Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Inadequate oral feeding as a barrier to discharge in moderately preterm infants

Journal of Perinatology volume 39, pages 1219–1228 (2019)Cite this article

Subjects

Abstract

Objectives

The objectives describe the frequency that inadequate oral feeding (IOF) is the reason why moderately preterm (MPT) infants remain hospitalized and its association with neonatal morbidities.

Study design

Prospective study using the NICHD Neonatal Research Network MPT Registry. Multivariable logistic regression was used to describe associations between IOF and continued hospitalization at 36 weeks postmenstrual age (PMA).

Result

A total of 6017 MPT infants from 18 centers were included. Three-thousand three-seventy-six (56%) remained hospitalized at 36 weeks PMA, of whom 1262 (37%) remained hospitalized due to IOF. IOF was associated with RDS (OR 2.02, 1.66–2.46), PDA (OR 1.86, 1.37–2.52), sepsis (OR 2.36, 95% 1.48–3.78), NEC (OR 16.14, 7.27–35.90), and BPD (OR 3.65, 2.56–5.21) compared to infants discharged and was associated with medical NEC (OR 2.06, 1.19–3.56) and BPD (OR 0.46, 0.34–0.61) compared to infants remaining hospitalized for an alternative reason.

Conclusion

IOF is the most common barrier to discharge in MPT infants, especially among those with neonatal morbidities.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Eichenwald EC, Blackwell M, Lloyd JS, Tran T, Wilker RE, Richardson DK. Inter-neonatal intensive care unit variation in discharge timing: influence of apnea and feeding management. Pediatrics. 2001;108:928–33.

    Article  CAS  Google Scholar 

  2. Bakewell-Sachs S, Medoff-Cooper B, Escobar GJ, Silber JH, Lorch SA. Infant functional status: the timing of physiologic maturation of premature infants. Pediatrics. 2009;123:e878–86.

    Article  Google Scholar 

  3. Lau C. Oral feeding in the preterm infant. NeoReviews. 2006;7:e19–e27.

    Article  Google Scholar 

  4. Mizuno K, Ueda A. Neonatal feeding performance as a predictor of neurodevelopmental outcome at 18 months. Dev Med Child Neurol. 2005;47:299–304.

    Article  Google Scholar 

  5. Torola H, Lehtihalmes M, Yliherva A, Olsen P. Feeding skill milestones of preterm infants born with extremely low birth weight (ELBW). Infant Behav Dev. 2012;35:187–94.

    Article  Google Scholar 

  6. Arvedson J, Clark H, Lazarus C, Schooling T, Frymark T. Evidence-based systematic review: effects of oral motor interventions on feeding and swallowing in preterm infants. Am J Speech-Lang Pathol. 2010;19:321–40.

    Article  Google Scholar 

  7. Cotten CM, Oh W, McDonald S, Carlo W, Fanaroff AA, Duara S, et al. Prolonged hospital stay for extremely premature infants: risk factors, center differences, and the impact of mortality on selecting a best-performing center. J Perinatol. 2005;25:650–5.

    Article  Google Scholar 

  8. March of Dimes. http://marchofdimes.org. Accessed 17 Aug 2018.

  9. Walsh MC, Bell EF, Kandefer S, Saha S, Carlo WA, D’Angio CT, et al. Neonatal outcomes of moderately preterm infants compared to extremely preterm infants. Pediatr Res. 2017;82:297–304.

    Article  Google Scholar 

  10. Brumbaugh JE, Colaizy TT, Saha S, Van Meurs KP, Das A, Walsh MC, et al. Oral feeding practices and discharge timing for moderately preterm infants. Early Hum Dev. 2018;120:46–52.

    Article  Google Scholar 

  11. Pridham K, Steward D, Thoyre S, Brown R, Brown L. Feeding skill performance in premature infants during the first year. Early Hum Dev. 2007;83:293–305.

    Article  Google Scholar 

  12. Blackwell MT, Eichenwald EC, McAlmon K, Petit K, Linton PT, McCormick MC, et al. Interneonatal intensive care unit variation in growth rates and feeding practices in healthy moderately premature infants. J Perinatol. 2005;25:478–85.

    Article  Google Scholar 

  13. Merritt TA, Pillers D, Prows SL. Early NICU discharge of very low birth weight infants: a critical review and analysis. Semin Neonatol. 2003;8:95–115.

    Article  Google Scholar 

  14. Pridham K, Saxe R, Limbo R. Feeding issues for mothers of very low-birth-weight, premature infants through the first year. J Perinat Neonatal Nurs. 2004;18:161–9.

    Article  Google Scholar 

  15. DeMauro SB, Patel PR, Medoff-Cooper B, Posencheg M, Abbasi S. Postdischarge feeding patterns in early- and late-preterm infants. Clin Pediatr. 2011;50:957–62.

    Article  Google Scholar 

  16. Collins CT, Makrides M, McPhee AJ. Early discharge with home support of gavage feeding for stable preterm infants who have not established full oral feeds. Cochrane Database Syst Rev. 2003;Cd003743.

