Baylor

Attainment of independent oral feeding being one of the discharge criteria recommended by the American Academy of Pediatrics, hospital discharge of infants who have difficulties transitioning from tube to oral feeding is often delayed. In addition to prolonged hospitalization, such difficulty leads to delayed mother-infant reunion and increased medical cost. The latter concern has pressured caretakers in accelerating the advancement of oral feedings without necessarily evaluating its appropriateness for individual patients. Poor oral feeding may result from immature oral-motor skills, disorganized or delayed swallowing, respiratory incompetence, and/or incoordination of sucking, swallowing, and respiration. The latter is essential if these infants are to feed safely and successfully. Safety is defined as no sings of aspiration, bradycardia, and/or oxygen desaturation. Success is defined as the ability to complete all their feedings by mouth within an allotted time with adequate daily weight gain (>/= 15g/kg/day). If attainment of independent oral feeding is difficult for medically stable infants born prematurely, it is even more difficult for those with chronic conditions such as bronchopulmonary dysplasia,intraventricular hemorrhage, and/or infants born with congenital heart anomalies. Over the last 10 years, we have developed a device that allows for the simultaneous monitoring of sucking, swallowing, and respiration. With it, we have been able to characterize the development of sucking skills in preterm infants born < 30 weeks gestation (GA), measure the amplitude of the suction and expression components of sucking (mmHg), the "maturation" of swallow-respiratory interfacings over time, i.e., the respiratory phase(s) during which swallowing most frequently occurs and compared these measures with those of healthy term infants, the values of which were used as "gold standards".The purpose of this protocol is to identify measures indicative of suck-swallow and swallow-breathe coordination in medically stable infants (preterm and term) and in infants with chronic conditions, specifically,bronchopulmonary dysplasia (BPD) defined as oxygen required at 36 weeks postmenstrual age, intraventricular hemorrhage (IVH) grade III and IV, diaphragmatic hernia, and congenital heart anomalies. It is hypothesized that with knowledge of coordinated and in-coordinated suck-swallow and swallow-breathe, interventions can be developed to compensate/correct for in-coordination(s) of these 3 functions so as to enhance infants' oral feeding performance.

To identify measures of suck-swallow and swallow-breathe coordination in medically stable preterm and term infants and to compare these measures to those of infants with chronic medical conditions, i.e., BPD, IVH grade III and IV, diaphragmatic hernia, and/or congenital heart anomalies. It is expected that such comparisons will help identify the components of sucking, swallowing, respiration, and/or their degree of coordination, which impede safe and successful oral feeding in these infants. It is expected that such information will facilitate the development of appropriate interventions to enhance/facilitate oral feeding in hospitalized infants.

Pilot

Oral feeding will be offered by the regular caretaker. These evaluations will be conducted so as not to interfere with any other procedures. These studies are not intensive nor invasive to the subjects based on our having monitored over 300 infants in the last 10 years. If indication of overstimulation is observed, oral feeding will be halted.

The subjects will not benefit from this study.