Learning Objective #1: State the relationship between physiologic manifestations and behavioral outcomes in feeding preterm infants

Learning Objective #2: State clinical implications of physiologic parameters in assessing feeding performance in preterm infants

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The purpose of this study was to examine the relationship of physiological and behavioral aspects of feeding performance in preterm infants. The study is derived from Al's synactive theory of neurobehavioral development, which posits synergistic relationships among various aspects of preterm infant behavior. In particular, the theory assumes that stability in autonomic functioning is necessary for smooth functioning in other areas of neurobehavior that require greater infant involvement with the environment and with caregivers. Data were collected in a longitudinal study of 95 preterm infants who were each observed at 14 daily feedings. Physiological aspects of feeding performance, collected by a computerized data acquisition system, included heart rate (HR) and heart rate variability (HRV), oxygen saturation, and sucking behavior. Behavioral aspects of feeding performance, collected by direct observation, included efficiency (volume/minute) and consumption (percent of prescribed volume consumed). Data were analyzed using general estimating equations and generalized linear models with the repeated measures nature of the data taken into account. Covariates of interest were also examined, including neurological maturation and feeding experience. Physiological and behavioral aspects of feeding performance were significantly correlated. The relationships were affected by both neurologic maturation (post-conceptional age and day of life) and feeding experience (cumulative feeding opportunities). With increased maturation and experience, both physiological and behavioral aspects of feeding performance improved. The findings of the study support the need to examine both physiological and behavioral aspects of phenomena. In preterm infants, this ‘biobehavioral' approach is more complicated and requires thoughtful consideration of appropriate measures. The study has resulted in a model of feeding care that incorporates physiological outcomes with more directly observable behavioral outcomes.