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Be Up-To-Date: NICU Feeding

Case Studies Supported by the Evidence

Be Up-To-Date: NICU Feeding

Case Studies Supported by the Evidence

Louisa Ferrara, PhD CCC-SLP, BCS-S, CNT

Jenny Reynolds, MS CCC-SLP, CLC, CNT, BCS-S

Louisa Ferrara, PhD CCC-SLP, BCS-S, CNT

Jenny Reynolds, MS CCC-SLP, CLC, CNT, BCS-S

DISCLOSURESDISCLOSURES

Louisa Ferrara:

Financial : Employed at NYU Winthrop Hospital & Molloy College

Financial : Advisory Board Member Innara Health

Non-Financial : Board Member NTNCB

Jenny Reynolds:

Financial : Employed at Baylor University Medical Center

Non-Financial : Member of the NPC

Louisa Ferrara:

Financial : Employed at NYU Winthrop Hospital & Molloy College

Financial : Advisory Board Member Innara Health

Non-Financial : Board Member NTNCB

Jenny Reynolds:

Financial : Employed at Baylor University Medical Center

Non-Financial : Member of the NPC

OBJECTIVESOBJECTIVES

As a result of participation in this continuing education activity, participants should be able to:

Summarize recent publications supporting specific feeding or pre-feeding strategies in the NICU population.

Describe why evidence-based practice is crucial for feeding development and later infant outcomes.

Identify one therapeutic strategy you can implement with your management team to establish positive change in your NICU.

As a result of participation in this continuing education activity, participants should be able to:

Summarize recent publications supporting specific feeding or pre-feeding strategies in the NICU population.

Describe why evidence-based practice is crucial for feeding development and later infant outcomes.

Identify one therapeutic strategy you can implement with your management team to establish positive change in your NICU.

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ATTENTION: ADVANCED CLINICIANS ATTENTION: ADVANCED CLINICIANS

Focus not on the techniques, but the rationales so you can improve consistency in your units.

Write down the references so you can share with management to implement unit wide, evidence-based changes.

Think about the gaps in the literature and what you think is missing from an efficacy standpoint.

Value that fact that you already know many of these techniques. Feel good about your practice and strive to improve the practice patterns of others.

Focus not on the techniques, but the rationales so you can improve consistency in your units.

Write down the references so you can share with management to implement unit wide, evidence-based changes.

Think about the gaps in the literature and what you think is missing from an efficacy standpoint.

Value that fact that you already know many of these techniques. Feel good about your practice and strive to improve the practice patterns of others.

FEEDING BEGINS DAY OF LIFE #1

FEEDING BEGINS DAY OF LIFE #1

ORAL FEEDING IN THE NICUORAL FEEDING IN THE NICU

OUR GOAL:

To promote a safe feeding experience for

the infant while supporting the

infant-family dyad through

recognizing strategies to support safety,

growth & neuroprotection

OUR GOAL:

To promote a safe feeding experience for

the infant while supporting the

infant-family dyad through

recognizing strategies to support safety,

growth & neuroprotection

Medical causes of feeding & swallowing disorders

Prematurity

Respiratory

Disorders

Cardiac Disorders

GI Disorders

Neurological

Disorders

Anatomic abnormalities of the aerodigestive tract

Genetic conditio

ns

Maternal and

Perinatal issues

(Lefton-Greif 2008; Dodrill and Gosa 2015)

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ADVOCATING FOR BREAST MILKADVOCATING FOR BREAST MILK

All NICU professionals are charged with ways to promote breastfeeding as the exclusive route to providing nutrition for

their infant. (Nyqvist 2013)

Exclusive use of human milk for the first 6 months of life

(Institute of Medicine, 2011; AAP section of Breastfeeding 2012; World Health Organization 2001))

All NICU professionals are charged with ways to promote breastfeeding as the exclusive route to providing nutrition for

their infant. (Nyqvist 2013)

Exclusive use of human milk for the first 6 months of life

(Institute of Medicine, 2011; AAP section of Breastfeeding 2012; World Health Organization 2001))

World Health Organization/United Nations Children’s Fund Baby-Friendly

Hospital Initiative

(Dodrill et al., 2008; Jadcherla, et al., 2010)

ORAL FEEDING IN THE NICU

Healthy premature infants typically achieve full oral feeding skills

by 36–38 weeks postmenstrual age, & co-morbidities are important

confounders to the acquisition of timely feeding milestones.

