% received a score of 44 of 46 on the Complex Movement Patterns subscale, indicating that some typical children had not established all of these complex skills by seven years. CONCLUSION: The ChOMPS is the first valid and reliable parent-report measure of eating, drinking and related skills that has age-based norm-reference values for use in clinical practice and research.

Systematic Review: What Is the Evidence for the Side-Lying Position for Feeding Preterm Infants?

BACKGROUND: Side-lying position is an increasingly common feeding strategy used by parents, nurses, and feeding therapists to support oral feeding in preterm infants. Better understanding of the research evidence on the effect of the side-lying position will help clinicians make informed decisions and guide future research in this important area. PURPOSE: To identify and summarize the available evidence on the effect of side-lying position on oral feeding outcomes in preterm infants. METHODS/SEARCH STRATEGY: PubMed, CINAHL, Web of Science and PsycINFO were searched for ("preterm" OR "premature") AND "feed*" AND "position*". The full text of 47 articles was reviewed to identify eligible studies that use a quasi-experimental or experimental design to examine the intervention effectiveness; 4 studies met criteria. FINDINGS/RESULTS: Four studies compared the effect of the side-lying position with either the semi-upright, cradle-hold, or semi-reclined positions on various feeding outcomes. The findings were conflicting: 2 studies found the side-lying position to be beneficial for supporting physiologic stability during feeding compared with the semi-upright position whereas 2 studies did not find significant differences in any of their outcomes between the side-lying position and other feeding positions. However, this finding should be interpreted cautiously because of various methodological weaknesses and limited generalizability. IMPLICATIONS FOR PRACTICE: This review does not provide strong or consistent evidence that the side-lying position improves preterm infants' oral feeding outcomes. IMPLICATIONS FOR RESEARCH: A large randomized controlled trial with a diverse group of preterm infants is needed to determine the effects of the side-lying position and identify infants who would receive the most benefit.Video Abstract Available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.

Factor Structure and Psychometric Properties of the Neonatal Eating Assessment Tool-Bottle-Feeding (NeoEAT-Bottle-Feeding).

BACKGROUND: Feeding difficulties are common in infancy. There are currently no valid and reliable parent-report measures to assess bottle-feeding in infants younger than 7 months. The Neonatal Eating Assessment Tool (NeoEAT)-Bottle-feeding has been developed and content validated. PURPOSE: To determine the factor structure and psychometric properties of the NeoEAT-Bottle-feeding. METHODS: Parents of bottle-feeding infants younger than 7 months were invited to participate. Exploratory factor analysis was used to determine factor structure. Internal consistency reliability was tested using Cronbach α. Test-retest reliability was tested between scores on the NeoEAT-Bottle-feeding completed 2 weeks apart. Construct validity was tested using correlations between the NeoEAT-Bottle-feeding, the Infant Gastroesophageal Reflux Questionnaire-Revised (I-GERQ-R), and the Infant Gastrointestinal Symptoms Questionnaire (IGSQ). Known-groups validation was tested by comparing scores between healthy infants and infants with feeding problems. RESULTS: A total of 441 parents participated. Exploratory factor analysis revealed a 64-item scale with 5 factors. Internal consistency reliability (α= .92) and test-retest reliability (r = 0.90; P < .001) were both excellent. The NeoEAT-Bottle-feeding had construct validity with the I-GERQ-R (r = 0.74; P < .001) and IGSQ (r = 0.64; P < .001). Healthy infants scored lower on the NeoEAT-Bottle-feeding than infants with feeding problems (P < .001), supporting known-groups validity. IMPLICATIONS FOR PRACTICE: The NeoEAT-Bottle-feeding is an available assessment tool for clinical practice. IMPLICATIONS FOR RESEARCH: The NeoEAT-Bottle-feeding is a valid and reliable measure that can now be used in feeding research.Video Abstract Available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.

Psychometric Properties of the Early Feeding Skills Assessment Tool.

