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Nipple feeding practices of infants with respiratory distress syndrome and infants with mild to moderate bronchopulmonary dysplasia during the first hospitalization
TUESDAY, OCTOBER 26 POSTER SESSION: CLINICAL NUTRITION ,ii
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NIPPLE FEEDING PRACTICES OF INFANTS WITH RESPIRATORY DISTRESS SYNDROME AND INFANTS WITH MILD TO MODERATE BRONCHOPULMONARY DYSPLASIA DURING THE FIRST HOSPITALIZATION. N.Y. Wedel, MS, RD, S. Sondel, RD, MEd, F. Greer, MD, K.F. Pridham, RN, PhD. Dept. of Food and Nutrition Services and School of Nursing. University of Wisconsin Hospital and Clinics, Madison, WI. Very prematurely born infants with bronchopulmonary dysplasia (BPD) or respiratory distress syndrome (RDS) are believed to lack suck-swallow-breathe coordination until 33 to 35 weeks gestational age. This retrospective study investigated nipple feeding practices in infants with RDS (n=39) and infants with mild or moderate BPD (n=52) during the first hospitalization. All infants in this study were 32 weeks or less gestational age (GA) at birth with birth weight appropriate for age, and discharged to home on complete nipple feeding. Mean GA at birth for BPD group was 1.2 weeks earlier than that for RDS infants (28.0 + 2.3 vs. 29.2 + 1.6 weeks GA). Mean birth weight and length were significantly smaller in BPD group than RDS group. BPD group required supplemental oxygen significantly longer than RDS group. Nipple feeding was first introduced to BPD group significantly later than RDS group (36.2 + 4.2 vs. 33.5 + 1.4 weeks GA). In RDS group, age of nipple introduction (NI) was positively correlated with GA, however, not in BPD group. Age at which infants were completely nipple fed (CNF) was positively correlated with NI in RDS group. Period of time when BPD.group was receiving supplemental oxygen positively correlated with CNF. Period of transition from NI to CNF in BPD group inversely correlated with NI in BPD group, and was significantly longer than that for RDS group. These results indicate that increased need for oxygen may have contributed to slower progression of nipple feeding in BPD group and that earlier nipple feeding may not be warranted for infants with BPD who are struggling for adequate oxygenation.
IRON STATUS OF PARALYMPIC FEMALE ATHLETES WITH CEREBRAL PALSY L.A. Yochum, BS; R.K. Johnson, PhD, MPH, RD; M.S. Ferrara, PhD, ATC Department of Nutritional Sciences, University of Vermont, Burlington, VT Female athletes are a population well known to be at increased risk for developing iron deficiency. In addition, people with cerebral palsy (CP) are known to have feeding difficulties which often result in inadequate iron intake. Thus, when individuals are members of both groups, the risk for poor iron status may be compounded. We assessed the iron status of eleven female athletes with CP during a training camp sponsored by the U.S. Olympic Committee. The athletes were training for the 1992 Summer Paralympic Games. Three-day dietary records were collected to assess iron intake. Hemoglobin, serum ferritin, and transferrin iron binding capacity (TIBC) were measured to give a complete profile of iron status. Mean age of the sample was 28 (range 17-39). Mean iron intake was 13.0 mg or 87 percent of the RDA for females ages 11-55 (range 4.2 - 26.8 mg). Monsen has suggested that menstruating females should consume 1.2-1.4 mg of absorbable iron per day. In our sample 73 percent of the athletes fell below this level, consuming an average of 1.1 mg of absorbable iron (range .2 - 3.4 mg). Thirty-six percent (4 of 11) of the sample had low serum ferritin levels (< 25ug/L), 27 percent (3 of 11)had elevated TIBC levels (> 360ug/100ml), and one subject was anemic (hemoglobin < 12 gm/dL). It has been reported that 40 to 80 percent of able-bodied female athletes have low serum ferritin levels and 8 to 10 percent are anemic. Thus, this group of female athletes with CP does not appear to be at any greater risk for developing iron deficiency when compared with their able-bodied counterparts.
A-34 / SEPI'TEMB13ER 1993 SUUP1 LEMENT VOLUME 93 NUMBER 9
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CUSICLIZING DETERAL NUTRITION CARE IN AN ERA OF STANDARDIZATION. D.O. Weddle, PhD, RD, C. Ross, ScD, P. Dillon, RD, and H. A. Hawkins, RD, VA Westside Medical Center, Chicago, IL Providing enteral nutrition care for the special needs of small segments of the patient population is often difficult in an era of standardized, cost controlled care. This study was designed to assist clinical decision making when caring for a small, at risk group of patients. Its purpose was to determine if an alternative liquid product that "custcanized" care by providing flavor variety and ease in use would be more clinically effective than the currently used single flavor powder product that required mixing. It was expected that patients receiving the liquid product would better reach their goal of maintaining or improving nutrition status as measured by maintenance or increase in weight or protein/kilocalorie intake; and be better satisfied with their treatment. The study population consisted of fifty patients from the ENT ambulatory clinic who were appropriately receiving the powder product either as a tube feeding or supplement, but unable to consume it because of taste fatigue or inability to prepare the product. Subjects were randomly assigned to the experimental group (E) to receive an individualized treatment program with the liquid product or to the control (C) group to continue with the established powder product regime. Progress for both groups was monitored at clinic visits or by telephone on as close to a bi-weekly schedule as possible. Seventeen E subjects and 20 C subjects ccpleted the study. While not statistically significant, the E group experienced increases in body weight, kilocalorie and protein intake, in contrast to the C group which exhibited decreases in each of the three categories. The E group was significantly more satisfied (p=O.001) with its treatment, ad reported a decrease in feeding problems. The Nutrition committee used the results to recmmnend the liquid product be routinely available to these patients. The small difference found may indicate that, in a larger study, a more customized " treatment could result in positive changes in nutrition status.
