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Nonnutritive Sucking During Tube Feedings: Effects on Preterm Neonates in an ICU
Abstract
Preterm neonates (mean 32 weeks' gestation, 1,300 gm birth weight) were provided a pacifier for nonnutritive sucking during tube feedings in the intensive care nursery. Their clinical course, subsequent bottle feeding behavior, and performance on the Brazelton Neonatal Behavior Assessment scale were compared with those of control group infants. The infants provided with pacifiers averaged 27 fewer tube feedings, started bottle feeding three days earlier, averaged a greater weight gain per day, and were discharged eight days earlier for an average hospital cost savings of approximately $3,500. Formula intake was similar for the two groups, although nurses appeared to provide more feeding stimulation for the control infants. On the Brazelton scale, the infants provided with pacifiers showed weak reflexes more frequently. Increased restfulness and diminished activity level in these infants may have contributed to the appearance of weak reflexes. The consistency between these findings and those of previous investigators suggests that the provision of a pacifier for nonnutritive sucking during tube feedings may be a cost-effective form of intervention.
... Non-nutritive sucking accelerated the transition from tube to independent oral feeding and enhanced sucking maturation. [17][18][19] Gaebler and Hanzlik, 20 demonstrated that infants receiving a peri-and intra-oral stimulation just before oral feedings scored better on the Neonatal Oral Motor Assessment Scale 8 had greater weight gain and fewer days of hospitalization. Across all studies, there is considerable evidence that oral stimulation through non-nutritive sucking or sensorimotor input to the oral structures has beneficial effects on oral feeding performance when applied before or during oral feedings in medically stable preterm infants >30 weeks gestational age (GA). ...
... This observation corroborates similar studies conducted on older preterm infants. [17][18][19][20] There was no significant difference in postmenstrual age, days of life, and weights between either groups at each of the oral feeding milestones. In this study, the management of oral feedings was left to the discretion of the attending physician. ...
... Although the experimental infants were discharged 5 days earlier, there was no significant difference, contrary to other studies, [16][17][18][19] in length of stay at the hospital between the 2 groups. This was an unexpected finding. ...
... Non-nutritive sucking accelerated the transition from tube to independent oral feeding and enhanced sucking maturation. [17][18][19] Gaebler and Hanzlik, 20 demonstrated that infants receiving a peri-and intra-oral stimulation just before oral feedings scored better on the Neonatal Oral Motor Assessment Scale 8 had greater weight gain and fewer days of hospitalization. Across all studies, there is considerable evidence that oral stimulation through non-nutritive sucking or sensorimotor input to the oral structures has beneficial effects on oral feeding performance when applied before or during oral feedings in medically stable preterm infants >30 weeks gestational age (GA). ...
... This observation corroborates similar studies conducted on older preterm infants. [17][18][19][20] There was no significant difference in postmenstrual age, days of life, and weights between either groups at each of the oral feeding milestones. In this study, the management of oral feedings was left to the discretion of the attending physician. ...
... Although the experimental infants were discharged 5 days earlier, there was no significant difference, contrary to other studies, [16][17][18][19] in length of stay at the hospital between the 2 groups. This was an unexpected finding. ...
... � ����������� p������� �� ����������� VO � � �������� �� p���í��� �� ���������� �� ����� p���� VO p������� ���� �b����� � p������� �� ����������� �� SNN. � SNN p����������� �� RNPT ���������� � �����v��v������ ������-�����, � q��, p��� ��� v�z, ��v� �������b���� �� ������������� �� ��� ����������� ���� ���q���� à� ������������ �� RN �, �����q����������, p���� q�� � ���p� �� ����������� ��j� ���������� (7,(19)(20)(21)(22)(23)(24)(25)(26) . ...
... C������������ (19) ��� ���ê� ����; p���� ��������� et al (28) , 3,4 ����; p���� S�hw����z et al (29) , 2,9 ����; � p���� S�hg�� et al (7) (20,21,(23)(24)(25) , �� ������p���� �� ��í��� �� ����������� VO (7,19,29) � �� �������� �� p���í��� �� ���������� �� ����� p���� � ����������� ����� (17,(21)(22)(23) . (17,18,27) , ��b���� � ������������ ��� ����-b����� �����é����� ��fi����� p���� ���� �v������� (12) . ...
... C������������ (19) ��� ���ê� ����; p���� ��������� et al (28) , 3,4 ����; p���� S�hw����z et al (29) , 2,9 ����; � p���� S�hg�� et al (7) (20,21,(23)(24)(25) , �� ������p���� �� ��í��� �� ����������� VO (7,19,29) � �� �������� �� p���í��� �� ���������� �� ����� p���� � ����������� ����� (17,(21)(22)(23) . (17,18,27) , ��b���� � ������������ ��� ����-b����� �����é����� ��fi����� p���� ���� �v������� (12) . ...