Acquisition of independent safe oral feeding

among NICU infants is an essential criterion for hospital discharge as per American

Academy of Pediatrics.

(AAP Committee on Fetus and Newborn, 2008)

STRESS = BRAIN ALTERATIONSSTRESS = BRAIN ALTERATIONS

(Smith et al., 2011)

INCREASED EXPOSURE TO STRESSORS IN THE NICU WAS ASSOCIATED WITH:

• Decreased brain size in the frontal and parietal regions

• Altered brain microstructure

• Altered functional connectivity within the temporal lobes

• Alterations in neuro-behavior at term equivalent

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STRESS CAN CAUSE…STRESS CAN CAUSE…

(Smith et al., 2011)

Abnormal reflex development

Stunts later motor, sensory, psychological and cognitive

development

Stressful procedures prime preterm infant’s system to subsequent

handling, producing heightened responses

to routine handling

Abnormal behavioral response to their environment

LEARNED AVERSIONS

SOOOOO…WHAT ARE YOU TRYING TO SAY?

SOOOOO…WHAT ARE YOU TRYING TO SAY?

LESS STRESS = LESS MORBIDITYLESS STRESS = LESS MORBIDITY

All possibilities should be exploited to

decrease potential stressors

&routine caregiving

tasks should be performed in the

least stressful manner

(Lyngstad et al.,2014)

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RECOGNIZE & INTERPRET BEHAVIORAL STRESS CUES DURING FEEDING

RECOGNIZE & INTERPRET BEHAVIORAL STRESS CUES DURING FEEDING

(Thoyre et al., 2012)

EXTENDED AIRWAY CLOSURE

• Pulling away• Finger splays• Extending arms • Pushing nipple• Eyebrow raise/ Eye

lid flutter • Furrowed brow• Gaze Aversion• Flailing

FLUID THREATS TO THE AIRWAY

• Drooling• Hard swallows • Wet breathing • Multiple swallows• Sputtering• Yelping• Gulping• Coughing• Nasal Congestion

REDUCED RATE & DEPTH

OF BREATHING

•WOB• Head bobbing• Head back• Stridor• Grunting• Color change• Nasal Flaring

Arching/turning away

DISENGAGEMENT CUESDISENGAGEMENT CUES

Shutdown

“Stop” sign

Looking away

OBVIOUS

NOT SO OBVIOUS

Eyebrow raise

Crying

CASE STUDY: BABY ECASE STUDY: BABY E

Born at 26 weeks gestation

Twin B

IUGR, PDA, PFO

Intubated 2 weeks, nCPAP 3 weeks, NC 1 week,

Room Air since 32w CGA

Initiated PO trials at 33 w CGA within a volume-driven unit

Feeding consult at 35w CGA due to frequent As,Bs,Ds with feedings, poor volume intake, frequency fatigue and long feeding

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CASE STUDY: BABY EWithout Feeding TechniquesCASE STUDY: BABY EWithout Feeding Techniques

OH NO!

NOW WHAT?

Evidence Based Practice

Evidence Based Practice

PRE-FEEDING

• States of arousal

• Presence of oral reflexes

• NNS/Oral stimulation

FEEDING

• Swaddling• Positioning• Slow Flow

Nipple• Elevated

Side-Lying Position

• Pacing

FUTURE DIRECTIONS

• Technology

Lets Get Up-To-Date!!!

FEEDING INTERVENTIONS

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STATES OF AROUSAL STATES OF AROUSAL Quiet awake state is

optimal for achieving successful full oral feeding

(McGrath et al., 2002; Pickler et al., 1996)

The maturity of their state system allows them to

wake when hungry and maintain that alertness for eating, then transition to a deep sleep to rest for the

next feeding

Premature infants have more difficulty maintaining

arousal long enough for adequate intake

More difficulty achieving a deep sleep state, so they are not as rested for the

next feeding

(Ludwig & Waitzman, 2007)

STATES OF AROUSAL STATES OF AROUSAL

PARK et al., 2020• Two distinct feeding groups were

identified: typical and delayed feeding progression (FP).

