Knowledge Bank

Background/Purpose: Full term infants with complex congenital heart disease (CCHD), often have poor feeding skills. Position changes are used to support the infant during feeding. This study aimed to describe physiologic and behavioral responses of infants who experienced multiple position changes during feeding and those who did not. Methods: This cross-sectional, descriptive study consisted of ten infants on cardiac care units who were divided into two groups: five with feedings that involved at least three position changes (Change) and five having no position changes (No-Change). Feedings were videotaped and continuous heart rate (HR) and oxygen saturations (SpO2) were concurrently recorded from the bedside monitors. Data were then uploaded to the Noldus Observer behavioral coding system where fluid management (organization of swallowing), engagement in feeding, and position changes were coded. These behavioral variables were calculated for the entire feeding as well as 15 seconds before and after each position change. Analysis was performed using Mann-Whitney tests, t-tests, and graphical analysis. Results: All five infants in the Change group had single ventricle disease whereas four of the five in the No-Change group had bi-ventricular disease. The Change group had an average of 5.8 position changes with a range from 3 to 15 changes. Mean HR was similar between groups. SpO2 was significantly lower in the Change group (t=-34.861, p<.001) with significantly more variability (F=287.269, p<.001). Fluid management did not differ between groups, however, engagement was higher in the No-Change group (U=3.0, p=.084). Within the Change group, 16 out of 28 position changes (57.1%) resulted in an increase in HR. SpO2 with position changes was equally distributed. Using graphical analysis of behavioral codings, position changes showed no association with levels of engagement or fluid management in any of the feedings.
Conclusion: Single ventricle infants showed more issues with physiologic and behavioral responses to feeding in spite of feeders' attempts to support the infant with position changes. Further research should focus on a larger sample size and identifying additional factors differentiating infants requiring position changes from those who do not.