title: A self-paced oral feeding system that enhances preterm infants' oral feeding skills.
abstract: OBJECTIVE
  Very low birth weight (VLBW) infants have difficulty transitioning to independent oral feeding, be they breast- or bottle-feeding. We developed a 'self-paced' feeding system that eliminates the natural presence of the positive hydrostatic pressure and internal vacuum build-up within a bottle during feeding. Such system enhanced these infants' oral feeding performance as monitored by overall transfer (OT; % ml taken/ml prescribed), rate of transfer (RT; ml/min over an entire feeding). This study hypothesizes that the improvements observed in these infants resulted from their ability to use more mature oral feeding skills (OFS).
  
  
  METHODS
  'Feeders and growers' born between 26-29 weeks gestation were assigned to a control or experimental group fed with a standard or self-paced bottle, respectively. They were monitored when taking 1-2 and 6-8 oral feedings/day. OFS was monitored using our recently published non-invasive assessment scale that identifies 4 maturity levels based on infants' RT and proficiency (PRO; % ml taken during the first 5 min of a feeding/total ml prescribed) during bottle feeding.
  
  
  RESULTS
  Infants oral feeding outcomes, i.e., OT, RT, PRO, and OFS maturity levels were enhanced in infants fed with the self-paced vs. standard bottle (p ≤ 0.007).
  
  
  CONCLUSIONS
  The improved oral feeding performance of VLBW infants correlated with enhanced OFS. This study is a first to recognize that VLBW infants'trueOFS are more mature than recognized. We speculate that the physical properties inherent to standard bottles that are eliminated with the self-paced system interfere with the display of theirtrueoral feeding potential thereby hindering their overall oral feeding performance.
authors.affiliation: Department of Pediatrics/Neonatology, Baylor College of Medicine, Houston TX USA.
authors.forename: C
authors.initials: C
authors.lastname: Lau
authors.affiliation: Department of Pediatrics/Neonatology, University of Florida, Gainesville FL USA.
authors.forename: S
authors.initials: S
authors.lastname: Fucile
authors.affiliation: Neonatal-Perinatal Medicine, Cohen Children's Medical Center of New York, New Hyde Park NY ; Hofstra North Shore Long Island Jewish School of Medicine, Hempstead NY.
authors.forename: R J
authors.initials: RJ
authors.lastname: Schanler
keywords: bottle feeding; newborn; prematurity