A Cue-based Developmental Approach Toward the Preterm Infants During Feeding Transition Period

Study Overview
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Brief Summary
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The coordination of sucking, swallowing, and breathing during the transition from gavage to oral feeding is a challenge for preterm infants. Efficient management of the feeding transition without other comorbidities can not only improve their oral movements and gastrointestinal function development, facilitate their oral feeding learning behavior, but also facilitate them to direct breastfeeding, improve mother-infant attachment, and ultimately reduce the length of hospitalization. However, the current status of strategies in supporting preterm infants throughout their feeding transition are inconsistent, and lack of guidelines and monitor indicators based on existing evidence. This project proposed a three-year plan the explore the current situation, examine effective strategies for care bundles, and further develop a new clinical guideline that can be implemented in the future. The first year of this research will use chart review among two neonatal intensive care units of Medical Center from Taipei and Tainan. A semi-structured interview and questionnaire (DSCS-N) will be used to explore nurses' knowledge, attitude and skills of developmental care; and the experience of caring for preterm infants during feeding transition in the neonatal intensive care units. In addition, gestational age, body weight, gavage and oral feeding amount, and special events happened during feeding will be recorded and analyzed. The second year, an experimental with a stratified random assignment and repeated measure design will be used with feeding transition care bundles. 120 preterm infants will be recruited and assigned to experimental or control group. The subjects will be fed by the routine care approach or by the feeding transition approach in one neonatal intensive care unit. Intervention components include oral stimulation and cue-based feeding during the transition to oral feeding. Study measures will include physical indicators, POFRAS and EFS during feeding to evaluate the implementation and guide further development of the clinical guideline. The third year of guideline development will follow Bowker and the National Health Insurance Bureau which including 5 stage. The results of this guideline can offer better recommendations to support preterm infants' oral development, provide cue-based feeding, and help them succeed in the transition to oral nutrition.

Official Title
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A Cue-based Developmental Approach Toward the Preterm Infants During Feeding Transition Period - Explore Clinical Facts, Evaluate Intervention Effects and Develop Clinical Guideline

Conditions
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Preterm Infant, Feeding Behavior, Feeding Patterns

Intervention / Treatment
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* Other: The premature infant oral motor intervention (PIOMI)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Preterm infant born less then 33 weeks Fraction of inspired oxygen(FiO2) less then 30% Can tolerance enteral feeding Exclusion Criteria: Using ventilator(except non-invasive ventilator) Complications including Hypoxic Ischemic Encephalopathy (HIE), Intraventricular Hemorrhage (IVH) ≥Grade III, Periventricular Leukomalacia (PVL), Necrotizing Enterocolitis(NEC) ≥Stage II Congenital abnormalities including chromosomal abnormalities, congenital anomalies of digestive system, cleft lip and palate Because of custody problem or can't get the inform consent of the preterm infant's parents/guardian

Ages Eligible for Study
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Maximum Age: 33 Weeks

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: PIOMI treat group<br>Preterm infant receive oral massage using the premature infant oral motor intervention (PIOMI) | Other: The premature infant oral motor intervention (PIOMI)<br>* The premature infant oral motor intervention (PIOMI) is an oral motor program that provides assisted movement to activate muscle contraction and provides movement against resistance to build strength in the areas of the mouth necessary for feeding. It is designed to increase the maturation of neural structures, improving their ability to suck and swallow.<br>* Other names: Cue-based feeding;|
| No Intervention: Routine care group<br>Preterm infant receive routine care of neonatal intensive care unit(NICU) | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Preterm infant's oral feeding readiness | We use the Preterm Oral Feeding Readiness Assessment Scales (POFRAS) to assess preterm infants' readiness to start oral feeding. The scale comprised of 5 five categories including corrected Gestational Age, Behavioral Organization (3 item), Oral Posture (2 item), Oral Reflexes (4 item), Nonnutritive Sucking (8 item) with a total of 18 items to evaluate. Each item score from 0 2, the higher the score means that the preterm infant has better oral feeding preparation. | Change from day 1(Baseline) up to day 7 in oral stimulation phase | 
| Preterm infant's oral feeding skills | Using Early Feeding Skills Assessments for Preterm Infants (EFS). The Early Feeding Skills Assessments for Preterm Infants (EFS) checklist is to assess preterm infants' oral feeding readiness (before feeding; yes/no), oral feeding skill (when feeding; all/most/some/none; never/occasionally/often), oral feeding tolerance (after feeding; yes/no) and feeding descriptors(after feeding). | From day 1(Baseline) up to the day 30 in cue-base feeding phase | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Body weight change | body weight change in grams | Change from day 1(baseline) up to the day 200. | 
| hospital stay length(days) | How many days from admission(birth day) to discharge(leave) hospital. | From day 1 up to the day 200. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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preterm infants, transitional feeding period, cue-based care, clinical guidelines