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NIPPLE FEEDING PRACTICES OF INFANTS WITH RESPIRATORY DISTRESS SYNDROME AND INFANTS WITH MILD TO MODERATE BRONCHOPULMONARY DYSPLASIA DURING THE FIRST HOSPITALIZATION. N.Y. Wedel, MS, RD, S. Sondel, RD, MEd, F. Greer, MD, K.F. Pridham, RN, PhD. Dept. of Food and Nutrition Services and School of Nursing. University of Wisconsin Hospital and Clinics, Madison, WI. Very prematurely born infants with bronchopulmonary dysplasia (BPD) or respiratory distress syndrome (RDS) are believed to lack suck-swallow-breathe coordination until 33 to 35 weeks gestational age. This retrospective study investigated nipple feeding practices in infants with RDS (n=39) and infants with mild or moderate BPD (n=52) during the first hospitalization. All infants in this study were 32 weeks or less gestational age (GA) at birth with birth weight appropriate for age, and discharged to home on complete nipple feeding. Mean GA at birth for BPD group was 1.2 weeks earlier than that for RDS infants (28.0 + 2.3 vs. 29.2 + 1.6 weeks GA). Mean birth weight and length were significantly smaller in BPD group than RDS group. BPD group required supplemental oxygen significantly longer than RDS group. Nipple feeding was first introduced to BPD group significantly later than RDS group (36.2 + 4.2 vs. 33.5 + 1.4 weeks GA). In RDS group, age of nipple introduction (NI) was positively correlated with GA, however, not in BPD group. Age at which infants were completely nipple fed (CNF) was positively correlated with NI in RDS group. Period of time when BPD.group was receiving supplemental oxygen positively correlated with CNF. Period of transition from NI to CNF in BPD group inversely correlated with NI in BPD group, and was significantly longer than that for RDS group. These results indicate that increased need for oxygen may have contributed to slower progression of nipple feeding in BPD group and that earlier nipple feeding may not be warranted for infants with BPD who are struggling for adequate oxygenation.
IRON STATUS OF PARALYMPIC FEMALE ATHLETES WITH CEREBRAL PALSY L.A. Yochum, BS; R.K. Johnson, PhD, MPH, RD; M.S. Ferrara, PhD, ATC Department of Nutritional Sciences, University of Vermont, Burlington, VT Female athletes are a population well known to be at increased risk for developing iron deficiency. In addition, people with cerebral palsy (CP) are known to have feeding difficulties which often result in inadequate iron intake. Thus, when individuals are members of both groups, the risk for poor iron status may be compounded. We assessed the iron status of eleven female athletes with CP during a training camp sponsored by the U.S. Olympic Committee. The athletes were training for the 1992 Summer Paralympic Games. Three-day dietary records were collected to assess iron intake. Hemoglobin, serum ferritin, and transferrin iron binding capacity (TIBC) were measured to give a complete profile of iron status. Mean age of the sample was 28 (range 17-39). Mean iron intake was 13.0 mg or 87 percent of the RDA for females ages 11-55 (range 4.2 - 26.8 mg). Monsen has suggested that menstruating females should consume 1.2-1.4 mg of absorbable iron per day. In our sample 73 percent of the athletes fell below this level, consuming an average of 1.1 mg of absorbable iron (range .2 - 3.4 mg). Thirty-six percent (4 of 11) of the sample had low serum ferritin levels (< 25ug/L), 27 percent (3 of 11)had elevated TIBC levels (> 360ug/100ml), and one subject was anemic (hemoglobin < 12 gm/dL). It has been reported that 40 to 80 percent of able-bodied female athletes have low serum ferritin levels and 8 to 10 percent are anemic. Thus, this group of female athletes with CP does not appear to be at any greater risk for developing iron deficiency when compared with their able-bodied counterparts.
A-34 / SEPI'TEMB13ER 1993 SUUP1 LEMENT VOLUME 93 NUMBER 9
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CUSICLIZING DETERAL NUTRITION CARE IN AN ERA OF STANDARDIZATION. D.O. Weddle, PhD, RD, C. Ross, ScD, P. Dillon, RD, and H. A. Hawkins, RD, VA Westside Medical Center, Chicago, IL Providing enteral nutrition care for the special needs of small segments of the patient population is often difficult in an era of standardized, cost controlled care. This study was designed to assist clinical decision making when caring for a small, at risk group of patients. Its purpose was to determine if an alternative liquid product that "custcanized" care by providing flavor variety and ease in use would be more clinically effective than the currently used single flavor powder product that required mixing. It was expected that patients receiving the liquid product would better reach their goal of maintaining or improving nutrition status as measured by maintenance or increase in weight or protein/kilocalorie intake; and be better satisfied with their treatment. The study population consisted of fifty patients from the ENT ambulatory clinic who were appropriately receiving the powder product either as a tube feeding or supplement, but unable to consume it because of taste fatigue or inability to prepare the product. Subjects were randomly assigned to the experimental group (E) to receive an individualized treatment program with the liquid product or to the control (C) group to continue with the established powder product regime. Progress for both groups was monitored at clinic visits or by telephone on as close to a bi-weekly schedule as possible. Seventeen E subjects and 20 C subjects ccpleted the study. While not statistically significant, the E group experienced increases in body weight, kilocalorie and protein intake, in contrast to the C group which exhibited decreases in each of the three categories. The E group was significantly more satisfied (p=O.001) with its treatment, ad reported a decrease in feeding problems. The Nutrition committee used the results to recmmnend the liquid product be routinely available to these patients. The small difference found may indicate that, in a larger study, a more customized " treatment could result in positive changes in nutrition status.