BACKGROUND: Supporting infants as they develop feeding skills is an essential component of neonatal and pediatric care. Selecting appropriate and supportive interventions begins with a thorough assessment of the infant's skills. The Early Feeding Skills (EFS) tool is a clinician-reported instrument developed to assess the emergence of early feeding skills and identify domains in need of intervention. PURPOSE: The purpose of this study was to identify the factor structure of the EFS and test its psychometric properties, including internal consistency reliability and construct validity. METHODS: EFS-trained interprofessional clinicians in 3 settings scored 142 feeding observations of infants 33 to 50 weeks' postmenstrual age. Redundant and rarely endorsed items were removed. Factor analysis methods clustered items into subscales. Construct validity was examined through the association of the EFS with (1) concurrently scored Infant-Driven Feeding Scale-Quality (IDFS-Q), (2) infant birth risk (gestational age), and (3) maturity (postmenstrual age). RESULTS: Principal components analysis with varimax rotation supported a 5-factor structure. The total EFS demonstrated good internal consistency reliability (Cronbach α= 0.81). The total EFS score had construct validity with the IDFS-Q (r =-0.73; P < .01), and with gestational age of a subsample of premature infants (r = 0.22; P < .05). IMPLICATIONS FOR PRACTICE: As a valid and reliable tool, the EFS can assist the interprofessional feeding team to organize feeding assessment and plan care. IMPLICATIONS FOR RESEARCH: The strong psychometric properties of the EFS support its use in future research.

Heart Rate Variability as a Feeding Intervention Outcome Measure in the Preterm Infant.

BACKGROUND: Feeding interventions for preterm infants aim to reduce the physiologic stress of feeding to promote growth. Heart rate variability (HRV) is a potential noninvasive measure of physiologic stress that may be useful for evaluating efficacy of feeding interventions. PURPOSE: To evaluate whether HRV is a sensitive measure of physiologic stress compared with standard physiologic outcomes in the context of a feeding intervention study. METHODS: This was a secondary analysis of a within-subjects, cross-over design study comparing usual care feeding with a gentle, coregulated (CoReg) feeding approach in 14 infants born less than 35 weeks' postmenstrual age. HRV indices were calculated from electrocardiogram data and compared with standard physiologic outcomes, including oxygen saturation (Spo2), respiratory rate (RR), apnea, heart rate (HR), and bradycardia. Data were analyzed using linear mixed modeling. RESULTS: Infants fed using the CoReg approach had fewer apneic events and higher RR, suggesting they were able to breathe more during feeding. No statistically significant differences were found in SpO2, HR, bradycardia, or high frequency power (the most commonly reported measure of HRV). Infants fed using the usual care approach had significantly higher SD12, a measure of HRV indicating randomness in the HR, which is a potential indicator of elevated stress. IMPLICATIONS FOR PRACTICE: SD12 was more sensitive to stress than SpO2, HR, and bradycardia. The utility of HRV as a measure of feeding outcomes in clinical practice needs further exploration. IMPLICATIONS FOR RESEARCH: Further exploration of HRV as an intervention outcome measure is needed, particularly evaluating nonlinear indices, such as SD12.

Feeding problems in infancy and early childhood: evolutionary concept analysis.

AIM: The aim of this study was to report an analysis of the concept of pediatric feeding problems. BACKGROUND: Reviews of the literature on pediatric feeding problems and disorders repeatedly reference the lack of a shared conceptualization of feeding problems. It is difficult to track aetiology, prevalence and incidence of a phenomenon when available definitions and diagnoses lack practical utility. DESIGN: An evolutionary concept analysis. DATA SOURCES: A search was conducted in October 2014 of Google Scholar, CINAHL, PubMed and Web of Science databases, with MeSH terms and key words including: failure to thrive, feeding disorder/difficulty/problems, infantile anorexia, oral aversion, mealtime behaviour and dysphagia. Inclusion criteria were: subject of feeding problems, index children 0-10 years of age, English language and full text. METHODS: The articles (n = 266) were sorted into disciplines of authorship, including Psychology, Medicine, Nursing, Nutrition, Occupational Therapy, Speech Language Pathology or Other. The sample was divided into a historical sample (n = 42) for pre-2000 articles and current for those published post-2000. The current sample was later reduced to 100 and coded for surrogate terms, related concepts, attributes, antecedents and consequences. RESULTS: The historical view of pediatric feeding problems shows a tradition of mother blame or parental culpability, both direct and indirect. Currently, there exist many different definitions and typologies, but none have sound validity or generalizability. Areas of attribute consensus across disciplines are problematic feeding behaviours and selective or restrictive intake. CONCLUSION: A spectrum conceptualization of feeding problems is suggested for further development, with attributes that would be critical to have a feeding problem.

