Page 349 - Encyclopedia of Nursing Research

316 n NeuROBeHAvIORAL DeveLOPMeNT

They reported a significant relationship was neonatal morbidity of developmental
between average bolus size and sucking pres- outcome at 6 months of age. At 12 months of
N sures and sucking frequency. The ability to age, organized feeding patterns at 40 weeks
tolerate, as well as adapt to, increasing bolus PMA was significantly correlated with both
size serves as an indicator of maturation in Mental Developmental and Psychomotor
feeding behaviors. Developmental Index (Medoff-Cooper et al.,
Gewolb, Bosma, Reynolds, and vice 2009). Mizuno and ueda (2005) found sig-
(2003) used increasing rhythmic stability as nificant correlation between feeding assess-
the index of maturation of sucking or feed- ment and neurodevelopmental outcome at
ing behaviors. In their comparison of healthy 18 months. The sensitivity and specificity of
preterm infants and preterm infants with feeding assessment were higher than those
bronchopulmonary dysplasia, an increase in of ultrasound assessment. In summary,
stability of rhythm and uniformity of wave- nutritive sucking, a noninvasive and easily
form morphology was correlated with feed- measured behavior, appears to be an excel-
ing efficiency and increasing PMA in healthy lent index of neurodevelopment in preterm
preterm infants. This relationship was not infants.
found to be true in the bronchopulmonary Sleeping and waking states are clusters
dysplasia cohort. They hypothesized that that of behaviors that tend to occur together and
the poor feeding efficiency may be related to represent the infant’s level of arousal, respon-
decreased respiratory reserves or to nonspe- sivity to external stimulation, and central
cific neurologic impairment. nervous system activation. Three states have
Mizuno and ueda (2005) assessed the been identified in adults: wakefulness, non-
feeding behavior of preterm infants by mea- ReM sleep, and ReM sleep. In infants, it is
suring sucking pressure, frequency, duration, also possible to identify states within wak-
and efficiency, as well as the coordination of ing and states that are transitional between
swallowing and respiration. The sucking waking and sleeping. Infant sleep states are
efficiency significantly increased between 34 usually designated as active and quiet sleep
and 36 weeks after conception and exceeded because the electrophysiological patterns
7 ml/min at 35 weeks. There were significant associated with sleep in infants are different
increases in sucking pressure and frequency than those in adults.
and in duration between 33 and 36 weeks. Because of newborn infants’ neurologi-
Swallowing patterns demonstrated matu- cal immaturity, eeG and behavioral scoring
rational changes as well, which occurred of states in preterm and full-term infants
mostly during pauses in respiration at 32 and provide quite similar results. Sleeping and
33 weeks and then at the end of inspiration waking states in infants can be validly scored
after 35 weeks. either by using eeG or by directly observing
The potential link between nutritive infant behaviors. Four standardized systems
sucking and future developmental prob- for scoring behavioral observations of sleep–
lems has been identified throughout the wake states are currently being used by nurse
feeding literature. One early study by Burns researchers: the 6-state system developed
et al. (1987) showed that infants with sig- by T. Berry Brazelton, the 10-state system of
nificant intraventricular hemorrhage were evelyn Thoman (1990), the 12-state system
delayed in their ability to achieve a nutritive from Heideliese Als’s (2003) Assessment of
suck reflex. At week 40, only 75% of the 110 Preterm Infant’s Behavior, and the Anderson
infants demonstrated mature nutritive suck- Behavioral State Scale developed by Gene
ing patterns. Medoff-Cooper and Gennaro Anderson (Holditch-Davis & Blackburn,
(1996) reported that sucking organization or 2007). These systems define states in very
rhythmicity was a far better predictor than similar ways and are probably equally useful