  17. Meerlo-Habing ZE, Kosters-Boes EA, Klip H, Brand PL. Early discharge with tube feeding at home for preterm infants is associated with longer duration of breast feeding. Arch Dis Child Fetal Neonatal Ed. 2009;94:F294–7.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the National Center for Advancing Translational Sciences provided grant support for the Neonatal Research Network’s Moderate Preterm Registry through cooperative agreements. While NICHD staff did have input into the study design, conduct, analysis, and paper drafting, the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Duke University, Durham, NC, 27708, USA

    Laura Edwards, C. Michael Cotten, P. Brian Smith, Ronald Goldberg & William F. Malcolm

  2. WakeMed Health and Hospitals, Raleigh, NC, 27610, USA

    Laura Edwards

  3. Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, 27709, United States

    Shampa Saha

  4. Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD, 27709, USA

    Abhik Das

  5. Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, RI, 02912, USA

    Abbot R. Laptook & Betty R. Vohr

  6. Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, 30322, USA

    Barbara J. Stoll

  7. Department of Pediatrics, University of Iowa, Iowa City, IA, 52242, USA

    Edward F. Bell

  8. Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA

    Waldemar A. Carlo

  9. University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA

    Carl T. D’Angio

  10. Department of Pediatrics, The Children’s Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, PA, 19104, USA

    Sara B. DeMauro

  11. Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, 43205, USA

    Pablo J. Sanchez

  12. Department of Pediatrics, Wayne State University, Detroit, MI, 48202, USA

    Seetha Shankaran

  13. Department of Pediatrics, Division of Neonatal and Developmental Medicine, Lucile Packard Children’s Hospital, Stanford University School of Medicine, Palo Alto, CA, 94305, USA

    Krisa P. Van Meurs

  14. Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH, 44106, USA

    Michele C. Walsh

Authors
  1. Laura Edwards
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Michael Cotten
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Brian Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ronald Goldberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shampa Saha
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Abhik Das
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Abbot R. Laptook
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Barbara J. Stoll
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Edward F. Bell
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Waldemar A. Carlo
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Carl T. D’Angio
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Sara B. DeMauro
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Pablo J. Sanchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Seetha Shankaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Krisa P. Van Meurs
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Betty R. Vohr
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Michele C. Walsh
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. William F. Malcolm
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the Eunice Kennedy Shriver National Institute of Child Health and Human Development

Contributions

Dr. LE conceptualized and designed the study, drafted the initial paper, and approved the final paper as submitted. Drs. MC, BS, RG, and WM critically revised the initial proposal, reviewed the data and reviewed and revised the paper and approved the final paper as submitted. Drs. AD, AL, BS, EB, WC, CA, SD, PS, SS, KVM, BV, MW, and Miss Newman served on the committee that developed and managed the Moderate Preterm Registry; each of them reviewed and revised the paper and approved the final paper as submitted. Dr. SS carried out the initial data analyses, reviewed, and revised the paper, and approved the final paper as submitted.

Corresponding author

Correspondence to William F. Malcolm.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

*A complete list of non-author contributors appears in Appendix 1.

Appendix 1: Collaborators

Appendix 1: Collaborators

The following members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development are non-author contributors.

Alpert Medical School of Brown University and Women and Infants Hospital of Rhode Island (U10 HD27904)–Martin Keszler, MD; Angelita M. Hensman, MS RNC-NIC BSN; Elisa Vieira, RN BSN.

Case Western Reserve University, Rainbow Babies and Children's Hospital (U10 HD21364, M01 RR80)–Anna Marie Hibbs, MD; Nancy S. Newman, RN; Bonnie S. Siner, RN.

Children's Mercy Hospital (U10 HD68284)–William E. Truog, MD; Eugenia K. Pallotto, MD MSCE; Howard W. Kilbride MD; Cheri Gauldin, RN MSN CCRC; Anne Holmes RN MSN MBA-HCM CCRC; Kathy Johnson RN, CCRC.

Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical Center, and Good Samaritan Hospital (U10 HD27853, UL1 TR77)–Brenda B. Poindexter, MD MS; Kurt Schibler, MD; Suhas G. Kallapur, MD; Cathy Grisby, BSN CCRC; Barbara Alexander, RN; Estelle E. Fischer, MHSA MBA; Lenora Jackson, CRC; Kristin Kirker, CRC; Jennifer Jennings, RN BSN; Sandra Wuertz, RN BSN CLC; Greg Muthig, BA.

Duke University School of Medicine, University Hospital, University of North Carolina, and Duke Regional Hospital (U10 HD40492, UL1 TR1117, UL1 TR1111)–Ronald N. Goldberg, MD; Joanne Finkle, RN JD; Kimberley A. Fisher, PhD FNP-BC IBCLC; Matthew M. Laughon, MD MPH; Carl L. Bose, MD; Janice Bernhardt, MS RN; Cindy Clark, RN.

