Feeding Problems and Long-Term Outcomes in Preterm Infants-A Systematic Approach to Evaluation and Management

Ranjith Kamity, Prasanna K Kapavarapu, Amit Chandel, Ranjith Kamity, Prasanna K Kapavarapu, Amit Chandel

Abstract

Preterm infants are known to have long-term healthcare needs. With advances in neonatal medical care, younger and more preterm infants are surviving, placing a subset of the general population at risk of long-term healthcare needs. Oral feeding problems in this population often play a substantial yet under-appreciated role. Oral feeding competency in preterm infants is deemed an essential requirement for hospital discharge. Despite achieving discharge readiness, feeding problems persist into childhood and can have a residual impact into adulthood. The early diagnosis and management of feeding problems are essential requisites to mitigate any potential long-term challenges in preterm-born adults. This review provides an overview of the physiology of swallowing and oral feeding skills, disruptions to oral feeding in preterm infants, the outcomes of preterm infants with feeding problems, and an algorithmic approach to the evaluation and management of neonatal feeding problems.

Keywords: deglutition; dysphagia; feeding problems; fiberoptic endoscopic evaluation of swallowing (FEES); manometry; oral feeding; outcomes; prematurity; videofluoroscopic swallow study (VFSS).

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Risk factors: Common clinical conditions associated with feeding problems in preterm infants. (BPD: bronchopulmonary dysplasia, EoE: eosinophilic esophagitis, GER: gastroesophageal reflux, HIE: hypoxic ischemic encephalopathy, IUGR: intrauterine growth restriction, IVH: intraventricular hemorrhage, LBW: low birth weight, NEC: necrotizing enterocolitis, PVL: periventricular leukomalacia, RDS: respiratory distress syndrome).
Figure 2
Figure 2
Etiopathophysiology of dysphagia in preterm infants: phases of normal swallowing, disruptions to swallowing, and clinical presentation in the neonatal period.
Figure 3
Figure 3
Approach to a preterm infant with feeding problems. (EGD: esophagogastroduodenoscopy, FEES: fiberoptic endoscopic evaluation of swallowing, GER: gastroesophageal reflux, H2RA: H2-receptor antagonists, MRI: magnetic resonance imaging, NICU: neonatal intensive care unit, NNS: non-nutritive suck, NS: nutritive suck, pH-MII: pH monitoring multichannel impedance, PPIs: proton pump inhibitors, UGI: upper gastrointestinal fluoroscopy, VFSS: videofluoroscopic swallow study).
Figure 4
Figure 4
Instrumental assessment for feeding problems. Green boxes with dotted outlines depict advantages; red boxes with dashed outlines depict disadvantages. (EGD: esophagogastroduodenoscopy, FEES: fiberoptic endoscopic evaluation of swallowing, GER: gastroesophageal reflux, LES: lower esophageal sphincter, pH-MII: pH monitoring multichannel impedance, UES: upper esophageal sphincter, VFSS: videofluoroscopic swallow study, UGI: Upper Gastrointestinal Fluoroscopy).

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Source: PubMed

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