Factors Associated With Feeding Progression in Extremely Preterm Infants

Background: Among infants born prematurely, competence at oral feeding is necessary for growth and hospital discharge. Extremely preterm (EP) infants (28 weeks of gestational age [ GA]) are at risk for a variety of medical complications, which can limit the infant's capacity to develop oral feeding competence. Objective: This study examined feeding progression by assessing timing of acquisition of five early feeding milestones among EP infants and the impact of immaturity and medical complications. Design: A chart review was conducted for 94 EP infants who participated in a larger longitudinal randomized study. Feeding progression was defined as infants' postmenstrual age (PMA) at five milestones: first enteral feeding, full enteral feeding, first oral feeding, half oral feeding, and full oral feeding. GA at birth and five medical complications (neurological risk, bronchopulmonary dysplasia, necrotizing enterocolitis, patent ductus arteriosus, and gastroesophageal reflux disease) were used as potential factors influencing the feeding progression. Linear mixed models were used to examine feeding progression across the milestones and contributions of GA at birth and five medical complications on the progression, after controlling for milk type as a covariate. Result: EP infants gradually achieved feeding milestones; however, the attainment of the feeding milestones slowed significantly for infants with younger GA at birth and the presence of medical complications, including neurological risk, bronchopulmonary dysplasia, necrotizing enterocolitis, and patent ductus arteriosus but not gastroesophageal reflux disease. Milk type was a significant covariate for all analyses, suggesting that infants fed with breast milk achieved each of five milestones earlier than formula-fed infants. Discussion: Improved understanding of the timing of essential feeding milestones among EP infants and the contribution of specific medical conditions to the acquisition of these milestones may allow for more targeted care to support feeding skill development.