Emory University, Children’s Healthcare of Atlanta, Grady Memorial Hospital, and Emory University Hospital Midtown (U10 HD27851, UL1 TR454)–David P. Carlton, MD; Ellen C. Hale, BS RN CCRC; Yvonne Loggins, RN; Diane I. Bottcher, RN MSN.

Eunice Kennedy Shriver National Institute of Child Health and Human Development–Rosemary D. Higgins, MD; Stephanie Wilson Archer, MA.

Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children at Indiana University Health, and Eskenazi Health (U10 HD27856, UL1 TR6)–Greg Sokol, MD; Dianne E. Herron, RN.

Nationwide Children’s Hospital and the Ohio State University Medical Center (U10 HD68278)–Leif D. Nelin, MD; Sudarshan R. Jadcherla, MD; Patricia Luzader, RN; Nehal A. Parikh, DO MS; Marliese Dion Nist, BSN; Jennifer Fuller, MS RNC; Julie Gutentag, BSN; Marissa E. Jones, RN MBA; Sarah McGregor, BSN RNC; Elizabeth Rodgers, BSN; Jodi A. Ulloa, MSN APRN NNP-BC; Tara Wolfe, BSN.

RTI International (U10 HD36790)–Dennis Wallace, PhD; Kristin M. Zaterka-Baxter, RN BSN CCRP; Margaret Crawford, BS CCRP; Jenna Gabrio, BS CCRP; Sarah Kandefer, BS; Jeanette O’Donnell Auman, BS.

Stanford University and Lucile Packard Children's Hospital (U10 HD27880, UL1 TR93)–David K. Stevenson, MD; M. Bethany Ball, BS CCRC; Melinda S. Proud, RCP.

University of Alabama at Birmingham Health System and Children’s Hospital of Alabama (U10 HD34216)–Namasivayam Ambalavanan, MD; Monica V. Collins, RN BSN MaEd; Shirley S. Cosby, RN BSN.

University of California—Los Angeles, Mattel Children's Hospital, Santa Monica Hospital, Los Robles Hospital and Medical Center, and Olive View Medical Center (U10 HD68270)–Uday Devaskar, MD; Meena Garg, MD; Teresa Chanlaw, MPH; Rachel Geller, RN BSN.

University of Iowa and Mercy Medical Center (U10 HD53109, UL1 TR442)–Tarah T. Colaizy, MD MPH; Dan L. Ellsbury, MD; Jane E. Brumbaugh, MD; Karen J. Johnson, RN BSN; Donia B. Campbell, RNC-NIC; Jacky R. Walker, RN.

University of New Mexico Health Sciences Center (U10 HD53089, UL1 TR41)–Kristi L. Watterberg, MD; Robin K. Ohls, MD; Conra Backstrom Lacy, RN; Sandy Sundquist Beauman, MSN RNC-NIC; Carol Hartenberger, MPH, RN CCRC.

University of Pennsylvania, Hospital of the University of Pennsylvania, Pennsylvania Hospital, and Children's Hospital of Philadelphia (U10 HD68244)–Barbara Schmidt, MD; Haresh Kirpalani, MB MSc; Sara B. DeMauro, MD MSCE; Noah Cook, MD; Aasma S. Chaudhary, BS RRT; Soraya Abbasi, MD; Toni Mancini, RN BSN CCRC; Dara Cucinotta.

University of Rochester Medical Center, Golisano Children's Hospital, and the University of Buffalo Women's and Children's Hospital of Buffalo (U10 HD68263, UL1 TR42)–Satyan Lakshminrusimha, MD; Ronnie Guillet, MD PhD; Ann Marie Scorsone, MS; Julianne Hunn, BS; Rosemary Jensen; Holly I.M. Wadkins, MA; Stephanie Guilford, BS; Ashley Williams, M.S. Ed.

University of Texas Southwestern Medical Center at Dallas, Parkland Health & Hospital System, and Children's Medical Center Dallas (U10 HD40689)–Myra Wyckoff, MD; Luc P. Brion, MD; Diana M. Vasil, RNC-NIC; Lijun Chen, PhD RN; Lizette E. Torres, RN.

University of Texas Health Science Center at Houston Medical School and Children's Memorial Hermann Hospital (U10 HD21373)–Kathleen A. Kennedy, MD MPH; Jon E. Tyson, MD MPH; Julie Arldt-McAlister, RN BSN; Carmen Garcia, RN CCRP; Karen Martin, RN; Georgia E. McDavid, RN; Sharon L. Wright, MT (ASCP).

Wayne State University, University of Michigan, Hutzel Women’s Hospital, and Children’s Hospital of Michigan (U10 HD21385)–Athina Pappas, MD; John Barks, MD; Rebecca Bara, RN BSN; Shelley Handel, AD; Diane F White, RT; Mary Christensen, RT; Stephanie A. Wiggins, MS.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Edwards, L., Cotten, C.M., Smith, P.B. et al. Inadequate oral feeding as a barrier to discharge in moderately preterm infants. J Perinatol 39, 1219–1228 (2019). https://doi.org/10.1038/s41372-019-0422-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-019-0422-x

This article is cited by

Search

Advanced search

Quick links