The American Journal of Occupational Therapy, Vol. 73, No.

4_Supplement_1, August 2019

Early Feeding Behaviors in Preterm Infants and Their Relationships to

Neurobehavior
Molly Grabill, Roberta Pineda, PhD, OTR/L, Kylie VanRoekel
Washington University School of Medicine, St. Louis, MO, USA

Downloaded from http://research.aota.org/ajot/article-pdf/73/4_Supplement_1/7311500021p1/71993/po7002.pdf by Integracion Sensorial Acis, Adriana Ramirez on 12 November 2022
DOI: 10.5014/ajot.2019.73S1-PO7002
Date presented: April 6, 2019
Primary Author and Speaker: Molly Grabill, molly.grabill@wustl.edu

PURPOSE: Preterm infants are at risk for altered brain structure and adverse neurodevelopmental outcomes, which can be
exacerbated by medical complications associated with prematurity (Padilla, 2011; Pineda, 2013). Alterations in tone, reflexes and
sensory development can impact the ability to orally feed, which is one of the most complex skills of infancy. Oral feeding requires
contributions of the physiologic, sensory, and neuromotor systems (Jadcherla, 2016). Feeding problems are common in preterm
infants due to their poorly developed central nervous systems. While research suggests a relationship between feeding behaviors
and many neural mechanisms, it remains unclear what connections exist between key neurobehavioral components and feeding
behaviors (Jadcherla, 2016). Continued investigation is necessary to understand this relationship and identify potential markers for
neonatal brain injury and/or adverse developmental outcome. The purpose of this study is to identify relationships between
neurobehavior and early feeding performance in preterm infants.
DESIGN: In this prospective cohort study, 44 preterm infants born ≤32 weeks gestation were consecutively enrolled within the first
week of life at the Level IV NICU at St. Louis Children’s Hospital. Infants with an identified congenital anomaly were excluded.
METHOD: Oral feeding was evaluated with the Neonatal Eating Outcome (NEO) assessment at term-equivalent age (37–42 weeks
postmenstrual age). Infant neurobehavior was also assessed at this time using the NICU Network Neurobehavioral Scale (NNNS).
One-way ANOVA (p<0.05) was used to determine relationships between feeding and neurobehavior.
RESULTS: Of the 44 participants, 25% (n=11) displayed feeding challenges, 50% (n=22) had questionable feeding performance,
and 25% (n=11) displayed normal feeding behavior. Preterm infants who exhibited normal feeding behavior had greater tolerance
of handling (p= 0.040) and decreased hypertonia (p= .026) as compared to preterm infants with feeding challenges.
CONCLUSION: Preterm infants have a high risk of feeding problems. Alterations in neurobehavior appear to relate to alterations in
feeding behaviors. Feeding-related abnormalities may indicate adverse neurodevelopmental outcomes. Feeding problems may
not be in isolation, and a comprehensive approach to rehabilitation that considers oral motor and neurobehavioral alterations may
enable interventions that can optimize outcomes.

References
Padilla, N., et al., Differential effects of intrauterine growth restriction on brain structure and development in preterm infants: a magnetic resonance imaging
study. Brain Res, 2011. 1382: p. 98-108. doi:10.1016/j.brainres.2011.01.032
Pineda, R.G., et al., Patterns of altered neurobehavior in preterm infants within the neonatal intensive care unit. J Pediatr, 2013. 162(3) : p. 470-476 e1. doi:
10.1016/j.jpeds.2012.08.011
Jadcherla, S., Dysphagia in the high-risk infant: potential factors and mechanisms. Am J Clin Nutr, 2016. 103(2): p. 622S-8S. doi:10.3945/ajcn.115.110106

Copyright © 2019 by the American Occupational Therapy Association, Inc.