OBJECTIVE: To analyze the effects of nonnutritive sucking stimulation (NNS) on the age of introduction of oral feedings in preterm newborns (PTNB). METHODS: 95 PTNB with gestational age (GA) at birth < 33 weeks, born at the Nursery Annex to the Maternity of the Clinical Hospital of the University of São Paulo School of Medicine, São Paulo, Brazil, were studied. They were distributed into the following groups: Group 1 (G1), control group, without a specific incentive for oral feedings; Group 2 (G2), stimulation of NNS with an orthodontic pacifier (Nuk®) for premature infants; and Group 3 (G3), stimulation of NNS with a gloved finger. RESULTS: The GA varied from 26 to 32.7 weeks (30.5±1.6), the corrected GA at the moment of enrollment in the study varied from 27.4 to 33 weeks (31.6 ±1.3), and the average birthweight was 1,390g, without statistic differences among groups. G2 and G3 NB with GA at enrollment <32 weeks started oral feeding earlier than the control group. G1 started oral feeding was 34 weeks of corrected GA. The lower the GA at enrollment, the lower the corrected GA for beginning of oral feeding among NB that received NNS stimulation. CONCLUSIONS: Early NNS stimulation lowered the corrected GA at the introduction of oral feeding, contributing to the oral motor development and maturation of PTNB.
... A literatura relata que os benefícios da estimulação da sucção não-nutritiva são a adequação da musculatura oral; a regulação dos estados de consciência do bebê; o ganho de peso, recebendo a mesma quantidade calórica; a alta precoce; a facilidade de digestão; a transição para alimentação por via oral mais rápida e mais fácil; entre outras (1,(5)(6)(7)(8)(9)(10)(11)(12)(13) . Entretanto, as indicações ou parâmetros para início de uma sucção não-nutritiva não são unânimes, não havendo indicadores precisos sobre quando iniciá-la, como deve ser e ainda como proceder para levar o recém-nascido à prontidão para a alimentação oral. ...
... O estado clínico estável foi um dos parâmetros determinados para inclusão dos bebês prematuros nos estudos pesquisados (6)(7)(8)(9)(10)(11) , pois, muitas vezes, desordens respiratórias ou cardiovasculares, malformações orofaciais ou alterações neurológicas têm influência negativa no estado clínico dos bebês, quando estimulados em sua sucção não-nutritiva e nutritiva. Em relação ao peso dos bebês, a literatura consultada apontou uma média que fica entre 1400 a 1800 gramas de peso, ao iniciar o programa de estimulação da sucção não-nutritiva. ...
... O estímulo mais citado foi a chupeta (6,(8)(9)(10)(12)(13) , seguido de bico de mamadeira preenchido com gaze, para evitar aerofagia (7,11) . Todos os bebês estimulados estavam sendo alimentados via gavagem, porém, em dois trabalhos (9)(10) , os autores referiram que os bebês já estavam sendo alimentados via oral, através de mamadeira. ...
This is a bibliographic study on non-nutritive sucking in pre-term infants. Objectives: to characterize and analyze the scientific production on non-nutritive sucking in pre-term infants and identify how the transition from gastric to oral feeding takes place as well as how it begins and develops by considering the stimulation of non-nutritive sucking. Methodology: review of secondary sources (MEDLINE and LILACS). Results: pre-term infants presented a stable clinical condition, without cardio-respiratory, neurological or gastro-intestinal alterations. Gestational age varied from 30 to 35 weeks and the weight from 1,400 to 1,800 g. The stimulus for non-nutritive sucking used was a pacifier or bottle nipple. The time and frequency of stimulus application varied. As a result of the stimulation programs, there were early hospital discharges and greater weight gain. Literature on this subject, particularly that of national authorship, is scarce and the articles do not address a detailed description of the transition from gastric to oral feeding, thus leaving a gap that deserves to be further studied.
... One RCT compared pacifier non-nutritive sucking during the whole procedure of tube feedings and at any other time than tube feedings ( Field et al., 1982 ). Infants that used a pacifier during the whole procedure of tube feedings gained more daily weight, had less total tube feeding days and hospital duration as compared to those who used a pacifier at any other time than tube feedings. ...
... In the six studies comparing pacifier non-nutritive sucking with no intervention or routine care ( Calik and Esenay, 2019 ;Field et al., 1982 ;Harding et al., 2014 ;Kamhawy et al., 2014 ;Say et al., 2018 ;Yue et al., 2003 ), positive effects on weight, transition time from tube feeding to oral feeding, and hospital duration were demonstrated. This partially agrees with the results from a Cochrane review ( Foster et al., 2016 ), which illustrated a significant effect of non-nutritive sucking on transition time from tube feeding to full oral feeding and length of hospital stay. ...
Background
Enteral tube feeding is commonly used in preterm infants to provide enteral nutrition. Nurses play a crucial role in promoting feeding safety and performance.
Objectives
The aims of this systematic review were to identify nursing practices regarding feeding safety and performance promotion in preterm infants with enteral tube feeding and summarize evidence on the effectiveness of these practices.
Methods
A comprehensive search was performed in six databases (MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane Library, and Scopus). Studies on nursing practices aimed at promoting feeding safety and performance in preterm infants with enteral tube feeding were included. Risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) for randomized controlled studies and the tool of risk-of-bias in non-randomized studies of interventions (ROBINS-I) for non-randomized studies of interventions. A narrative synthesis strategy was employed to gather evidence and analyze data.
