Neuropredictors of oromotor feeding impairment in 12 month-old children. (August 2017) - Sanchez, Katherine
Abstract: Background: Feeding impairment is prevalent in children with neurodevelopmental issues. Neuroimaging and neurobehavioural outcomes at term are predictive of later neuromotor impairment, but it is unknown whether they predict feeding impairment. Aims: To determine whether neurobehavior and brain magnetic resonance imaging (MRI) at term predict oromotor feeding at 12 months in preterm and term-born children. Study design: Prospective cohort study. Subjects: 248 infants (97 born < 30 weeks and 151 born at term) recruited at birth. Outcome measures: Neurobehavioral assessments (General Movements (GMA), Hammersmith Neonatal Neurological Examination (HNNE), Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS)); and brain MRI were administered at term-equivalent age. Oromotor feeding was assessed at 12 months corrected age using the Schedule for Oral Motor Assessment. Results: 49/227 children had oromotor feeding impairment. Neurobehavior associated with later feeding impairment was: suboptimal NNNS stress (odds ratio [OR] 2.68; 95% confidence interval [CI] 1.20–6.01), non-optimal reflexes (OR 3.33; 95% CI 1.37–8.11) and arousal scales (OR 2.54; 95% CI 1.03–6.27); suboptimal HNNE total (OR 4.69; 95% CI 2.20–10.00), reflexes (OR 2.62; 95% CI 1.06–6.49), and tone scores (OR 3.87; 95% CI 1.45–10.35); and abnormal GMA (OR 2.60; 95% CI 1.21–5.57). Smaller biparietal diameter also predicted feeding impairment (OR 0.88; 95% CI 0.79–0.97). There was little evidence that relationships differed between birth groups. Conclusions: Neurobehavior and biparietal diameter at term are associated with oromotor feeding at 12 months. These results may identify children at greatest risk of oromotor feeding impairment. Highlights: Feeding impairment is prevalent and debilitating in children with neurodevelopmental issues. Neuroimaging and neurobehaviour at term predict later neuromotor outcomes, but predictive value for feeding impairment has not been examined. We found that neurobehavioural outcomes and biparietal diameter at term are associated with oromotor feeding impairment at 12 months. Children with abnormal neuroimaging and neurobehaviour at term should be monitored for oromotor feeding problems during their first year of life.