1

Introduction

In Japan, the percentage of low birth weight (LBW) infants born weighing less than 2500 g has remained constant at approximately 9.5% [ ]. Although the causes of LBW infants vary, the morbidity and mortality rates are significantly higher than those of normal body weight (NBW) infants [ ]. In addition, problems with the feeding function caused by delayed gross motor activity and other factors are often observed [ ].

Guardians of LBW children often feel that their children’s physical growth and development are delayed compared with children of the same age, even when they do not have disabilities, and they often feel anxious about their children’s development [ ]. The highest rates of anxiety were found in items related to feeding, such as “feeding” and “weaning/food”, following “height and weight” [ ]. This indicates that many guardians tend to have anxiety and difficulties in raising their children, and it is clear that support related to food, such as feeding function therapy and nutritional guidance, is indispensable.

Numerous studies conducted to date have focused on gross motor movements, and few studies have referred to the feeding function [ ]. The feeding function consists of the development of oral and self-feeding functions. However, reports on the feeding problems in LBW children have not examined the actual timing of acquisition of the feeding function [ ]. In addition, although weaning and public administrative services are described in the Maternal and Child Health Handbook, they are not fully utilized, and public administrative services are not well understood by the parents of children who have been hospitalized in the Neonatal Intensive Care Unit (NICU) [ ].

A retrospective study was conducted on the relationship between the birth and care environment and the time of acquisition of feeding function in order to assess low birthweight infants using feeding function assessment, and to identify the appropriate time of acquisition of feeding function to provide effective support.

2

Methods

The subjects were children under 12 years of age who visited Meikai University Hospital and a certain medical center affiliated with the Meikai University School of Dentistry between 2010 and 2021 and sat for multiple feeding guidance sessions. Overall, 134 children (79 boys and 55 girls) were included in the study, excluding 20 children with cerebral palsy, Down’s syndrome, and other congenital disorders, cleft palate, esophageal atresia, and tracheostomy. The subjects were divided into two groups: 84 LBW children weighing less than 2500 g and 50 NBW children weighing 2500 g or more.

The timing of acquisition of feeding function was determined based on the subjects’ medical records ( Table 1 ). The time of fixed neck acquisition, rolling over acquisition, sitting up without support acquisition, and pulling up to stand acquisition (actual age) were used as gross motor assessment items. The following items were also included: stage of feeding function, motor function, number of weeks of gestation, duration of NICU hospitalization (at least 1 day was included), duration of tube feeding (at least 1 day was included), and use of public services ( Table 2 ).

The EZR statistical analysis software was used, and significant differences were considered when p < 0.05 [ ]. No statistical sample size calculations were conducted. However, with a sample size of 84 in the LBW group and 50 in the NBW group, a two-tailed t -test was used at a two-sided significance level of p < 0.05 for differences in the timing of functional acquisition between the LBW and NBW groups.

The posterior power to detect the difference between the common standard deviation (SD) at each functional gain period and the duration of each functional gain period is as follows.

• ●

  oral intake preparation 4.17 months, 1.57 months, 56%

• ●

  swallowing function acquisition 6.79 months, 3.62 months, 85%

• ●

  predatory function acquisition 8.82 months, 3.03 months, 49%

• ●

  acquisition of mashing function 8.65 months, 3.39 months, 59%

• ●

  acquisition of chewing function 10.89 months, 2.63 months, 27%

• ●

  self-feeding preparation 5.72 months, 2.18 months, 57%

• ●

  acquiring the function of eating with hands 10.94 months, 0.73 months, 6%

• ●

  acquiring the function of tool-eating 13.1 months, 3.47 months, 32%

• ●

  fixed neck acquisition 3.59 months, 2.13 months, 91%

• ●

  rolling over acquisition 5.45 months, 1.88 months, 49%

• ●

  sitting up without support acquisition 5.48 months, 2.75 months, 80%

• ●

  pulling up to stand acquisition 5.49 months, 1.35 months, 28%

To compare the attributes of the LBW and NBW groups, the Fisher’s exact probability test was used for sex, percentage of preterm infants, history of NICU admission, history of tube feeding, and use of public services, and the Mann–Whitney U test was used for birth weight, number of weeks of gestation, age at the first visit, final age, and period of hospital visits.

