TRANSITION TO BREAST BOTTLE FEEDINGS - THE PREMATURE-INFANT

Premature infants present a nutritional challenge to the health care p rovider for a variety of reasons: reduced gastric capacity, poorly int egrated intestinal motility, limited digestive capabilities, neurobeha vioral immaturity and limited ability to take feedings by mouth. There is often a prolonged need for oro-gastric/nasogastric supplementation until nipple feedings can commence. Neurobehavioral organization is e ssential for a smooth and gradual transition to full nipple feedings. This article describes the expected progression of behavioral competen cies as reflected in recognizable infant cues which can be identified by care providers to facilitate an optimal feeding interaction The ess ential components of nutritive sucking, including the integration of s uck-swallow-breathe, are detailed. Common problems with their warning signs and methods of prevention are described. Specific recommendation s to limit hypoventilation during feedings are discussed, as well as o ptimal route and rate of delivery of milk. Prefeeding techniques used to arouse the infant to best performance are delineated including stat e modulation, correct positioning and oral motor stimulation. The seco nd half of the article focuses on the breast-fed premature infant and includes information on maternal markers for success/failure, a detail ed discussion of lactogenesis and the establishment of lactation, and specific recommendations for maintaining lactation in the absence of a suckling infant. Practical guidelines based on neurobehavioral develo pment are provided for facilitating the transition from gavage feeding to nursing. Common concerns encountered at discharge are reviewed, in cluding those parameters which require continued healthcare supervisio n.