Transition From Nasogastric Tube to Oral Feeding: The Role of Parental Guided Responsive Feeding

Background and Objective: Strategies to transition preterm infants from tube to oral feeding vary greatly and the transition may take days to weeks. The study objective was to evaluate the effect of parental guided responsive feeding (PGRF) on this transition.Methods: We conducted a randomized controlled trial on infants born at <32 weeks gestation. The PGRF intervention was performed by parents, and included feeding intervals and volumes which were guided by the infants' behavioral cues of hunger and satiety. If a minimum volume was not taken orally, an intermediate volume was supplemented via nasogastric tube. The control group was traditionally fed (TF), with pre-planned volumes of intake and at given scheduled intervals.Results: The study comprised 67 infants (PGRF 32, TF 35). PGRF infants reached full oral feeding within less days (median 2 vs. 8 days, p = 0.001), at an earlier age (median 34.28 vs. 35.14 weeks, p < 0.001), returned to baseline weight gain at 35 weeks (1.77 ± 0.70 vs. 1.25 ± 0.63 g/kg/day, p = 0.002), were discharged earlier (36.34 ± 0.6 vs. 36.86 ± 0.9 weeks, p = 0.001), were more likely to be fed by their parents (p < 0.001), and experienced less apnea/bradycardia events at 34 weeks (median 3.5 vs. 9 per week p = 0.047) compared to the TF infants. The regression model demonstrated that independent variables predicted 43.7% of the variance of time to full oral feeding [F(9, 65) = 4.84 p < 0.001]. The only significant variable was feeding group (B = −6.43 p < 0.001); The PGRF infants were more likely to reach full oral feeding earlier.Conclusion: PGRF is safe, and associated with short-term advantages, higher parental engagement, and earlier discharge.Clinical Trial Registration: Identifier: SHEBA-12-9574-IM-CTIL; “Adjusted Individual Oral Feeding for Improving Short and Long Term Outcomes of Preterm Infants.

Brain Diffusivity in Infants With Hypoxic-Ischemic Encephalopathy Following Whole Body Hypothermia: Preliminary Results

Abstract Hypoxic-ischemic encephalopathy is an important cause of neuropsychological deficits. Little is known about brain diffusivity in these infants following cooling and its potential in predicting outcome. Diffusion tensor imaging was applied to 3 groups: (1) three infants with hypoxic-ischemic encephalopathy: cooled; (2) three infants with hypoxic-ischemic encephalopathy: noncooled; and (3) four controls. Diffusivity values at the corticospinal tract, thalamus, and putamen were correlated with Apgar scores and early neurodevelopmental outcome. While cooled infants exhibited lower Apgar scores than noncooled infants, their developmental scores at a mean age of 8 months were higher. All groups differed in their diffusivity values with the cooled infants showing better values compared with the noncooled, correlating with early neurodevelopmental outcome. These preliminary results indicate that diffusion tensor imaging performed at an early age in infants with hypoxic-ischemic encephalopathy may forecast clinical outcome and support the neuroprotective effect of hypothermia treatment

Talk the Walk: Does Socio-Cognitive Resource Reallocation Facilitate the Development of Walking?

Walking is of interest to psychology, robotics, zoology, neuroscience and medicine. Human's ability to walk on two feet is considered to be one of the defining characteristics of hominoid evolution. Evolutionary science propses that it emerged in response to limited environmental resources; yet the processes supporting its emergence are not fully understood. Developmental psychology research suggests that walking elicits cognitive advancements. We postulate that the relationship between cognitive development and walking is a bi-directional one; and further suggest that the initiation of novel capacities, such as walking, is related to internal socio-cognitive resource reallocation. We shed light on these notions by exploring infants' cognitive and socio-communicative outputs prospectively from 6-18 months of age. Structured bi/tri weekly evaluations of symbolic and verbal development were employed in an urban cohort (N = 9) for 12 months, during the transition from crawling to walking. Results show links between preemptive cognitive changes in socio-communicative output, symbolic-cognitive tool-use processes, and the age of emergence of walking. Plots of use rates of lower symbolic play levels before and after emergence of new skills illustrate reductions in use of previously attained key behaviors prior to emergence of higher symbolic play, language and walking. Further, individual differences in age of walking initiation were strongly related to the degree of reductions in complexity of object-use (r = .832, p < .005), along with increases, counter to the general reduction trend, in skills that serve recruitment of external resources [socio-communication bids before speech (r = -.696, p < .01), and speech bids before walking; r = .729, p < .01)]. Integration of these proactive changes using a computational approach yielded an even stronger link, underscoring internal resource reallocation as a facilitator of walking initiation (r = .901, p<0.001). These preliminary data suggest that representational capacities, symbolic object use, language and social developments, form an integrated adaptable composite, which possibly enables proactive internal resource reallocation, designed to support the emergence of new developmental milestones, such as walking

Relations between changes in cognitive resource allocation and the age of walking.

<p>Darker color shade for participants (N = 9) represents earlier age of walking initiation. Y-axis depicts standard Z scores.</p

Relations between age of walking initiation and changes in simple object use at that age of speech initiation.

<p>Darker color shade for participants represents earlier age of walking initiation; Y-axis depicts standard Z scores.</p

Multi-dimensional developmental sequences of the symbolic level (verbal and gestural) and motor behaviors from 6 to 18 months of age.

<p>Mean ages of initiation- black trajectory, SD- in grey shade).</p

Relations between age of walking initiation and changes in infant and mother social bids at the age of emergence of language.

<p>Darker color shade for participants represents earlier age of walking initiation; Y-axis depicts standard Z scores.</p

Inter-domain resource allocations.

<p>Frequency of use of representational behaviors [at Y axis, symbolic play (in blue and green), verbal communication (in red) and social bids (in purple) before and after age of attainment of key developmental milestones (in symbolic ability, communication and walking, marked by dotted arrows on X axis of age in months).</p

Relations between age of walking initiation and changes in frequency of language at that age.

<p>Darker color shade for participants represents earlier age of walking initiation; Y-axis depicts standard Z scores.</p

Relations between age of walking initiation and changes in multi-object play before multi-object sequence play emerges.

<p>Darker color shade for participants represents earlier age of walking initiation; Y-axis depicts standard Z scores.</p