Results
61 studies (47 randomized controlled studies and 14 quasi-experimental studies) covering seven categories of practices were included. The identified nursing practices included controlling feeding interval, selecting feeding position, monitoring gastric residual, disposing of gastric residual, managing feeding temperature, feeding promotion stimulation, and supplementary methods during the transition from tube to oral feeding. Evidence supported the effectiveness of oro-motor stimulation and non-nutritive sucking as feeding performance promotion strategies in preterm infants. Other practices were suggested to be used cautiously or recommended to be further studied due to limited evidence.
Conclusions
The review identified seven categories of nursing practices in promoting feeding safety and performance in preterm infants receiving enteral tube feeding. Oro-motor stimulation and non-nutritive sucking can be used in clinical settings to promote feeding performance in preterm infants with enteral tube feeding. Other practices will continue to be dictated by local preferences and cost factors until more robust evidence becomes available.
Registration: PROSPERO database (CRD42020196256).
... Speech and language therapists often recommend non-nutritive sucking programmes for tube fed preterm infants to hasten the transition to oral feeding and to provide a pattern for nutritive sucking. It may also assist neurodevelopmental organisation, aid neurobehavioural maturation and optimise ventilation in preterm babies who require nasal noninvasive ventilatory support 5,[16][17][18][19][20][21][22][23][24] . In addition, these programmes may allow critical aspects of oral motor development to receive stimulation and reduce the impact of other necessary procedures such as nasogastric feeding 25 . ...
... Specific details of the treatment protocol are not given, but the treatment group of infants were ready for bottle feeds earlier, had fewer tube feeds, gained more weight and were discharged earlier. Both Field and colleagues 18 and Seghal and colleagues 32 obtained similar results. ...
Non-nutritive sucking appears to promote an infant’s readiness to begin oral feeding. This smallpilot study examined a non-nutritive sucking programme to facilitate the transition to full oralfeeding in premature infants. The results suggest that the non-nutritive sucking programmeimplemented by a speech and language therapist positively benefited the feeding developmentof neonates. Issues raised by the pilot study should be investigated in a larger scale study.
... Accordingly, preterm infants fed through nonoral pathways display poorer and more unstable sucking performance than their orally fed peers [121]. In fact, the mere coupling of nonnutritive sucking with tube feeding influenced positively the organization of the sucking pattern and the developmental outcome of these infants [122,123]. As term-born infants increase mouthing activities in response to the odor of mother's milk or breast [2,109,124,125], the application of human milk odor was proposed to engage nonnutritive sucking during tube feeding in prematures [101,102]. ...
... This transition can be difficult and slow in certain infants, on average taking approximately 30 days. If mere nonnutritive sucking during tube-feeding already accelerates acquisition of oral feeding skills by 3 to 6 days [122,123], the addition of chemosensory cues (eg, odor/taste of maternal milk, a breast pad, or a preconditioned artificial odor) to the sucking exercise might shorten this transitional period even more. ...
It remains unclear at what stage during early ontogeny humans do have the ability to process olfactory information. Numerous studies have demonstrated olfactory detection, discrimination, preference and memory in full-term infants examined within hours or days after birth (see Schaal, 1988 for a review). Recent data have revealed that olfaction is functional before birth. Newborns evince selective responsiveness to complex or pure odorants, which they could only, or mainly contact in the prenatal environment (Marlier et al., 1998; Schaal et al., 1998, 2000).
... Alguns autores enfatizam como efeitos da SNN, o ganho de peso e a redução no período de transição para a alimentação oral [20][21][22][23] . ...
... Os achados significantes do presente estudo quanto ao ganho de peso após intervenção fonoaudiológica concordam com os descritos na lite-ratura. Bebês estimulados com SNN obtêm maior ganho de peso e conseqüentemente alta hospitalar precoce 1,2,4,[6][7][8]10,11,15,16,[19][20][21][22][23][24][25] . Em estudos realizados com grupo controle, observou-se que os bebês estimulados com SNN levaram menor tempo na ingesta oral total de alimentação prescrita do que os bebês do grupo controle 2 . ...
PURPOSE: to assess the efficacy of speech therapy in reducing hospital time in pre-term newborns. METHODS: comparing 46 pre-term infants between 2000 and 2002 in Marly Sarney maternity when the speech therapy service was not available in that hospital for 50 pre-term infants between 2002 and 2004 when that service was initiated. Data was obtained from patient charts. RESULTS: among the pre term newborns, those that received speech therapy had a shorter hospitalization time: 88% were discharged between day 1 and day 10, 8% between day 11 and day 20 and just 2% stayed between 41 and 50 days and 2% 61 and 70 days. Among those who did not undergo speech therapy just 47,9% were discharged between day 1 and day 10 17,7% of these patients were discharged between the 11th and the 20th day, 10,4% were discharged between the 21st and 30th days, 9,4% were discharged between 31 and 40 days, 9,4% were discharged between 41 and 50 days, 3,1% were discharged between 51 and 60 days and 2,1% were discharged between 61 and 70 days. This aspect was statistically significant (p-value
... These articles included were published from 1982 to 2023. Ten studies [26,27,[34][35][36][37][38][39][40][41] were conducted in China, three studies [42][43][44] in the United States, three studies [45][46][47] in Iran, five studies [28,30,[48][49][50] in Turkey, and one each in Canada [29] and Brazil [19]. Figs 2 and 3 depict the risk-of-bias assessment in minute detail. ...
