Despite increasing technologic advances and improved care, approximately 10-20% of all preterm infants with birth weights less than 1500 grams will experience some degree of neurologic morbidity which includes developmental and behavioral problems. Nevertheless, it has not been possible to predict who among the seemingly healthy preterm infants are at most risks for later neurologic sequelae. In the newborn period, the standard assessment techniques in current use such as the neurologic examination or neurobehavioral assessments are able to distinguish infants with flagrant abnormalities. However, there are other infants who may appear grossly normal, but who later develop a variety of developmental or behavioral problems.
Objective: To examine the relationship between feeding behaviors in the early weeks of life and developmental outcomes at 6 and 12 months corrected age.
Population: One hundred and two preterm infants with a mean gestational age of 30.21 ± 2.90 weeks, mean birthweight of 1455.41± 468.22 grams, mean length of stay of 44.13 ± 32.62 days, and mean maternal age of 28.17 ± 6.99 years were studied between the years 1995-2000 from two large urban medical centers.
Concepts: Feeding behaviors and neurobehavioral development
Methods: Kron Nutritive Sucking Apparatus and the Bayley Scales of Infant Development (BSID). The Kron Nutritive Sucking Apparatus examines the following sucking parameters: the number of sucks, number of bursts, number of sucks per burst, interburst width, suck width, intersuck width and the mean maximum pressure per suck. Infant sucking behaviors were evaluated at 34 and 40 weeks post-conceptional age (PCA). The BSID were completed at 6 and 12 months corrected age.
Findings: Simple linear regression was used to examine the correlation between the 6 and 12 month BSID with feeding variables completed at 34 and 40 weeks PCA. At 6 months corrected gestational age (CGA) there were significant correlations between the number of sucks (p=.13), intersuck width (p=.09), birth weight and length of stay with the Psychomotor Developmental Index (PDI). The Mental Developmental Index (MDI) was significantly correlated with only the demographic variables of gestational age, birth weight, length of stay and race. At 12-months, MDI and PDI were significantly correlated with a variety of feeding parameters as measured at 34 weeks and 40 weeks (PCA). Twelve month PDI was positively correlated with the number of sucks (p=.007),intersuck width (p=.006), number of sucks per burst (p=.01) as well as gestational age at birth, birth weight and length of stay at 34 weeks ost-conceptional age (PCA). Twelve month MDI was also positively correlated with the length of stay, number of sucks (p=.01), intersuck width (p=.01) and 34 weeks PCA. Likewise, at 40 week (PCA), the number of sucks (p=.03), number of bursts (p=.022), sucks/bursts (p=.001), intersuck width (p=.01), and suck width (p=.03), as well as gestational age, birthweight and length of stay were significantly correlated with 12 month PDI. Number of sucks (p=.01), intersuck width (p=.016), number of sucks per burst (p=.022), suck width (p=.18) at 40 weeks (PCA) and gestational age and length of stay were significantly correlated with PDI at 12 months of age. Six month mean PDI and MDI were 84.1 ± 12.9 and 89.1 ± 10.7 respectively. At 12 months mean PDI and MDI were 88.34 ± 17.15 and 90.9 ± 13.2 respectively.
Conclusion: This is one of the first studies to demonstrate the noteworthy relationship between feeding behaviors and developmental outcomes in preterm infants during the first year of life. From these data we can conclude that preterm infant feeding organization appears to be an excellent index of developmental progress during the first year of life. However, it is the feeding at 40 weeks PCA that is the most powerful predictor of development at 12 months corrected gestational age.
Implications: These findings provide confirmatory evidence of the importance of feeding organization as a measure of neurobehavioral competence in the preterm infant, and should be considered an integral component of nursing practice.
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