• In infants with delayed FP, rates of active and quiet sleep development during the day were delayed compared to those with typical FP.

• Infants with delayed FP were more likely to be awake more often during the night compared to infants with typical FP.

RESULTS:

• Delays in sleep–wake state development may be associated with delays in feeding progression during hospitalization

• Infants with delayed feeding skill development may require more environmental protection to further support their sleep development.

CASE STUDY: BABY EWithout Feeding TechniquesCASE STUDY: BABY EWithout Feeding Techniques

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NNS decreases…

• Transition gavage to full oral feeding

• Transition from start of oral feeding to full oral feeding

• Length of hospital stay in preterm infants

• Need for NGT at discharge (Foster et al., 2016; Fucile, Gisel & Lau 2012; Pinelli et al., 2000, 2005; Kamisuka et al, 2017)

PIOMI

• 5 min oral stim intervention to build strength

• Infants in 1x/day group transitioned to full oral feedings sooner than control (Lessen et al., 2011)

NNS paired with olfactory stimuli (smell of EBM)

• Reduces time to oral feeding and earlier discharge compared to NNS alone (Khodagholi et al., 2018)

NNS and Breastfeeding

• Use of pacifier shortened transition to full breastfeeding and sucking skills of infant in NICU

(Aytekin et al., 2017)

NON-NUTRITIVE SUCKINGNON-NUTRITIVE SUCKING

Rooting and Mouth Opening Reflex

Sets stage for correct tongue position Tongue on floor of mouth - not roof

Initiates proper suckingSucking initiates safe swallowing

Rooting and Mouth Opening Reflex

Sets stage for correct tongue position Tongue on floor of mouth - not roof

Initiates proper suckingSucking initiates safe swallowing

PRESENCE OF ORAL REFLEXESPRESENCE OF ORAL REFLEXES

Not Rooting = Not Ready

SWADDLINGSWADDLINGWHAT WE KNOW

Supports general physical organization while reducing

extraneous movements, resulting in increased

endurance and focus for feeding

(Ross, 2008)

Provides external support for the infants' postural stability

NEU & BROWNE,1997

• 14 preemies• Mean PMA: 32weeks• Measured behavioral

organization during weighing

RESULTS:Infants who were swaddled

experienced: physiologic distress motor organization

effective self-regulatory ability

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ELEVATED SIDE-LYINGELEVATED SIDE-LYING

WHAT WE KNOW

• Affords more ease of anterior-posterior rib cage movement (Vandergehm et al., 1983)

• Increases lung compliance and decreases airway resistance

• Makes it easier to maintain head and trunk alignment

• Reduces potential for bolus misdirection • Reduced bolus flow rate due to lower hydro-

static pressure (Lau, 2013)

• Similar to the cross-cradle position for breastfeeding

(Shaker, 2017)

ELEVATED SIDE-LYINGELEVATED SIDE-LYING

CLARK et al., 2007

• Oxygen saturations

• Work of breathing

• HR variability

THOYRE et al., 2014

• State regulation

• Swallowing safety

• Physiologic stability

PARK et al., 2014

• Less HR variability

• O2 variability

• Endurance for feeding

NIPPLE SELECTION: FLOW MATTERSNIPPLE SELECTION: FLOW MATTERS

Respiration, feeding

ability and swallowing safety are

all affected by flow rate

Higher flow rate makes the

coordination of sucking, swallowing

and breathing more challenging

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Milk flow rate is affected by teat:

material shape

hole size rigidity

compressibility

The bottle material & rigidity

The pressures used by the infant

(da Costa et al., 2010; Goldfield et al., 2006; Mathew, 1990; Nowak et al., 1994; Walden & Prendergast,

2000)

Bottle and nipple characteristics were

revealed to affect infant feeding and milk intake

(Ardran et al., 1958; da Costa et al., 2010; Goldfield et al., 2006; Mathew, 1988; Pados,

Park, & Dodrill, 2019; Pados, Park, Thoyre, Estrem, & Nix, 2016; Weber et al., 1986)

NIPPLE SELECTION: FLOW MATTERSNIPPLE SELECTION: FLOW MATTERS

FAST FLOW NIPPLES Disposable nipples

FAST FLOW NIPPLES Disposable nipples

Matthew, 1991• Apneas and bradycardia

during feedings in preterm infants

Hiss, et al., 2001•Reduced ventilation as

more time is spent in swallowing, less time is available for breathing.

