Hostname: page-component-cb9f654ff-w5vf4 Total loading time: 0 Render date: 2025-08-02T23:34:03.541Z Has data issue: false hasContentIssue false
  • English
  • Français

Effects of milk flow on the physiological and behavioural responses to feeding in an infant with hypoplastic left heart syndrome

Published online by Cambridge University Press:  16 March 2016

Britt F. Pados ,
Suzanne M. Thoyre ,
Hayley H. Estrem ,
Jinhee Park ,
George J. Knafl  and
Brant Nix
Britt F. Pados*
Affiliation:
School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
Suzanne M. Thoyre
Affiliation:
School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
Hayley H. Estrem
Affiliation:
School of Nursing, Duke University, Durham, North Carolina, United States of America
Jinhee Park
Affiliation:
School of Nursing, Boston College, Chestnut Hill, Massachusetts, United States of America
George J. Knafl
Affiliation:
School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
Brant Nix
Affiliation:
School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
*
Correspondence to: B. F. Pados, School of Nursing, The University of North Carolina at Chapel Hill, Carrington Hall, CB#7460, Chapel Hill, NC 27599-7460, United States of America. Tel/Fax: +617 477 9982; E-mail: bpados@email.unc.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Infants with hypoplastic left heart syndrome often experience difficulty with oral feeding, which contributes to growth failure, morbidity, and mortality. In response to feeding difficulty, clinicians often change the bottle nipple, and thus milk flow rate. Slow-flow nipples have been found to reduce the stress of feeding in other fragile infants, but no research has evaluated the responses of infants with hypoplastic left heart syndrome to alterations in milk flow. The purpose of this study was to evaluate the physiological and behavioural responses of an infant with hypoplastic left heart syndrome to bottle feeding with either a slow-flow (Dr. Brown’s Preemie) or a standard-flow (Dr. Brown’s Level 2) nipple. A single infant was studied for three feedings: two slow-flow and one standard-flow. Oral feeding, whether with a slow-flow or a standard-flow nipple, was distressing for this infant. During slow-flow feeding, she experienced more coughing events, whereas during standard-flow she experienced more gagging. Disengagement and compelling disorganisation were most common during feeding 3, that is slow-flow, which occurred 2 days after surgical placement of a gastrostomy tube. Clinically significant changes in heart rate, oxygen saturation, and respiratory rate were seen during all feedings. Heart rate was higher during standard-flow and respiratory rate was higher during slow-flow. Further research is needed to examine the responses of infants with hypoplastic left heart syndrome to oral feeding and to identify strategies that will support these fragile infants as they learn to feed. Future research should evaluate an even slower-flow nipple along with additional supportive feeding strategies.

