638 - Respiratory-feeding coordination develops in association with neonatal maturity during the transition to independent oral feeding in preterm infants

Publication Number: 1615.638

Kensuke Kumazawa, Department of Pediatrics, The Jikei Univercity shool of Medicine, MInato-ku, Tokyo, Japan; Saya Yamada, Department of Pediatrics, The Jikei University Schoole of Medicine, Tokyo, Tokyo, Japan; Kimihiko Oishi, The Jikei University School of Medicine, MInato-ku, Tokyo, Japan; Chikako Mori, Research & Development Division, Pigeon Corporation, Tsukubamirai, Ibaraki, Japan; Kanae Yoshibe, Research＆Development Division,Pigeon Corporation, Tsukubamirai, Ibaraki, Japan

Background: Successful oral feeding in neonates requires precise coordination of sucking, swallowing, and breathing. However, how this coordination develops in preterm infants as they approach independence remains unclear. We developed a bedside system that simultaneously measures sucking pressure and respiratory airflow during bottle feeding and applied it to characterize developmental changes in feeding coordination.

Objective: To investigate how respiratory coordination develops in preterm infants in relation to postmenstrual age (PMA) and neonatal maturity during the transition to independent oral feeding, and to compare their coordination patterns with those of term neonates.

Design/Methods: Sucking pressure was measured using a custom nipple connected to a pressure transducer, and respiratory airflow was monitored through a nasal prong tube. A sucking burst was defined as a sequence lasting >4 seconds or containing ≥4 consecutive sucks. We calculated the maximum sucking pressure and the suck–respiration ratio during sucking bursts (respirations per suck during bursts). In preterm infants, measurements were performed weekly from the initiation of oral feeding until discharge. In term neonates, a single measurement was obtained between postnatal days 1-4. PMA and body weight at the time of nasogastric tube (NGT) removal in preterm infants were compared with those of term neonates.

Results: Nineteen preterm infants (median gestational age 26.9 weeks; birth weight 773 g) and 33 term neonates (38.7 weeks; 2,944 g) were analyzed. In preterm infants, the suck–respiration ratio gradually increased from around 35 weeks PMA. At NGT removal, PMA was comparable to that of term neonates (39.0 vs 38.5 weeks, p = 0.11), whereas body weight remained lower (2,256 vs 2,762 g, p < 0.0001). The suck–respiration ratio during sucking bursts was lower in preterm infants than in term neonates (0.59 vs 0.82, p = 0.01), while maximum sucking pressure did not differ significantly (−132 vs −144 mmHg, p = 0.32).

Conclusion(s): Respiratory-feeding coordination in preterm infants develops progressively with increasing PMA but remains immature compared with that of term neonates at the time of NGT removal. These findings indicate that feeding coordination reflects neonatal maturity and highlight the need for continued observation and support even after the transition to independent oral feeding.