title: The Relationship Between Behavioral States and Oral Feeding Efficiency in Preterm Infants.
abstract: BACKGROUND
  The relationship between behavioral states (alert, sleep, drowsy, and crying) and oral feeding efficiency in preterm infants is not well understood.
  
  
  OBJECTIVE
  To determine the relationship between behavioral states and feeding efficiency in preterm infants.
  
  
  METHODS
  This correlational study was conducted as a secondary analysis from a randomized controlled trial. Medically stable preterm infants born between 29 and 34 weeks' gestational age participated. Baseline data from the randomized controlled trial (week 0), 1 minute prior to feeding, were used. Behavioral states were coded by 2 blinded coders. Oral feeding efficiency (mL/min) was calculated as the amount of intake over the first 10 minutes of feeding.
  
  
  RESULTS
  Data from 147 infants were included. The proportion of time spent in alert states (β = .76, F = 11.29, P ≤ .05), sleep states (β = -1.08, F = 25.26, P ≤ .05), and crying (β = 1.50, F = 12.51, P ≤ .05) uniquely predicted oral feeding efficiency.
  
  
  CONCLUSIONS
  Comprehensive assessment of behavioral states and infant characteristics for oral feeding readiness is crucial. Alert states are optimal for oral feeding. Forced oral feeding when infants are sleeping should be avoided. Infants in crying or drowsy states prior to feeding should be closely evaluated. Sleeping or drowsy infants may benefit from interventions (eg, oral sensory stimulation, nonnutritive sucking, or multisensory intervention) to support transition to alert states prior to feeding.
  
  
  CONCLUSIONS
  Future research should evaluate behavioral states prior to and during feeding and their relationship to oral feeding efficiency.
authors.affiliation: Children's Hospital of Wisconsin, Milwaukee (Ms Griffith and Dr White-Traut); and Women, Children and Family Health Science, College of Nursing (Ms Griffith and Dr White-Traut), and Division of Epidemiology and Biostatistics, School of Public Health (Dr Rankin), University of Illinois at Chicago.
authors.forename: Thao
authors.initials: T
authors.lastname: Griffith
authors.forename: Kristin
authors.initials: K
authors.lastname: Rankin
authors.forename: Rosemary
authors.initials: R
authors.lastname: White-Traut
mesh_terms: D003448:Crying; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D018730:Infant Behavior; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D012890:Sleep; D012894:Sleep Stages; D014851:Wakefulness