Martin, et al., 1994• Inspiratory post-swallow

breath, instead of an expiratory post-swallow breath, which increases the risk of aspiration

Sheppard et al., 2007•Result in poor use of mouth

musculature and can lead to oral dysfunction

Chang et al., 2007• Inhibits infants' ability to self-

regulate flow and can contribute to subsequent oral aversion and feeding dysfunction

PREEMIE

SIMILAC

STANDARD FLOW

SIMILAC

ENFAMIL STANDARD FLOW

ENFAMIL

STANDARD FLOW

NUK

SLOW FLOW NIPPLES Disposable nipples

SLOW FLOW NIPPLES Disposable nipples

SIMILAC

ENFAMIL

Teal Slow Flow

Purple Extra Slow Flow

ENFAMILSIMILAC

Yellow Slow Flow

Jackman, 2013Allow infants to self-regulate flow and pace themselves better, which results in:• Increased feeding efficiency• Shorter feeding duration • Quicker acquisition of oral feeding

skills

Allow 3-5 days for an infant to adjust to the slow flow nipple

Bridges

the Gap

between our

“normal”

breastfeeding

to the bottle

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Dr. Brown’s Bottles and Nipples Offer Great Variety in Flow-RatesDr. Brown’s Bottles and Nipples Offer Great Variety in Flow-Rates

www.drbrownsbaby.com

FLOW RATE : PADOS et al., 2019 FLOW RATE : PADOS et al., 2019

VARIABILITY : PADOS et al., 2019 VARIABILITY : PADOS et al., 2019

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Use of imposed breaks during an infants feeding to facilitate improved:burst/pause rhythm breathing regulation bolus control

Which results in optimal:endurancesafety(Shaker, 2013)

Use of imposed breaks during an infants feeding to facilitate improved:burst/pause rhythm breathing regulation bolus control

Which results in optimal:endurancesafety(Shaker, 2013)

Encourages positive, stress-free

feeding skill development

PACINGPACING

o Reduces infant stress during a feedingo Improves respiratory status throughout feeding

o Bradycardia (1)o SaO2 variability, decline, and time spent in a desaturated state; o HR fluctuation and decline (2)

o Reduces risk of liquid misdirection into the airwayo Behavioral disorganization (2)o Efficiency of their sucking patterns at discharge (2)

o Most similar to Breastfeeding, which is our gold standardo Routing neural pathways

(1,Law-Morstat et al., 2008; 2, Thoyre, et al. 2012)

o Reduces infant stress during a feedingo Improves respiratory status throughout feeding

o Bradycardia (1)o SaO2 variability, decline, and time spent in a desaturated state; o HR fluctuation and decline (2)

o Reduces risk of liquid misdirection into the airwayo Behavioral disorganization (2)o Efficiency of their sucking patterns at discharge (2)

o Most similar to Breastfeeding, which is our gold standardo Routing neural pathways

(1,Law-Morstat et al., 2008; 2, Thoyre, et al. 2012)

PACINGPACING

CASE STUDY: BABY EWith Feeding TechniquesCASE STUDY: BABY EWith Feeding Techniques

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WHAT ABOUT WHEN YOU TRY ALL THE FEEDING STRATEGIES… WITHOUT SUCCESS?

WHAT ABOUT WHEN YOU TRY ALL THE FEEDING STRATEGIES… WITHOUT SUCCESS?

Don’t worry. Just call your SLP to see if the infant is a candidate for an instrumental swallow examination! Don’t worry. Just call your SLP to see if the infant is a candidate for an instrumental swallow examination!

INSTRUMENTAL SWALLOWING ASSESSMENTS

INSTRUMENTAL SWALLOWING ASSESSMENTS

Using Feeding Interventions DiscussedUsing Feeding Interventions Discussed

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FUTURE DIRECTIONS…FUTURE DIRECTIONS…

o nfant

o Ntrainer

o High resolution cervical auscultation

TECHNOLOGY

LET’S GET BACK TO BABY T…….LET’S GET BACK TO BABY T…….