Background
Preterm infants have imperfect neurological development, uncoordinated sucking-swallowing-breathing, which makes it difficult to realize effective oral feeding after birth. How to help preterm infants achieve complete oral feeding as soon as possible has become an important issue in the management of preterm infants. Non-nutritive sucking (NNS), as a useful oral stimulation, can improve the effect of oral feeding in preterm infants. This review aimed to explore the effect of NNS on oral feeding progression through a meta-analysis.
Methods
We systematically searched PubMed, CINHAL, Web of Science, Embase, Cochrane databases, China’s National Knowledge Infrastructure (CNKI), Wanfang and VIP database from inception to January 20, 2024. Search terms included ’non-nutritive sucking’ ’oral feeding’ and ’premature.’ Eligibility criteria involved randomized controlled studies in English or Chinese. Studies were excluded if they were reviews, case reports, or observational studies from which valid data could not be extracted or outcome indicators were poorly defined. The meta-analysis will utilize Review Manager 5.3 software, employing either random-effects or fixed-effects models based on observed heterogeneity. We calculated the mean difference (MD) and 95% confidence interval (CI) for continuous data, and estimated pooled odds ratios (ORs) for dichotomous data. Sensitivity and publication bias analyses were conducted to ensure robust and reliable findings. We evaluated the methodological quality of randomized controlled trials (RCTs) utilizing the assessment tool provided by the Cochrane Collaboration.
Results
A total of 23 randomized controlled trials with 1461 preterm infants were included. The results of the meta-analysis showed that NNS significantly shortened time taken to achieve exclusive oral feeding (MD = -5.37,95%CI = -7.48 to-3.26, p <0.001), length of hospital stay(MD = -4.92, 95% CI = -6.76 to -3.09, p <0.001), time to start oral feeding(MD = -1.41, 95% CI = -2.36 to -0.45, p = 0.004), time to return to birth weight(MD = -1.72, 95% CI = -2.54 to -0.91, p <0.001). Compared to the NNS group, the control group had significant weight gain in preterm infants, including weight of discharge (MD = -61.10, 95% CI = -94.97 to -27.23, p = 0.0004), weight at full oral feeding (MD = -86.21, 95% CI = -134.37 to -38.05, p = 0.0005). In addition, NNS reduced the incidence of feeding intolerance (OR = 0.22, 95% CI = 0.14 to 0.35, p <0.001) in preterm infants.
Conclusion
NNS improves oral feeding outcomes in preterm infants and reduces the time to reach full oral feeding and hospitalization length. However, this study was limited by the relatively small sample size of included studies and did not account for potential confounding factors. There was some heterogeneity and bias between studies. More studies are needed in the future to validate the effects on weight gain and growth in preterm infants. Nevertheless, our meta-analysis provides valuable insights, updating existing evidence on NNS for improving oral feeding in preterm infants and promoting evidence-based feeding practices in this population.
... A complete OMI promotes the maturation of oral motor skills to prevent oral feeding difficulties [9], such as disorganized sucking patterns, oral hypersensitivity, and absent suck-swallow-breathe coordination. NNS was reported to enhance feeding performance [27][28][29], specifically the coordination of jaw and tongue movements, thereby accelerating the acquisition of mature nutritive sucking patterns [14,25,30]. We speculate that complete OMI and NNS alone exerted different effects on transition time because NNS does not improve the coordination between swallowing and breathing. ...
We explore the effect of complete oral motor intervention (OMI) and nonnutritive sucking (NNS) alone on oral feeding in preterm infants through a meta-analysis. We searched the Embased, Medline, Cochrane Library, and Web of Science databases for randomized controlled trials up to 8 August 2023, based on established selection criteria. Quality evaluations of the studies were carried out by applying both the Cochrane risk of bias assessment tool and the Jadad scale. The outcome measures of three clinical indicators included transition time to oral feeding, weight gain, and hospitalization duration. We conducted a meta-analysis using a random-effects model to determine the pooled effect sizes, expressed as standardized mean differences (SMDs) and their corresponding confidence intervals (CIs). Additionally, we undertook a subgroup analysis and meta-regression to investigate any potential moderating factors. Eight randomized controlled trials with 419 participants were selected. Meta-analysis revealed that receiving a complete OMI had significantly reduced transition time compared with those receiving NNS alone in preterm newborns (SMD, −1.186; 95% CI, −2.160 to −0.212, p = 0.017). However, complete OMI had no significant effect on shortened hospitalization duration (SMD, −0.394; 95% CI, −0.979 to 0.192, p = 0.188) and increased weight gain (SMD, 0.346; 95% CI, −0.147 to 0.838, p = 0.169) compared with NNS alone. In brief, a complete OMI should not be replaced by NNS alone. However, we were unable to draw decisive conclusions because of the limitations of our meta-analysis. Future well-designed randomized controlled trials are necessary to confirm our conclusion.