A Mann–Whitney U test was performed for differences in the time of acquiring each function, and a multiple regression analysis was performed for the time of acquiring each function for which significant differences were found. The nominal scale variables for sex, number of weeks of gestation, birth weight, history of NICU hospitalization, history of tube feeding, and use of public services were dichotomized and forced entry was performed as explanatory variables. In addition, the time of acquisition of feeding function was used as the objective variable, and each motor function was used as an explanatory variable.

The correlation between the time of functional acquisition and influencing factors was analyzed using Spearman’s rank correlation coefficient.

This study was approved by the Ethics Committee of the Meikai University School of Dentistry (Approval no.: A2126).

3

Results

There was no significant difference with respect to sex between the LBW and NBW groups ( Table 3 ). The number of weeks of gestation were significantly shorter in the LBW group, and birth weight was significantly lower in the LBW group. The LBW group was significantly more likely to have been hospitalized in the NICU and to have been tube-fed. There were no significant differences in the use of public administrative services between the two groups. The age at the first visit was significantly lower in the LBW group. The LBW children were significantly older than the LBW children at the end of the hospital visit or at the end of the study. The duration of hospital visits was significantly longer in the LBW group.

Fig. 1 : The LBW children showed a significantly delayed acquisition of oral intake preparation, swallowing function, and mashing function compared with the NBW children. However, there were no significant differences in the time of predatory function acquisition and the time of acquisition of chewing function between the two groups.

Oral function during the acquisition of feeding function. Data are presented as mean ± standard deviation. *p < 0.05.

Fig. 2 : The time of self-feeding preparation was significantly delayed in the LBW group. However, the time of acquiring the function of eating with hands and the function of tool-eating did not differ significantly between the two groups.

Self-feeding function during the acquisition of feeding function. Data are presented as mean ± standard deviation. *p < 0.05.

Fig. 3 : The LBW group showed a significantly delayed acquisition of gross motor function (i.e., fixed neck, rolling over, sitting up without support, and pulling up to stand).

Time of motor function acquisition. Data are presented as mean ± standard deviation. *p < 0.05.

Table 4 : The results of the multiple regression analysis with forced entry are shown below. The factors influencing the time of oral intake preparation were the number of weeks of gestation and NICU hospitalization, while the factors influencing the time of acquiring the swallowing function and mashing function were the number of weeks of gestation, NICU hospitalization, and use of government services. The factors affecting the time of self-feeding preparation were sex, number of weeks of gestation, and history of NICU hospitalization.

Table 4

Multiple regression analysis for timing of acquisition of feeding function.

Time of oral intake preparation	estimate	p-value	VIF
Sex	0.41	0.56	1.03
number of weeks pregnant	−0.28	<0.001 a	1.17
NICU	−4.23	0.001 a	1.88
tube feeding	1.63	0.22	2.05
public services	1.49	0.06	1.10
Model p-value	<0.001 a
R 2	0.18
Time of swallowing function acquisition	estimate	p-value	VIF
Sex	−2.02	0.16	1.04
number of weeks pregnant	−0.46	0.003 a	1.16
NICU	−8.48	<0.001 a	1.63
tube feeding	3.74	0.15	2.03
public services	5.06	0.002 a	1.30
Model p-value	<0.001 a
R 2	0.39
Time of acquisition of mashing function	estimate	p-value	VIF
Sex	0.88	0.56	1.03
number of weeks pregnant	−0.45	0.003 a	1.27
NICU	−7.88	0.005 a	2.33
tube feeding	4.23	0.14	2.55
public services	7.82	<0.001 a	1.08
Model p-value	<0.001 a
R 2	0.28
Time of self-feeding preparation	estimate	p-value	VIF
Sex	3.67	0.012 a	1.15
number of weeks pregnant	−0.36	0.009 a	1.26
NICU	−7.10	0.018 a	3.04
tube feeding	3.56	0.25	3.68
public services	0.57	0.69	1.17
Model p-value	<0.001 a
R 2	0.17

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