Born at 39 weeks at a birthing center

Apgar 0 0 1

Total Body Cooling

Seizures post delivery and post warming

Hypoxic Ischemic Encephalopathy

Continuous EEG monitoring for 7 days

Born at 39 weeks at a birthing center

Apgar 0 0 1

Total Body Cooling

Seizures post delivery and post warming

Hypoxic Ischemic Encephalopathy

Continuous EEG monitoring for 7 days

BABY T IS HEADED HOMEBABY T IS HEADED HOME

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GROWING & THRIVINGGROWING & THRIVING

CONSISTENCY MATTERS: FOR BOTH INFANTS AND CAREGIVERS

CONSISTENCY MATTERS: FOR BOTH INFANTS AND CAREGIVERS

A positive relationship exists between the consistency and

continuity of feeding management practices and

improved feeding performance (Sables-Baus et al., 2013)

A positive relationship exists between the consistency and

continuity of feeding management practices and

improved feeding performance (Sables-Baus et al., 2013)

TherapistNICU Staff

There should be unit-wide consensus

for which feeding techniques each

baby needs

CALL TO ACTION!CALL TO ACTION!

Identify one therapeutic strategy you can implement

with your management team

to establish positive change

in your NICU

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[email protected]

[email protected]

[email protected]

[email protected]

Your Babies Thank You For Always Being Up-To-Date!!

Bibliography:• Als H, Butler S, Kosta S, et al. The Assessment of Preterm Infants’ Behavior (APIB): Furthering the understanding and measurement of

neurodevelopmental competence in preterm and full-term infants. Ment Retard Dev Disabil Res Rev. 2005;11(1):94–102.• Anderson PJ, Doyle LW, Group VICS. Neurobehavioral outcomes of school-aged children born extremely low birth weight or very preterm in

the 1990s. JAMA 2003; 289: 3264–72.• Arvedson, Joan C. "Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches." Developmental disabilities

research reviews 14.2 (2008): 118-127.• Aucott, S., Donohue, P. K., Atkins, E., & Allen, M. C. (2002). Neurodevelopmental care in the NICU. Mental Retardation and Developmental

Disabilities Research Reviews, 8(4), 298–308. https://doi.org/10.1002/mrdd.10040• Chang, Y. J., Lin, C. P., Lin, Y. J., & Lin, C. H. (2007). Effects of single-hole and cross-cut nipple units on feeding efficiency and physiological

parameters in premature infants. Journal of Nursing Research, 15(3), 215–223. https://doi.org/10.1097/01.JNR.0000387617.72435.c6• Dodrill, Pamela, and Memorie M. Gosa. "Pediatric dysphagia: physiology, assessment, and management." Annals of Nutrition and

Metabolism 66.Suppl. 5 (2015): 24-31.• Dodrill, P., et al. "Attainment of early feeding milestones in preterm neonates." Journal of perinatology 28.8(2008): 549-555.• Eidelman, Arthur I. "Breastfeeding and the use of human milk: an analysis of the American Academy of Pediatrics 2012 Breastfeeding

Policy Statement." Breastfeeding medicine 7.5 (2012): 323-324.• Foster, Jann P., Kim Psaila, and Tiffany Patterson. "Non‐nutritive sucking for increasing physiologic stability and nutrition in preterm

infants." Cochrane Database of Systematic Reviews 10 (2016).• Fucile, Sandra, et al. "Oral and nonoral sensorimotor interventions facilitate suck–swallow–respiration functions and their coordination in

preterm infants." Early human development 88.6 (2012): 345-350.• Geddes, D. T., Kent, J. C., Mitoulas, L. R., & Hartmann, P. E. (2008). Tongue movement and intra-oral vacuum in breastfeeding infants. Early

Human Development, 84(7), 471–477. https://doi.org/10.1016/j.earlhumdev.2007.12.008

Bibliography:• Gewolb, I. H., Vice, F. L., Schwietzer-Kenney, E. L., Taciak, V. L., & Bosma, J. F. (2001). Developmental patterns of

rhythmic suck and swallow in preterm infants. Developmental Medicine and Child Neurology, 43(1), 22–27. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11201418

• Hafström, M., & Kjellmer, I. (2000). Non-nutritive sucking in the healthy pre-term infant. Early Human Development, 60(1), 13–24. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11054580

• Harrison, D., Boyce, S., Loughnan, P., Dargaville, P., Storm, H., & Johnston, L. (2006). Skin conductance as a measure of pain and stress in hospitalised infants. Early Human Development, 82(9), 603–608. https://doi.org/10.1016/j.earlhumdev.2005.12.008

• Hiss, S. G., Treole, K., & Stuart, A. (2001). Effects of age, gender, bolus volume, and trial on swallowing apnea duration and swallow/respiratory phase relationships of normal adults. Dysphagia, 16(2), 128-135.

