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Effects of milk flow on the physiological and behavioural responses to feeding in an infant with hypoplastic left heart syndrome

Published online by Cambridge University Press:  16 March 2016

Britt F. Pados ,
Suzanne M. Thoyre ,
Hayley H. Estrem ,
Jinhee Park ,
George J. Knafl  and
Brant Nix
Britt F. Pados*
Affiliation:
School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
Suzanne M. Thoyre
Affiliation:
School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
Hayley H. Estrem
Affiliation:
School of Nursing, Duke University, Durham, North Carolina, United States of America
Jinhee Park
Affiliation:
School of Nursing, Boston College, Chestnut Hill, Massachusetts, United States of America
George J. Knafl
Affiliation:
School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
Brant Nix
Affiliation:
School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
*
Correspondence to: B. F. Pados, School of Nursing, The University of North Carolina at Chapel Hill, Carrington Hall, CB#7460, Chapel Hill, NC 27599-7460, United States of America. Tel/Fax: +617 477 9982; E-mail: bpados@email.unc.edu
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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.

Keywords

Hypoplastic left heart syndromebottle feedingfeeding methods
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 1 , January 2017 , pp. 139 - 153
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Copyright
© Cambridge University Press 2016 

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