title: Effects of milk flow on the physiological and behavioural responses to feeding in an infant with hypoplastic left heart syndrome.
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.
authors.affiliation: 1School of Nursing,The University of North Carolina at Chapel Hill,Chapel Hill,North Carolina,United States of America.
authors.forename: Britt F
authors.initials: BF
authors.lastname: Pados
authors.affiliation: 1School of Nursing,The University of North Carolina at Chapel Hill,Chapel Hill,North Carolina,United States of America.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Thoyre
authors.affiliation: 2School of Nursing,Duke University,Durham,North Carolina,United States of America.
authors.forename: Hayley H
authors.initials: HH
authors.lastname: Estrem
authors.affiliation: 3School of Nursing,Boston College,Chestnut Hill,Massachusetts,United States of America.
authors.forename: Jinhee
authors.initials: J
authors.lastname: Park
authors.affiliation: 1School of Nursing,The University of North Carolina at Chapel Hill,Chapel Hill,North Carolina,United States of America.
authors.forename: George J
authors.initials: GJ
authors.lastname: Knafl
authors.affiliation: 1School of Nursing,The University of North Carolina at Chapel Hill,Chapel Hill,North Carolina,United States of America.
authors.forename: Brant
authors.initials: B
authors.lastname: Nix
mesh_terms: D001903:Bottle Feeding / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D007223:Infant; D018730:Infant Behavior; D007231:Infant, Newborn; D008297:Male; D008895:Milk, Human
keywords: Hypoplastic left heart syndrome; bottle feeding; feeding methods