• Jadcherla, Sudarshan R., et al. "Impact of prematurity and co-morbidities on feeding milestones in neonates: Aretrospective study." Journal of Perinatology 30.3 (2010): 201-208.

• Jackman, K. T. (2013). Go with the Flow: Choosing a Feeding System for Infants in the Neonatal Intensive Care Unit and Beyond Based on Flow Performance. Newborn and Infant Nursing Reviews, 13(1), 31–34. https://doi.org/10.1053/j.nainr.2012.12.003

• Kaya, Vildan, and Aynur Aytekin. "Effects of pacifier use on transition to full breastfeeding and sucking skills in preterm infants: a randomised controlled trial." Journal of clinical nursing 26.13-14 (2017): 2055 2063.

• Khodagholi Z, Zarifian T, Soleimani F, Khoshnood MS, Bakhshi E. The Effect of Non-Nutritive Sucking and Maternal Milk Odor on the Independent Oral Feeding in Preterm Infants. Iranian journal of child neurology. 2018;12(4):55-64.

• Law-Morstatt, L., Judd, D. M., Snyder, P., Baier, R. J., & Dhanireddy, R. (2003). Pacing as a treatment technique for transitional sucking patterns. Journal of Perinatology : Official Journal of the California Perinatal Association, 23(6), 483–488. https://doi.org/10.1038/sj.jp.7210976

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Bibliography:• Lefton-Greif, Maureen A. "Pediatric dysphagia." Physical Medicine and Rehabilitation Clinics 19.4 (2008): 837-851• Lessen, Brenda S. "Effect of the premature infant oral motor intervention on feeding progression and length of stay in

preterm infants." Advances in Neonatal care 11.2 (2011): 129-139.• Ludwig, S., & Waitzman, K. (2007). Changing Feeding Documentation to Reflect Infant-Driven Feeding Practice.

Newborn and Infant Nursing Reviews, 7(3), 155–160. https://doi.org/10.1053/j.nainr.2007.06.007• Lyngstad, L. T., Tandberg, B. S., Storm, H., Ekeberg, B. L., & Moen, A. (2014). Does skin-to-skin contact reduce stress

during diaper change in preterm infants? Early Human Development, 90(4), 169–172. https://doi.org/10.1016/j.earlhumdev.2014.01.011

• Mathew, O. P. (1991). Breathing patterns of preterm infants during bottle feeding: Role of milk flow. Journal of Pediatrics,119, 960-965.

• Martin, B., Corlew, M., Wood, H., Olson, D., Golopol, L., Wingo, M., & Kirmani, N. (1994). The association of swallowing dysfunction and aspiration pneumonia. Dysphagia, 9, 1–6.

• McCain, G., Gartside, P., Greenberg, J., Lott, Wright, Sept 2001. A feeding protocol for healthy preterm infants that shortens time to oral feeding. J. Paediatr. 139 (3), 374e379. McInnes,

• McGrattan K, McFarland D, Dean J, Hill E, White D, Martin‐Harris B. Effect of single‐use, laser‐cut, slow flow nipples on respiration and milk ingestion in preterm infants. American Journal of Speech Language Pathology. 2017;26(3):832‐9.

• McGrath, J. M., & Braescu, A. V. B. (2004). State of the science feeding readiness in the preterm infant. Journal of Perinatal and Neonatal Nursing, 18(4), 353–368.

• McGuire, Shelley. "Institute of medicine (IOM) early childhood obesity prevention policies. washington, DC:• The national academies press; 2011." (2012): 56-57.

