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Coregulated Approach to Feeding Preterm Infants With Lung Disease: Effects During Feeding

Thoyre, Suzanne M.; Holditch-Davis, Diane; Schwartz, Todd A.; Melendez Roman, Carlos R.; Nix, William

doi: 10.1097/NNR.0b013e31824b02ad

Background: Very preterm (VP) infants are at risk for poor oral feeding endurance, early cessation of eating, poor fluid management with aspiration risk, behavioral distress, and unstable heart rate (HR) and oxygenation during feeding.

Objective: The study aims to determine the preliminary effectiveness of a coregulated approach (CoReg) to oral feeding for VP infants at risk for lung disease.

Methods: A randomized, within-subject, cross-over design was used with 20 VP infants requiring oxygen at the start of oral feeding. Infants were bottle-fed by the Usual Care approach and by the CoReg approach on two consecutive days for an average of four feedings each. Intervention components included coregulation of suck, swallow, and breathe rhythms using enhanced auditory assessment, infant-guided feeding onsets, and infant positioning in a semielevated, side-lying position. Infant physiology metrics (HR and SaO2) were collected continuously before and during the feeding. Behavioral and auditory indicators of regulation were coded continuously from videotape during the feeding.

Results: Up to 75 feedings were analyzed (40 Usual Care and 35 CoReg) using repeated measures modeling. CoReg feedings were characterized by more frequent preparation of the infant for the feeding, were more commonly initiated in response to infant readiness cues, had more rest periods and breath regulation events, and had fewer sucking stimulation events. CoReg feedings had less SaO2 variability, decline, and time spent in a desaturated state; less HR fluctuation and decline; less behavioral disorganization; better fluid management; and less observed effort to breathe.

Discussion: Support is provided for an approach to feeding vulnerable infants. Enhanced auditory assessment of infant feeding rhythms increases the responsiveness of the feeder and improves infant behavioral and physiological responses.

Suzanne M. Thoyre, PhD, RN, is Associate Professor and Director, PhD and Postdoctoral Programs, School of Nursing, University of North Carolina at Chapel Hill.

Diane Holditch-Davis, PhD, RN, FAAN, is Marcus E. Hobbs Distinguished Professor of Nursing and Associate Dean for Research Affairs, Duke University, Durham, North Carolina.

Todd A. Schwartz, DrPH, is Research Assistant Professor, School of Nursing, University of North Carolina at Chapel Hill.

Carlos R. Melendez Roman, PhDc, is Doctoral Student, School of Education, University of North Carolina at Chapel Hill.

William Nix, BMET, BA, is Lab and Biomedical Engineer Technician, School of Nursing, University of North Carolina at Chapel Hill.

Accepted for publication January 12, 2012.

The authors thank the families and nurses who participated in the study. Special acknowledgement is given to speech pathologists Jennifer Rayburn Paulson and Krisi Brackett.

This study was supported by Grant K01 NR007668 from the National Institute for Nursing Research, National Institutes of Health, and by The University of North Carolina at Chapel Hill, School of Nursing.

The authors have no conflicts of interest to disclose.

Corresponding author: Suzanne M. Thoyre, PhD, RN, School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall CB 7460, Chapel Hill, NC 27599 (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.