... Chez le nouveau-né humain, la succion, même lorsqu'elle est découplée de l'ingestion, module l'équilibre des hormones gastro-intestinales et favorise ainsi la croissance. Cet effet de la succion a été utilisé pour améliorer la croissance chez l'enfant prématuré alimenté par voie parentérale (Field et al 1982, Bernbaum et al 1983. ...
L’élevage des jeunes est une étape importante pour le succès reproductif des mammifères. La survie postnatale dépend de l’activation du comportement maternel et de l’orientation du comportement des nouveau-nés. Les déclencheurs du comportement maternel diffèrent entre les espèces, mais il existe certaines règles générales. Chez certaines espèces, les informations sensorielles fournies par les nouveau-nés suffisent à déclencher un comportement maternel immédiat, mais dans d’autres les facteurs endocriniens maternels et proprioceptifs liés à la parturition sont indispensables. L’aptitude des femelles à s’occuper d’un jeune est généralement améliorée par l’expérience maternelle. Dans toutes les espèces étudiées, la parturition représente une période sensible de réceptivité au nouveau-né accrue, y compris chez les Primates et l’espèce humaine. Les facteurs activateurs internes à la femelle peuvent aussi varier entre espèces. Cependant les estrogènes, la progestérone, l’expulsion du fœtus et la libération intracérébrale d’ocytocine qui l’accompagne, sont les facteurs le plus souvent retrouvés. Les structures nerveuses cibles sont principalement le complexe aire préoptique médiane/noyau de la strie terminale, le noyau paraventriculaire de l’hypothalamus, les bulbes olfactifs et l’amygdale. Enfin, dans la plupart des espèces dont les jeunes sont bien développés à la naissance, la mère apprend à reconnaître son nouveau-né en quelques heures, principalement à son odeur, et rejette alors tout jeune étranger à la mamelle. Cet apprentissage dépend du système olfactif principal et est facilité par le processus d’expulsion du fœtus. Il met également en jeu l’amygdale et plusieurs structures corticales. Quant au comportement du nouveau-né, il est guidé par un certain nombre d’informations sensorielles maternelles. La valeur de certaines de ces informations peut être déjà déterminée à la naissance (phéromone maternelle de la lapine) ou acquise par renforcement lors de la tétée (préférence pour la mère chez l’agneau). Il en résulte des interactions réciproques entre les la mère et son jeune, où chacun des membres de la dyade devient un facteur de contrôle du comportement de l’autre.
... Pickler et al, has shown nonnutritive suck to improve oxygen tension and behavioral state during feeding when it is offered just prior to a feeding 14 . The provision of nonnutritive suck decreases the transition time from gavage to full oral feeding, accelerates the maturation of the sucking reflex during feeding, decreases intestinal transit time and induces more rapid weight gain in infants, leading to a shorter length of stay for preterm infants [15][16][17] . Patterned orocutaneous therapy effectively accelerates non-nutritive suck development and oral feeding success in preterm infants who are at risk for oromotor dysfunction 18 . ...
... ). Like similar studies of oral stimulation, the intervention groups had a decreased hospital LOS(Measel and Anderson 1979, Field, Ignatoff et al. 1982, Sehgal, Prakash et al. 1990). On average prior studies employed the oral intervention for 7 days. ...
Background: Survival rate in early preterm infants has increased over the last 30 years, but many of these infants have medical and developmental problems. Difficulty with feeding and poor nutrition complications are common, which contribute to their readmission and morbidity.Objective: To assess whether an oral motor stimulation intervention can decrease the time to achieve full oral feeding and shorten the length of hospitalization in preterm infants.Design and Methods: Seventy-five preterm infants born at 30 to ≤ 32 weeks gestational age were randomly assigned to three groups to assess intervention effects. Two groups received the intervention once per day with varying different intervention doses across time, while the control group received a sham intervention.Results: The time needed to reach full oral feeding was significantly different among groups (P <0.0001). Infants who received the intervention from initiation of tube feedings until full oral feeding (high dose) gained full oral feedings and were discharged from the hospital earlier than the low dose and control groups (P = 0.0001). Infants in the high dose group were discharged 6 days earlier than controls and 4 days earlier than the low dose group.Conclusion: Oral motor stimulation intervention accelerated the time to full oral feeding and decreased the length of hospital stay.
... Para que o bebê obtenha a coordenação entre respiração, sucção e deglutição, pode ser utilizada, como estímulo, a sucção não-nutritiva por meio do uso de chupeta e a sucção nutritiva, sendo que com esta última o bebê conseguirá uma adequada coordenação entre as funções. Pesquisa realizada com bebês demonstrou que quando a chupeta é oferecida durante a alimentação por SNG, a alimentação por via oral começa mais cedo do que quando não há sucção não-nutritiva associada, os bebês engordam mais e recebem alta hospitalar mais cedo (23) . ...