Keywords

Hypoplastic left heart syndromebottle feedingfeeding methods

Information

Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 1 , January 2017 , pp. 139 - 153
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1. Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.Google Scholar
2. Reller, MD, Strickland, MJ, Riehle-Colarusso, T, Mahle, WT, Correa, A. Prevalence of congenital heart defects in metropolitan Atlanta, 1998–2005. J Pediatr 2008; 153: 807–813.Google Scholar
3. Grossfeld, P. Hypoplastic left heart syndrome: new insights. Circ Res 2007; 100: 1246–1248.Google Scholar
4. Davis, D, Davis, S, Cotman, K, et al. Feeding difficulties and growth delay in children with hypoplastic left heart syndrome versus d-transposition of the great arteries. Pediatr Cardiol 2008; 29: 328–333.Google Scholar
5. Einarson, KD, Arthur, HM. Predictors of oral feeding difficulty in cardiac surgical infants. Pediatr Nurs 2003; 29: 315–319.Google Scholar
6. Jadcherla, SR, Vijayapal, AS, Leuthner, S. Feeding abilities in neonates with congenital heart disease: a retrospective study. J Perinatol 2009; 29: 112–118.Google Scholar
7. Skinner, ML, Halstead, LA, Rubinstein, CS, Atz, AM, Andrews, D, Bradley, SM. Laryngopharyngeal dysfunction after the Norwood procedure. J Thorac Cardiovasc Surg 2005; 130: 1293–1301.CrossRefGoogle ScholarPubMed
8. Al-Sayed, LE, Schrank, WI, Thach, BT. Ventilatory sparing strategies and swallowing pattern during bottle feeding in human infants. J Appl Physiol 1994; 77: 78–83.Google Scholar
9. Kao, HM, Lin, CH, Chang, YJ. Feeding with cross-cut teats has better sucking effects and oxygenation in preterm infants with chronic lung disease. J Clin Nurs 2010; 19: 3016–3022.Google Scholar
10. Mathew, OP. Breathing patterns of preterm infants during bottle feeding: role of milk flow. J Pediatr 1991; 119: 960–965.CrossRefGoogle ScholarPubMed
11. Mathew, OP. Science of bottle feeding. J Pediatr 1991; 119: 511–519.CrossRefGoogle ScholarPubMed
12. Schrank, W, Al-Sayed, LE, Beahm, PH, Thach, BT. Feeding responses to free-flow formula in term and preterm infants. J Pediatr 1998; 132: 426–430.CrossRefGoogle ScholarPubMed
13. Colley, JR, Creamer, B. Sucking and swallowing in infants. BMJ 1958; 2: 422–423.CrossRefGoogle ScholarPubMed
14. Mathew, OP, Belan, M, Thoppil, CK. Sucking patterns of neonates during bottle feeding: comparison of different nipple units. Am J Perinatol 1992; 9: 265–269.CrossRefGoogle ScholarPubMed
15. Lau, C, Schanler, RJ. Oral feeding in premature infants: advantage of a self-paced milk flow. Acta Paediatr 2000; 89: 453–459.CrossRefGoogle ScholarPubMed
16. Pearl, JM, Nelson, DP, Schwartz, SM, Manning, PB. First-stage palliation for hypoplastic left heart syndrome in the twenty-first century. Ann Thorac Surg 2002; 73: 331–340.Google Scholar
17. Tweddell, JS, Hoffman, GM, Fedderly, RT, et al. Patients at risk for low systemic oxygen delivery after the Norwood procedure. Ann Thorac Surg 2000; 69: 1893–1899.CrossRefGoogle ScholarPubMed
18. Sachdeva, R, Hussain, E, Moss, MM, et al. Vocal cord dysfunction and feeding difficulties after pediatric cardiovascular surgery. J Pediatr 2007; 151: 312–315.Google Scholar
19. Goldfield, EC, Smith, V, Buonomo, C, Perez, J, Larson, K. Preterm infant swallowing of thin and nectar-thick liquids: changes in lingual-palatal coordination and relation to bolus transit. Dysphagia 2013; 28: 234–244.Google Scholar
20. Porges, SW. Orienting in a defensive world: mammalian modifications of our evolutionary heritage. A polyvagal theory. Psychophysiology 1995; 32: 301–318.CrossRefGoogle Scholar
21. Porges, SW. The polyvagal perspective. Biol Psychol 2007; 74: 116–143.CrossRefGoogle ScholarPubMed
22. Porges, SW. The polyvagal theory: phylogenetic substrates of a social nervous system. Int J Psychophysiol 2001; 42: 123–146.CrossRefGoogle ScholarPubMed
23. Porges, SW. The polyvagal theory: phylogenetic contributions to social behavior. Physiol Behav 2003; 79: 503–513.Google Scholar
24. Mathew, OP. Nipple units for newborn infants: a functional comparison. Pediatrics 1988; 81: 688–691.CrossRefGoogle ScholarPubMed
25. Jackman, KT. Go with the flow: choosing a feeding system for infants in the neonatal intensive care unit and beyond based on flow performance. Newborn Infant Nurs Rev 2013; 13: 31–34.Google Scholar
26. Pados, BF, Park, J, Thoyre, SM, Estrem, H, Nix, WB. Milk flow rates from bottle nipples used for feeding infants who are hospitalized. Am J Speech Lang Pathol 2015; 24: 671–679.Google Scholar
27. Holditch-Davis, D. The development of sleeping and waking states in high-risk preterm infants. Infant Behav Dev 1990; 13: 513–531.Google Scholar
28. Dawson, JA, Myers, LR, Moorhead, A, et al. A randomised trial of two techniques for bottle feeding preterm infants. J Paediatr Child Health 2013; 49: 462–466.CrossRefGoogle ScholarPubMed
29. Masimo. Radical-7, 2012. Retrieved January 12, 2012, from http://www.masimo.com/pdf/radical-7/LAB4540E_radical-7_brochure.pdf.Google Scholar
30. Bamford, O, Taciak, V, Gewolb, IH. The relationship between rhythmic swallowing and breathing during suckle feeding in term neonates. Pediatr Res 1992; 31: 619–624.Google Scholar
