Heart Rate Variability and Feeding Bradycardia in Healthy Preterm Infants During Transition From Gavage to Oral Feeding

Healthy preterm infants, 32 to younger than 34 weeks postconceptional age, (n = 81) were randomly assigned to standard care or semidemand protocols for making the transition from gavage to oral feeding. Experimental infants showed less autonomic arousal (decreased low-frequency [LF] and decreased high-frequency [HF] power) when using a pacifier before feeding compared with control infants. During oral feeding, control infants showed an increase in the sympathetic to parasympathetic balance (LF/HF) from the prefeeding period, whereas LF/HF for experimental infants did not change significantly. In the 48 hours after achieving full oral feeding, control infants had significantly more feeding bradycardia episodes than experimental infants. The semidemand protocol that included use of a pacifier before oral feeding, opportunity to feed orally up to eight times per day, and use of infant behavior to begin and end feedings resulted in the autonomic balance of the experimental infants being more stable as they learned to feed orally.