OBJETIVO: Investigar a prevalência do uso de sonda nasogástrica em bebês com fissura labiopalatina, sua correlação com tipo de fissura, maternidade e cidade de origem, e a idade na primeira consulta. MÉTODOS: A amostra constituiu-se de 137 bebês de ambos os gêneros, com fissura de lábio e/ou palato, sem outros comprometimentos, nascidos a termo, e que chegaram para primeira consulta em um centro especializado em fissura entre zero e 12 meses (mediana=33 dias). Realizou-se análise estatística pelo teste de coeficiente de contingência (p<0,05). RESULTADOS: Da amostra total, 61% eram do gênero masculino e 39% do feminino, 51% apresentavam fissura de lábio e palato, 35% de palato e 14% de lábio. Quanto ao nascimento, 36% nasceram em maternidades particulares e 64% em públicas, 60% em Belo Horizonte, 15% em outras cidades da região metropolitana e 25% no interior do estado. O uso de sonda ocorreu em 23% dos casos. Não houve associação entre tipo de fissura ou de maternidade e o uso de sonda, mas este foi mais frequente na região metropolitana (p=0,007). CONCLUSÃO: A prevalência do uso de sonda em bebês com fissura foi considerada alta, visto que nasceram a termo e não apresentavam comprometimentos associados que indicassem o uso da mesma. O uso de sonda é mais frequente em bebês nascidos em maternidades da região metropolitana de Belo Horizonte, quando comparados a outras cidades do estado de Minas Gerais.
... Our results demonstrated that mean daily weight gain in the group A, with 10 days of NNS, was higher, as compare to the control group (no intervention group). This finding is confirmed by the study of Field et al., who showed a higher daily weight gain in preterm neonates admitted to NICU with nonnutritive sucking during tube feedings (12). ...
Background: Breastfeeding failures and oral feeding problems in preterm infants result in long-term health complications. In this study, therefore, we aimed to evaluate the effect of oral stimulation along with non-nutritive sucking (NNS) on independent oral feeding initiation and weight gain in preterm infants. Methods: This prospective randomized clinical trial was carried out at Aliasghar Hospital in Tehran, Iran, 2014. A total of 50 26-32 weeks gestational age hospitalized infants, who were fed through tubes, were recruited in the study. The newborns were randomized into A, B and C groups. In the A and B groups, the neonates were stimulated through oral stimulation as well as non-nutritive sucking for 5 or 10 days, while in the group C, no especial intervention was performed. Infants' mean daily weight gain, the number of days until initiation of oral feeding, oral feeding progression, the number of days until reaching full oral feeding and date of discharge were recorded. The obtained data were analyzed and compared in the three groups using SPSS version 16.0. Results: Of all the participants, 25 cases (55.55%) were male. Mean gestational age at birth and mean birth weight were 28.64±1.93 weeks and 1337.11±185.07 grams, respectively. In the group A, newborns' weight at reaching four and eight oral feedings per day and their weights at discharge were significantly higher than the other two groups (P=0.016, 0.001 and 0.001, respectively). Mean daily weight gain in the group A was higher (84.2850 g) than the other groups (69.5814 vs. 64.2677 g). However, ANOVA results showed that this difference was not significant (P=0.108). Moreover, independent samples t-test indicated that this difference between groups A and C was significant (P=0.049). Conclusion: In clinically stable preterm neonates, oral stimulation and should be implemented to increase their weight; however, further studies are required to address this issue.
... The feeding experience of tube-fed preterm infants being in principle decoupled from oro-nasal chemostimulation implies that they are deprived, or significantly impoverished, of opportunities to sense food, to associate gastric filling with chemosensory information, and to monitor odors and tastes as cues to the reinforcing consequences of feeding. In fact, the mere coupling of nonnutritive sucking with tube feeding influenced positively the maturation of the sucking pattern and the developmental outcome of these infants (e.g., Field et al., 1982;Raimbault et al., 2007). ...
Although evolution has selected newborn organisms that possess the physiological and behavioral keys leading to adapt to this harsh psychobiological challenge, their capabilities cannot be considered separately from the maternal organism and the environment she creates. Mammalian females provide indeed passive (physiological) and/or active (behavioral) assistance to complement and boost their offspring’s capacities. One notable strategy of mammalian females is to generate “sensory continuities” between the consecutive environmental niches their offspring have to go through to survive.
... Our results demonstrated that mean daily weight gain in the group A, with 10 days of NNS, was higher, as compare to the control group (no intervention group). This finding is confirmed by the study of Field et al., who showed a higher daily weight gain in preterm neonates admitted to NICU with nonnutritive sucking during tube feedings (12). ...
