Feeding Progression for PreTerm Infants

Infants born prematurely often have underdeveloped organ systems and behavioral organization, placing them at risk for short-term health challenges that may extend into later life. One common challenge preterm infants face is difficulty feeding, which frequently necessitates the use of enteral feeding tubes. Proper nourishment and the progression from tube to oral feeding are essential to infant growth and maturation. The Hospital to Home: Optimizing the Preterm Infant’s Environment (H-HOPE) intervention is an early developmental intervention designed to address the needs of the parents and the infant simultaneously and promote optimal growth during the transition from tube to oral feeding and from hospital to home.

Previous studies have established the efficacy of the H-HOPE intervention across several outcomes. We wanted to investigate the mechanisms underlying this effectiveness and identified the transition from tube to oral feeding, referred to as feeding progression, as a potential explanatory mechanism. Specifically, the goal of the project was to determine if feeding progression mediates the relationship between the H-HOPE intervention and positive infant outcomes, including improved growth, shorter hospital stays, and lower hospitalization costs.

To address this question, we conducted a mediation analysis, extending the traditional single-mediator model framework to accommodate the type of data collected. We employed linear regression, linear mixed-effects modeling, path analysis, and Sobol’s Test, aggregating the results to determine the presence of mediation effects and clarify the causal pathways linking the intervention to infant outcomes. Understanding these pathways provides insight into how the H-HOPE intervention functions which could facilitate further development of the intervention, ultimately supporting improved outcomes for preterm infants and their families.