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Lack of Feeding Progression in a Preterm Infant: A Case Study

White-Traut, Rosemary PhD, RN, FAAN; Shapiro, Nicole BA, RN; Healy-Baker, Elissa BSN, RN; Menchavez, Lina BSN, RN; Rankin, Kristin PhD; Medoff-Cooper, Barbara PhD, RN, FAAN

Section Editor(s): Heaberlin, Pamela

doi: 10.1097/ANC.0b013e31827bfd3e
Case of the Month

The purpose of this article was to present the case of a premature infant who displayed immature feeding progression because of nasal occlusion. Two male preterm infants of 33 weeks' gestational age at birth from a larger randomized trial were observed in a comparative case study. Using a prospective design, feeding assessments were conducted weekly from initiation of oral feeding until hospital discharge. Sucking organization was measured using the Medoff-Cooper Nutritive Sucking Apparatus (M-CNSA), which measured negative sucking pressure generated during oral feedings. Oral and nasogastric (NG) intake and vital signs were recorded. At 35 weeks, infant A demonstrated an immature feeding pattern with the M-CNSA NG feedings prevailing over oral feedings. When attempting to feed orally, infant A exhibited labored breathing and an erratic sucking pattern. During the third weekly feeding evaluation, nasal occlusion was discovered, the NG tube was discontinued, and phenylephrine (Neo-Synephrine) and humidified air were administered. Following treatment, infant A's sucking pattern normalized and the infant maintained complete oral feeding. Infant B demonstrated normal feeding progression. Nasal occlusion prevented infant A from achieving successful oral feeding. The M-CNSA has the ability to help clinicians detect inconsistencies in the sucking patterns of infants and objectively measures patterns of nutritive sucking. The M-CNSA has the potential to influence clinical decision making and identify the need for intervention.

Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago (Dr White-Traut and Mss Shapiro and Healy-Baker); Neonatal Intensive Care Unit, Sinai Children's Hospital, Chicago, Illinois (Ms Menchavez); Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago (Dr Rankin); and Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia (Dr Medoff-Cooper).

Correspondence: Rosemary White-Traut, PhD, RN, FAAN, Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, 845 S Damen Ave (MC 802), Chicago, IL 60612 (

This work was supported by grants from the National Institutes of Child Health and Human Development, the National Institute of Nursing Research (1 R01 HD050738-01A2), and the Harris Foundation.

The authors thank the infants and mothers who participated in this research.

The authors declare no conflict of interest.

© 2013 by The National Association of Neonatal Nurses