Background: Breastfeeding failures and oral feeding problems in preterm infants result in long-term health complications. In this study, therefore, we aimed to evaluate the effect of oral stimulation along with non-nutritive sucking (NNS) on independent oral feeding initiation and weight gain in preterm infants. Methods: This prospective randomized clinical trial was carried out at Aliasghar Hospital in Tehran, Iran, 2014. A total of 50 26-32 weeks gestational age hospitalized infants, who were fed through tubes, were recruited in the study. The newborns were randomized into A, B and C groups. In the A and B groups, the neonates were stimulated through oral stimulation as well as non-nutritive sucking for 5 or 10 days, while in the group C, no especial intervention was performed. Infants' mean daily weight gain, the number of days until initiation of oral feeding, oral feeding progression, the number of days until reaching full oral feeding and date of discharge were recorded. The obtained data were analyzed and compared in the three groups using SPSS version 16.0. Results: Of all the participants, 25 cases (55.55%) were male. Mean gestational age at birth and mean birth weight were 28.64±1.93 weeks and 1337.11±185.07 grams, respectively. In the group A, newborns' weight at reaching four and eight oral feedings per day and their weights at discharge were significantly higher than the other two groups (P=0.016, 0.001 and 0.001, respectively). Mean daily weight gain in the group A was higher (84.2850 g) than the other groups (69.5814 vs. 64.2677 g). However, ANOVA results showed that this difference was not significant (P=0.108). Moreover, independent samples t-test indicated that this difference between groups A and C was significant (P=0.049). Conclusion: In clinically stable preterm neonates, oral stimulation and should be implemented to increase their weight; however, further studies are required to address this issue.
... Chez le nouveau-né humain, la succion, même lorsqu'elle est découplée de l'ingestion, module l'équilibre des hormones gastro-intestinales et favorise ainsi la croissance. Cet effet de la succion a été utilisé pour améliorer la croissance chez l'enfant prématuré alimenté par voie parentérale (Field et al 1982, Bernbaum et al 1983. ...
Raising young is an important step of reproductive success in Mammals. Postnatal survival depends on the presence of maternal behaviour and an adequate behaviour of the neonate. The determinants of maternal care differ between species, but some general rules do exist. In some species, the sensory cues provided by the neonates suffice to trigger immediate maternal care while in others, maternal endocrine and proprioceptive factors of parturition are also necessary. The aptitude of females to care for the young is improved generally by maternal experience. In all species studied, parturition is a sensitive period of increased receptivity to the neonate, including in primates and humans. The activating factors internal to the female can also differ between species. Nonetheless, estrogens, progesterone, expulsion of the foetus and its resulting intracerebral liberation of oxytocin are the most commonly encountered factors. The nervous target structures are mainly the medial-preoptic-area/bed- nucleus-of-the-stria-terminalis complex, the hypothalamic paraventricular nucleus, the olfactory bulbs and the amygdala. Also, in most species that have mature neonates, the mother learns to recognise her young within a few hours, mainly by its smell and then rejects any alien young at the udder. This learning depends on the main olfactory system and is facilitated by the expulsion process. It also involves the amygdala and other cortical structures. As for the neonate, its behaviour is guided by maternal sensory cues. The value of some of these cues can already be determined at birth (maternal pheromone in rabbits) or acquired through reinforcement by suckling (preference for the mother in lambs). The outcome leads to reciprocal interactions between the mother and her young in which each member of the dyad becomes a factor of control of the other's behaviour.
... Lorsque l'aliment est introduit dans l'estomac sans passer par la cavité oropharyngée, et donc sans avoir déclenché la phase céphalique de la digestion, il produit une satiété plus faible et moins satisfaisante que la même quantité d'aliment ingérée par la bouche (Jordan, 1969). Une stimulation sensorielle alimentaire procurée aux prématurés nourris par tube nasogastrique améliore sensiblement les fonctions gastro-intestinales de l'enfant, accélère sa prise de poids, et avance de plusieurs jours l'autonomie nutritionnelle (Field et al, 1982;Mattes, 1987;Measel et Anderson 1979). Cet effet clinique suggère que l'expérience de la flaveur facilite l'utilisation de l'énergie et des nutriments. ...
Flavor is the global sensory message elicited by food. It has important olfactory and gustatory aspects, and also tactile, visual and auditory components. Flavor not only is a source of pleasure but also a guide which allows the consumer to select foods and adjust intake as a function of needs. The flavor of a familiar food is a complex conditioned stimulus which triggers a cascade of anticipatory metabolic responses which allow optimal utilisation of the ingested nutrients. Preferences and aversions for specific flavors are based on innate predispositions but mostly on the consumer's experience of the metabolic aftereffects of ingestion. Thus, from early childhood, satiety or malaise shape appetite or aversion for specific flavors.
... 수유 중인 미숙아에게 비영양성 흡철을 제공할 경우 경구수유 로의 이행이 빨라졌으며21,22) , 산소 포화도를 높이고, 행동적 상 태를 안정시킨다고 알려져 있다39) . 본 연구에서 시행된 구강자극 요법의 첫 번째 요소인 구강구조의 쓰다듬기는 적절한 흡철을 위해 필요한 구강근육을 강화시킬 수 있고, 두 번째 요소인 비영 양성 흡철은 이렇게 강화된 구강근육들을 적절하고 끈기 있게 이용하는 데 도움이 되었을 것으로 생각된다 26) . ...