Effects of milk flow on the physiological and behavioural responses to feeding in an infant with hypoplastic left heart syndrome.

Infants with hypoplastic left heart syndrome often experience difficulty with oral feeding, which contributes to growth failure, morbidity, and mortality. In response to feeding difficulty, clinicians often change the bottle nipple, and thus milk flow rate. Slow-flow nipples have been found to reduce the stress of feeding in other fragile infants, but no research has evaluated the responses of infants with hypoplastic left heart syndrome to alterations in milk flow. The purpose of this study was to evaluate the physiological and behavioural responses of an infant with hypoplastic left heart syndrome to bottle feeding with either a slow-flow (Dr. Brown's Preemie) or a standard-flow (Dr. Brown's Level 2) nipple. A single infant was studied for three feedings: two slow-flow and one standard-flow. Oral feeding, whether with a slow-flow or a standard-flow nipple, was distressing for this infant. During slow-flow feeding, she experienced more coughing events, whereas during standard-flow she experienced more gagging. Disengagement and compelling disorganisation were most common during feeding 3, that is slow-flow, which occurred 2 days after surgical placement of a gastrostomy tube. Clinically significant changes in heart rate, oxygen saturation, and respiratory rate were seen during all feedings. Heart rate was higher during standard-flow and respiratory rate was higher during slow-flow. Further research is needed to examine the responses of infants with hypoplastic left heart syndrome to oral feeding and to identify strategies that will support these fragile infants as they learn to feed. Future research should evaluate an even slower-flow nipple along with additional supportive feeding strategies.

The Neonatal Eating Assessment Tool: Development and Content Validation.

PURPOSE: To develop and content validate the Neonatal Eating Assessment Tool (NeoEAT), a parent-report measure of infant feeding. DESIGN: The NeoEAT was developed in three phases. Phase 1: Items were generated from a literature review, available assessment tools, and parents' descriptions of problematic feeding in infants.Phase 2: Professionals rated items for relevance and clarity. Content validity indices were calculated. Phase 3: Parent understanding was explored through cognitive interviews. SAMPLE: Phase 1: Descriptions of infant feeding were obtained from 12 parents of children with diagnosed feeding problems and 29 parents of infants younger than seven months. Phase 2: Nine professionals rated items. Phase 3: Sixteen parents of infants younger than seven months completed the cognitive interview. MAIN OUTCOME VARIABLE: Content validity of the NeoEAT. RESULTS: Three versions were developed: NeoEAT Breastfeeding (72 items), NeoEAT Bottle Feeding (74 items), and NeoEAT Breastfeeding and Bottle Feeding (89 items).

Postdischarge Feeding Interactions and Neurodevelopmental Outcome at 1-Year Corrected Gestational Age.

OBJECTIVE: To determine the extent to which postdischarge feeding behaviors and interactions among caregiver-preterm infant dyads are associated with infant neurodevelopment at 1-year corrected gestational age (CGA). STUDY DESIGN: We studied 119 preterm infants born <34 weeks gestation and <1750 g at birth, and their caregivers, enrolled in the Collaborative Home Infant Monitoring Evaluation with in-person feeding assessments according to the Nursing Child Assessment Feeding Scale (NCAFS) at 39-59 weeks postmenstrual age that completed Bayley Scales of Infant Development, Second Edition testing at 1 year CGA. RESULTS: Mean ± SD gestational age was 29.6 ± 2.4 weeks, and birth weight was 1260 ± 320 g. After adjustment for maternal and infant demographics, gestational age at birth, discharge and birth weight, mode of infant feeding, and caregiver type during the postdischarge NCAFS assessment, overall NCAFS scores were positively associated with higher 1-year CGA Bayley mental developmental index (MDI) scores (for each 1 SD increase in overall NCAFS score, MDI increased by 2.8 [95% CI 0.7, 4.9] points). Among individual NCAFS domains, strongest effects were seen for caregiver responsiveness to infant distress, such that, compared with dyads having domain scores of 11 (highest possible score), the adjusted mean difference in MDI was 8.3 points (95% CI -15.2, -1.4) lower among dyads with scores <9. CONCLUSIONS: Caregiver-preterm infant feeding interaction and caregiver responsiveness to preterm infant feeding distress were associated with preterm infant Bayley MDI at 1-year CGA. Caregiver-infant feeding interaction may represent a modifiable factor to improve the neurodevelopment of at-risk preterm infants.