Bibliography:• Miller, J. L., & Kang, S. M. (2007). Preliminary ultrasound observation of lingual movement patterns during nutritive

versus non-nutritive sucking in a premature infant. Dysphagia, 22(2), 150–160. https://doi.org/10.1007/s00455-006-9058-z

• Neu, M., & Browne, J. V. (1997). Infant physiologic and behavioral organization during swaddled versus unswaddledweighing. Journal of Perinatology: Official Journal of the California Perinatal Association, 17(3), 193. Ohgi,

• Pados, B. F., Park, J., & Dodrill, P. (2018). Know the Flow: Milk Flow Rates from Bottle Nipples Used in the Hospital and After Discharge. Advances in Neonatal Care •, 19(1), 32–41. https://doi.org/10.1097/ANC.0000000000000538

• Pados, Britt Frisk, Jinhee Park, and Pamela Dodrill. "Know the flow: Milk flow rates from bottle nipples used in the hospital and after discharge." Advances in Neonatal Care 19.1 (2019): 32-41.

• Pados, Britt Frisk, et al. "Milk flow rates from bottle nipples used after hospital discharge." MCN. The American journal of maternal child nursing 41.4 (2016): 237.

• Pados, Britt F., et al. "Effects of milk flow on the physiological and behavioural responses to feeding in an infant with hypoplastic left heart syndrome." Cardiology in the Young 27.1 (2017): 139-153

• Park, Jinhee, et al. "Sleep–Wake States and Feeding Progression in Preterm Infants." Nursing Research 69.1 (2020): 22-30.

• Pickler, R. H., Mauck, A. G., & Geldmaker, B. (1997). Bottle-feeding histories of preterm infants. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 26(4), 414–420.

• Pinelli, Janet, and Amanda J. Symington. "Non‐nutritive sucking for promoting physiologic stability and• nutrition in preterm infants." Cochrane Database of Systematic Reviews 4 (2005).• Ross, E. S. (2008). Feeding in the NICU and Issues That Influence Success. Perspectives on Swallowing And, 17(3), 94–

100. https://doi.org/10.1044/sasd17.3.94• Sables-Baus, S., DeSanto, K., Henderson, S., Kunz, J. L., Morris, A. C., Shields, L., . . . McGrath, J. M. (2013). Infant-

• Sheppard JJ, Fletcher KR. Evidence-based interventions for breast and bottle feeding in the neonatal intensive care unit. Semin Speech Lang. 2007;28:204-212. 13.Shaker, C. S. (2013). Cue-based feeding in the NICU: using the infant’s communication as a guide. Neonatal Network : NN, 32(6), 404–408. https://doi.org/10.1891/0730-0832.32.6.404

• Simpson, C., Schanler, R. J., & Lau, C. (2002). Early introduction of oral feeding in preterm infants. Pediatrics, 110(3), 517–522. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12205253

• Smith, G. C., Gutovich, J., Smyser, C., Pineda, R., Newnham, C., Tjoeng, T. H., … Inder, T. (2011). Neonatal intensive care unit stress is associated with brain development in preterm infants. Annals of Neurology, 70(4), 541–549. https://doi.org/10.1002/ana.22545

• Thoyre, S., Park, J.,., Knafl, G. J., Hodges, E. A., & Nix, W. B. (2014). Efficacy of Semielevated Side-Lying Positioning During Bottle-Feeding of Very Preterm Infants A Pilot Study. J Perinat Neonat Nurs R, 28(1), 69–79. https://doi.org/10.1097/JPN.0000000000000004

• Thoyre S, Park J, Pados B, Hubbard C. Developing a co-regulated, Cue-based feeding practice: the critical role of assessment and reflection. J Neonatal Nurs. 2013;19(4):139–148. doi: 10.1016/j.jnn.2013.01.002

• Thoyre, S. M., Holditch-Davis, D., Schwartz, T. a, Melendez Roman, C. R., & Nix, W. (2012). Coregulated Approach to Feeding Preterm Infants With Lung Disease: Effects During Feeding. Nursing Research, 61(4), 242–251. https://doi.org/10.1097/NNR.0b013e31824b02ad

• Vanderghem A, Beardsmore C, Silverman M. Postural variations in pulmonary resistance, dynamic compliance, and esophageal pressure in neonates. Crit Care Med 1983;11(6):424–427

• World Health Organization. Report of the expert consultation of the optimal duration of exclusive breastfeeding,Geneva, Switzerland, 28-30 March 2001. No. WHO/NHD/01.09. World Health Organization, 2001.

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