1. A RETROSPECTIVE ANALYSIS OF BEHAVIORAL AND PHYSIOLOGIC SIGNS OF ASPIRATION IN PREMATURE INFANTS Neina F. Ferguson, M.S. & Julie M. Estis, Ph.D. University of South Alabama, Mobile, AL Premature infants are introduced to oral feedings, regardless of their neurologic stage of development and AAP guidelines, in order to facilitate earlier hospital discharge (Raju et al., 2006). Often, successful oral feeding is viewed in terms of volume of intake during a single feeding (Shaker, 2010). Current practice is often based in tradition, rather than based on information from current research. This retrospective analysis explored nursing documentation of physiologic, behavioral, and nursing judgment clinical markers to determine if documentation distinguished among infants who aspirated on videofluoroscopic examination (VSS-A), infant who did not aspirate on VSS-NA, and a control group of infants (C-NA) who did not aspirate on an upper gastrointestinal study (GIS). Final analysis included 41 infants who completed 2,590 bottle- feedings during the 14-day period prior to radiographic imaging studies. However, nurses only documented clinical markers in 182 of these 2,590 bottle-feedings sessions. Therefore, statistical analyses were based on a small sample size with a limited data set. INTRODUCTION ONLY 182 OF THE 2,590 FEEDINGS ACROSS INFANTS HAD DOCUMENTATION OF THE CLINICAL MARKERS ANALYSIS OF THE 410 RANDOMLY SELECTED FEEDINGS FROM THE 2,590 FEEDINGS CODED ACROSS INFANT GROUPS COMPARISON OF CLINICAL MARKERS ACROSS INFANTS WITH AND WITHOUT ASPIRATION ON RADIOGRAPHIC IMAGING CONCLUSIONS  Logistic regression analysis revealed that documented episodes of clinical markers did not predict group membership in this group of premature infants.  While these infants were referred for evaluation, documentation of clinical markers in these preterm infants was very limited.  Referral criteria for feeding and swallowing assessments remain unclear due to limited documentation across clinical markers.  Chi-square and LR+ ratios suggested presence of coughing, desaturation, tachypnea, BPD, NEC, and neurologic disease increase likelihood of aspiration during bottle-feeding. The predictive nature of these variables needs to be studied in a larger sample of premature infants.  Retrospective nature did not allow exploration into rationale for lack of nursing documentation or the presence of clinical markers during bottle-feeding in premature infants. 2,590 total feedings across 41 infants 427 CLINICAL MARKERS WERE DOCUMENTED IN THE 182 FEEDINGS ACROSS INFANT GROUPS VSS-NA VSS-A C-NA VSS-NA VSS-A C-NA PARTICIPANTS METHODS COMPARISON OF DEVELOPMENTAL MILESTONES ACROSS INFANT GROUPS COMPARISON OF MEDICAL CO-MORBIDITIES ACROSS INFANT GROUPS COMPARISON OF TREATMENT REGIMENS ACROSS INFANT GROUPS  Participant charts were selected from all premature infants admitted to NICU with referrals for a videofluoroscopic examination or an upper gastrointestinal examination  41 records were coded for evidence of treatment regimens, medical co-morbidities, and infant characteristics  41 records were coded for documentation of physiologic clinical markers, behavioral clinical markers, and nursing judgments  10 feedings per infant were randomly selected from all coded feeding sessions CLINICAL MARKERS NURSING JUDGMENT OF “DIFFICULTY” BOTTLE FEEDING Documentation choices – Infant fed:  Well  With difficulty  Choked  Aspirated Nursing judgment of “no difficulty” Nursing judgment of “difficulty” Behavioral clinical markers 29 Physiological clinical markers 293 RN clinical marker 105 VSS-NA VSS-A C-NA