Feeding problems are recognized as a challenging issue faced by many preterm infants during infancy and early childhood. While in the neonatal intensive care unit (NICU), preterm infants often experience high rates of cerebral abnormalities and physiological immaturity, resulting in neurobehavioral dysfunction . This neurobehavioral dysfunction can result in difficulties in achieving the essential skills needed for successful oral feeding, including state regulation, motor organization, rhythmical sucking, and the ability to coordinate a suck-swallow-breath pattern. The invasive medical complications associated with preterm birth can further compromise feeding behavior by delaying the initiation and advancement to full oral feeds, decreasing opportunities for positive oral experiences, and altering feeding experiences for very preterm infants . Finally, delays in the attainment of full oral feeds can result in psychological distress amongst mothers, altering the mother-infant relationship.
While early medical, environmental, and parental factors have been identified as causes of feeding problems in preterm infants, only a few studies have examined the neonatal factors associated with feeding outcome in early childhood. These studies found associations with prolonged days on nasogastric/orogastric (NG/OG) feeds and longer periods of intubation and poor feeding outcome in preterm infants. Further, some studies have found high rates of poor feeding outcome in preterm infants with cerebellar injury and full term infants with basal ganglia injury. However, there is a paucity of research investigating specific regions of the brain that may be related to feeding outcome in the preterm infant.
The aim of the present study was to investigate the relationship between feeding problems at age two years corrected age and 1) NICU medical and environmental factors, 2) neurobehavioral functioning and feeding at term equivalent age, 3) cerebral structure on magnetic resonance imaging (MRI) at term equivalent age, and 4) maternal mental health and socio-demographics at NICU discharge. We hypothesized that infants with more medical complications, specifically those with lower gestational age and with longer periods of oral intubation, and those born to mothers subject to high levels of stress and anxiety at discharge would have more feeding problems at age two years.
NEW WORDS: https://quizlet.com/290533936/factors-associated-with-infant-feeding-difficulties-in-the-very-preterm-infant-flash-cards/
Normal fetal growth is a critical component of a healthy pregnancy and influences the long-term health of the offspring. Common adult diseases such as type 2 diabetes and cardiovascular conditions have been linked to abnormal fetal growth, particularly fetal growth restriction (FGR).1 However, the latter has not been clearly defined. The American College of Obstetricians and Gynecologists Practice Bulletin2 states: “Intrauterine growth restriction is one of the most common and complex problems in modern obstetrics. Diagnosis and management are complicated by the use of ambiguous terminology and a lack of uniform diagnostic criteria…… Size alone is not an indication of a complication. As a result of this confusion, underintervention and overintervention can occur.” Therefore, an objective assessment of normal and abnormal fetal growth has enormous utility in prenatal and neonatal care and outcome-based research. The purpose of this review is to summarize literature on the definition of abnormal fetal growth that go beyond simple fetal size.
Currently, estimated fetal weight (EFW) or birthweight below the 10th percentile of certain reference at a given gestational week is commonly defined as small for gestational age (SGA).3 EFW or birthweight < 5th or < 3rd percentiles are also used. Regardless of which percentile is applied, a reference or standard is required. A population reference is often established based on a large sample size (ideally representing the underlying population) using a study population including both low-risk and high-risk pregnancies, and both normal and abnormal perinatal outcomes. On the other hand, a standard is usually based on low-risk pregnancies with a normal outcome. When the population reference and the standard are applied to an individual fetus or infant, interpretation of the findings differs. Use of a population reference will yield a relative fetal size in relation to the total population, while a standard will assess a fetal size in comparison to normally-grown fetuses. Thus, a standard may have more clinical utility than a population reference.
NEW WORDS: https://quizlet.com/290535398/defining-normal-and-abnormal-fetal-growth-promises-and-challenges-flash-cards/
THS.BS Nguyễn Thái Duy
Anh Văn Y Khoa DR.DUY