31. Nixon, GM, Charbonneau, I, Kermack, AS, Brouillette, RT, McFarland, DH. Respiratory-swallowing interactions during sleep in premature infants at term. Respir Physiol Neurobiol 2008; 160: 76–82.Google Scholar
32. Tervo, RC, Estrem, TL, Bryson-Brockmann, W, Symons, FJ. Single-case experimental designs: applications in developmental-behavioral pediatrics. J Dev Behav Pediatr 2003; 24: 438–448.Google Scholar
33. Kratochwill, TR, Hitchcock, J, Horner, RH, et al. Single-case design technical documentation. What Works Clearinghouse, 2010. Retrieved 10 October 2014 from http://ies.ed.gov/ncee/wwc/pdf/wwc_scd.pdf.Google Scholar
34. McLellan, MC, Connor, JA. The Cardiac Children’s Hospital Early Warning Score (C-CHEWS). J Pediatr Nurs 2013; 28: 171–178.CrossRefGoogle ScholarPubMed
35. Chan, GM, Lechtenberg, E. The use of fat-free human milk in infants with chylous pleural effusion. J Perinatol 2007; 27: 434–436.CrossRefGoogle ScholarPubMed
36. Carpes, LF, Kozak, FK, Leblanc, JG, et al. Assessment of vocal fold mobility before and after cardiothoracic surgery in children. Arch Otolaryngol Head Neck Surg 2011; 137: 571–575.Google Scholar
37. Morris, SE, Klein, MD. Pre-Feeding Skills, 2 nd edn. Therapy Skill Builders, Edmonton, 2000.Google Scholar
38. Byars, KC, Burklow, KA, Ferguson, K, O’Flaherty, T, Santoro, K, Kaul, A. A multicomponent behavioral program for oral aversion in children dependent on gastrostomy feedings. J Pediatr Gastroenterol Nutr 2003; 37: 473–480.Google Scholar
39. Dodrill, P, McMahon, S, Ward, E, Weir, K, Donovan, T, Riddle, B. Long-term oral sensitivity and feeding skills of low-risk pre-term infants. Early Hum Dev 2004; 76: 23–37.CrossRefGoogle ScholarPubMed
40. Hyman, PE. Gastroesophageal reflux: one reason why baby won’t eat. J Pediatr 1994; 125: S103–S109.Google Scholar
41. Jadcherla, SR, Wang, M, Vijayapal, AS, Leuthner, SR. Impact of prematurity and co-morbidities on feeding milestones in neonates: a retrospective study. J Perinatol 2010; 30: 201–208.CrossRefGoogle ScholarPubMed
42. Hill, GD, Silverman, AH, Noel, RJ, et al. Feeding dysfunction in children with single ventricle following staged palliation. J Pediatr 2014; 164: 243–246.CrossRefGoogle ScholarPubMed
43. Maurer, I, Latal, B, Geissmann, H, Knirsch, W, Bauersfeld, U, Balmer, C. Prevalence and predictors of later feeding disorders in children who underwent neonatal cardiac surgery for congenital heart disease. Cardiol Young 2011; 21: 303–309.CrossRefGoogle ScholarPubMed
44. Park, M. The Pediatric Cardiology Handbook. Mosby, Philadelphia, PA, 2010.Google Scholar
45. Gupta, S, Sinha, SK. Shock and hypotension in the newborn, 2014. Retrieved October 25, 2014 from http://emedicine.medscape.com/article/979128-overview.Google Scholar
46. Photiadis, J, Sinzobahamvya, N, Fink, C, et al. Optimal pulmonary to systemic blood flow ratio for best hemodynamic status and outcome early after Norwood operation. Eur J Cardiothorac Surg 2006; 29: 551–556.CrossRefGoogle ScholarPubMed
47. Feinstein, JA, Benson, DW, Dubin, AM, et al. Hypoplastic left heart syndrome: current considerations and expectations. J Am Coll Cardiol 2012; 59: S1–S42.Google Scholar
48. Gabrielli, A, Layon, AJ, Yu, M, Civetta, JM, Taylor, RW, Kirby, RR. Civetta, Taylor, & Kirby’s Critical Care, 4 th edn. Lippincott Williams & Wilkins, Philadelphia, PA, 2009.Google Scholar
49. Bardella, IJ. Pediatric advanced life support: a review of the AHA recommendations. Am Fam Physician 1999; 60: 1743–1750.Google ScholarPubMed
50. Barlow, SM. Central pattern generation involved in oral and respiratory control for feeding in the term infant. Curr Opin Otolaryngol Head Neck Surg 2009; 17: 187–193.Google Scholar
51. Medoff-Cooper, B, Naim, M, Torowicz, D, Mott, A. Feeding, growth, and nutrition in children with congenitally malformed hearts. Cardiol Young 2010; 20: 149–153.Google Scholar
52. Svavarsdottir, EK, McCubbin, M. Parenthood transition for parents of an infant diagnosed with a congenital heart condition. J Pediatr Nurs 1996; 11: 207–216.CrossRefGoogle ScholarPubMed
53. Park, J, Thoyre, S, Knafl, GJ, Hodges, EA, Nix, WB. Efficacy of semielevated side-lying positioning during bottle-feeding of very preterm infants: a pilot study. J Perinat Neonatal Nurs 2014; 28: 69–79.Google Scholar
54. Thoyre, SM, Holditch-Davis, D, Schwartz, TA, Melendez Roman, CR, Nix, W. Coregulated approach to feeding preterm infants with lung disease: effects during feeding. Nurs Res 2012; 61: 242–251.CrossRefGoogle ScholarPubMed
55. Chen, CH, Wang, TM, Chang, HM, Chi, CS. The effect of breast- and bottle-feeding on oxygen saturation and body temperature in preterm infants. J Hum Lact 2000; 16: 21–27.Google Scholar
56. Meier, P. Bottle- and breast-feeding: effects on transcutaneous oxygen pressure and temperature in preterm infants. Nurs Res 1988; 37: 36–41.Google Scholar
57. Marino, BL, O’Brien, P, LoRe, H. Oxygen saturations during breast and bottle feedings in infants with congenital heart disease. J Pediatr Nurs 1995; 10: 360–364.Google Scholar
Supplementary material: Image

Pados supplementary material

Supplementary Figure

Download Pados supplementary material(Image)
Image 23.3 MB