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Key issues in supporting transition from tube to bottle feeding
Gillian KennedyConsultant Speech and Language
TherapistNIDCAP Trainer in trainingNeonatal UnitUniversity College London HospitalLondon.
.......por lo tanto
-Baby
-Maternal
-System(hospital /
social)
Key issues in supporting transition from tube to bottle feeding
Early input to redress negative peri-oral stimuli
Negative• Intubation• Suction• CPAP• Feeding tubes
Positive– Skin to skin / kangaroo –
mother care– PositiveTouch
Bond 1997
Influence of tube feeding
OGT
NGT
•Rate of flow•Contact with baby•Position of baby
Strategies to promote oral feeding have included:
Early introduction of oral feeds Oral stimulation programmes
Boiron et al 2007
Fucile et al 2002
Barlow 2009
31 weeks vs. 33-34 weeks ga Simpson et al 2002
Specific feeding techniques e.g. cheek and jaw support
Eishema 1991
Quantative outcome measures related to..
• Volume • length of feed• Speed of transfer from
tube oral feeding– e.g.
Entire prescribed volume taken within 20 mins without adverse effects......
Usually defined as apnoeic +/-bradycardic episodes
Influence of individualised care..based in NIDCAP approach Als 1982
Shift in feeding outcome focus from..
Quantative
Qualitative
Als Synactive Theory of Development
• Physiological• Motor• State• Attention / interaction
• Self regulatory
Focussing on the feeding experience for the baby
• Baby viewed as an active participant
• Co-regulation from the parent / carer to:– Facilitate and support
the baby’s own efforts– identify and respond to
the baby’s signals of sensitivity
Feeding readiness behavioursWhite-Traut et al 2005
Thoyre et al 2005• Alert – baby demonstrates the
ability to focus attention on feeding
• Rooting– Neurodevelopmental readiness
Shaker 1996
• Tongue organised to receive nipple
• Body posture orientates to midline – arms forward to assist
• > 90 % baseline oxygen saturation level in quiet state and in preparation period.
34-36 week infants
• Feeding issues for late preterm infants:
Bottle and Breast fed
Dodrill et al 2005
Meier et al 2007
Babies with Chronic Lung Disease• Anticipated maturational patterns of
suckle and swallow rhythms do not occur.
• ?does the absence of stable rhythms at 35 weeks predict subsequent feeding and neurological problems
Gewolb et al 2001
• > incidence in gastro-intestinal issues Jadcherla et al 2010
• > incidence of feeding difficultiesHawdon et al 2000
Modifications to introduction of oral intake for bottle fed babies weaned from long term CPAP
• EBM used for initial trialMizuno & Ueda 2002
• Elevated side-lying position used
Positioning is important because:
• Cranio-cervical posture and pharyngeal airway stability are interconnected
• Premature infant lacks the éxoskeleton’ and strong physiological flexor of the term infant.
Bosma 1972• Feeding success strongly
influenced by the feeders body mechanics
Jones et al 2002
Positioning
Elevated side lying
• Conserves energy• Affords baby more control
over feed• Facilitates infant using
self-regulatory strategies• Enables safer clearance of
oral residue• Allows feeder to feel
respiration
Pilot study investigating the elevated side-lying position Clark et al 2007
• Improved oxygen saturation levels……..when infants fed in elevated side-lying versus semi-upright
p < 0.001Trend • Quicker return to baseline of heart- rate
Further research presently underway
