Feeding problems after neonatal care.

Hoogewerf, M. (Marieke) (2014) Feeding problems after neonatal care. thesis, Medicine.

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Abstract

Background: Several factors could affect the feeding skill development of infants admitted to the Neonatal Intensive Care Unit (NICU) and thereby cause feeding problems. It is, however, not clear if feeding problems are more prevalent in a former NICU-population than in a norm-population and which factors are than, stimulating the development of feeding problems. Objective: The aim of this study was to determine the prevalence of feeding problems in a former NICU-population; infants born extremely preterm [< 32 weeks gestational age (GA)], infants with asphyxia at birth, infants with ductus dependent congenital heart defects and infants who suffered from severe infections, and whether clinical factors during NICU-admission increased the risk for developing feeding problems. Design/Methods: This study is an observational cohort study of 202 infants [91 males, 111 females; GA 25-41 weeks (median: 30); birth weight (BW) 1746 grams (SD: 972), with 10.4% (n = 20) small for gestational age] admitted to the NICU of the University Medical Center Groningen during 2011 or 2012. Four groups were formed; infants born extremely preterm < 32 weeks GA (n = 154), infants with asphyxia at birth (n = 9.), infants with ductus dependent congenital heart defects (n = 23) and infants who suffered from severe infections (n = 16). Infants with chromosomal deformations were excluded. The infants were 8 to 28 months (median 12) of corrected age at the time of testing. Parents of these infants completed the screening list eating behavior toddlers (SEP), which is the Dutch translation of the Montreal Children’s Hospital Feeding Scale (MCH-FS) a parent reported questionnaire designed to identify feeding problems, and the oral hypersensitivity (OH)-items, which are developed to detect oral hypersensitivity. The norm-population consisted of 769 infants, obtained from a study sample of 1448 infants, who were tested at the age of 35 – 121 weeks when visiting a local Preventive Child Health Center (consultatiebureau) and were living in the province of Groningen, the Netherlands. Based on the 95th percentile of the scores of the norm-population, cut-off values were generated for the SEP (45.8) and the OH-items (18). As potential risk factors we collected data on GA, BW, the duration of tube feeding (parental report), mechanical ventilation, non-invasive ventilation, NICU-admission, the occurrence of surgical procedures, infantile respiratory distress syndrome (IRDS), necrotizing enterocolitis (NEC), periventricular leukomalacia (PVL), post-hemorrhagic ventricular dilatation (PHVD), intraventricular hemorrhage (IVH), the specific congenital heart defect and the shortened Nursery Neurobiologic Risk Score (NBRS). Results: The results of this study indicate that feeding problems are more prevalent in an ex NICU-population (p < 0.01; Chi-square). Our data suggests that there is no difference in the prevalence of feeding problems between the four groups of infants, admitted to the NICU in the past (p = 0.31; Fisher’s). In a backward multiple logistic regression analysis, the SD-score for BW (OR 3.17; CI 1.14 – 8.85), duration of tube feeding (OR 1.05 ; CI 1.01 – 1.09) and the existence of NEC (OR 10.54; CI 1.04 – 106.36) were predictors for feeding problems in preterm infants, explaining 33.8% of the variance. Conclusion: Our study indicates that feeding problems are more prevalent in a former NICU-population. Our findings suggest that the prevalence does not differ between NICU-admission based on different diagnoses. In preterm born infants feeding problems at 1-2 years of age are associated with low BW for GA, prolonged tube feeding and the existence of NEC. Our findings emphasize the need to carefully monitor the development of the feeding skills in infants admitted to the NICU. This may prevent serious feeding problems later on.

Item Type:	Thesis (Thesis)
Supervisor name:	Bos, prof. dr. A.F.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:52
Last Modified:	25 Jun 2020 10:52
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1261

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