Purpose: Feeding desaturation is a common problem among preterm infants which can result in prolonged hospital stays, long-term feeding difficulties and growth delay. The purpose of this study was to identify the characteristics of premature infants with feeding desaturation and to examine the effect of orocutaneous stimulation on oral feeding. Methods: During the first phase of this study, 125 extremely low birth weight infants were reviewed retrospectively. Characteris-tics between infants with feeding desaturation (n=34) and those without feeding desaturation (n=91) were examined. During the second phase, 29 infants recruited from March, 2009 to May, 2010 were subjected to orocutaneous stimulation. The results of orocutaneous stimulation were compared to a control group (n=81). Results: The first phase of the study revealed that extremely low birth weight infants with feeding desaturation were significantly lower in gestational ages at birth, and had lower 5 minute apgar scores, more gastroesophageal refluxes and bronchopulmonary dysplasia. Infants without feeding desaturation reached full enteral feeding significantly earlier and showed shorter duration of hos-pital stay. At the second phase, infants in the intervention group showed shorter days to achieve initiation of bottle feeding, shorter days in achievement of full bottle feeding, last episodes of feeding desaturation and length of hospital stay compared to the control group of similar characteristics. Conclusion: Orocutaneous stimulation among extremely low birth weight infants results in earlier achievement of full bottle feed-ings without episodes of feeding desaturation hence shortens the length of hospital stay.
Background:
Preterm infants (< 37 weeks' post-menstrual age (PMA)) are often delayed in attaining oral feeding. Normal oral feeding is suggested as an important outcome for the timing of discharge from the hospital and can be an early indicator of neuromotor integrity and developmental outcomes. A range of oral stimulation interventions may help infants to develop sucking and oromotor co-ordination, promoting earlier oral feeding and earlier hospital discharge. This is an update of our 2016 review.
Objectives:
To determine the effectiveness of oral stimulation interventions for attainment of oral feeding in preterm infants born before 37 weeks' PMA.
Search methods:
Searches were run in March 2022 of the following databases: CENTRAL via CRS Web; MEDLINE and Embase via Ovid. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. Searches were limited by date 2016 (the date of the search for the original review) forward. Note: Due to circumstances beyond our control (COVID and staffing shortages at the editorial base of Cochrane Neonatal), publication of this review, planned for mid 2021, was delayed. Thus, although searches were conducted in 2022 and results screened, potentially relevant studies found after September 2020 have been placed in the section, Awaiting Classification, and not incorporated into our analysis.
Selection criteria:
Randomised and quasi-randomised controlled trials comparing a defined oral stimulation intervention with no intervention, standard care, sham treatment or non-oral intervention (e.g. body stroking protocols or gavage adjustment protocols) in preterm infants and reporting at least one of the specified outcomes.
Data collection and analysis:
Following the updated search, two review authors screened the titles and abstracts of studies and full-text copies when needed to identify trials for inclusion in the review. The primary outcomes of interest were time (days) to exclusive oral feeding, time (days) spent in NICU, total hospital stay (days), and duration (days) of parenteral nutrition. All review and support authors contributed to independent extraction of data and analysed assigned studies for risk of bias across the five domains of bias using the Cochrane Risk of Bias assessment tool. The GRADE system was used to rate the certainty of the evidence. Studies were divided into two groups for comparison: intervention versus standard care and intervention versus other non-oral or sham intervention. We performed meta-analysis using a fixed-effect model.
Main results:
We included 28 RCTs (1831 participants). Most trials had methodological weaknesses, particularly in relation to allocation concealment and masking of study personnel. Oral stimulation compared with standard care Following meta-analysis, it is uncertain whether oral stimulation reduces the time to transition to oral feeding compared with standard care (mean difference (MD) -4.07 days, 95% confidence interval (CI) -4.81 to -3.32 days, 6 studies, 292 infants; I2 =85%, very low-certainty evidence due to serious risk of bias and inconsistency). Time (days) spent in the neonatal intensive care unit (NICU) was not reported. It is uncertain whether oral stimulation reduces the duration of hospitalisation (MD -4.33, 95% CI -5.97 to -2.68 days, 5 studies, 249 infants; i2 =68%, very low-certainty evidence due to serious risk of bias and inconsistency). Duration (days) of parenteral nutrition was not reported. Oral stimulation compared with non-oral intervention Following meta-analysis, it is uncertain whether oral stimulation reduces the time to transition to exclusive oral feeding compared with a non-oral intervention (MD -7.17, 95% CI -8.04 to -6.29 days, 10 studies, 574 infants; I2 =80%, very low-certainty evidence due to serious risk of bias, inconsistency and precision). Time (days) spent in the NICU was not reported. Oral stimulation may reduce the duration of hospitalisation (MD -6.15, 95% CI -8.63 to -3.66 days, 10 studies, 591 infants; I2 =0%, low-certainty evidence due to serious risk of bias). Oral stimulation may have little or no effect on the duration (days) of parenteral nutrition exposure (MD -2.85, 95% CI -6.13 to 0.42, 3 studies, 268 infants; very low-certainty evidence due to serious risk of bias, inconsistency and imprecision).
Authors' conclusions:
There remains uncertainty about the effects of oral stimulation (versus either standard care or a non-oral intervention) on transition times to oral feeding, duration of intensive care stay, hospital stay, or exposure to parenteral nutrition for preterm infants. Although we identified 28 eligible trials in this review, only 18 provided data for meta-analyses. Methodological weaknesses, particularly in relation to allocation concealment and masking of study personnel and caregivers, inconsistency between trials in effect size estimates (heterogeneity), and imprecision of pooled estimates were the main reasons for assessing the evidence as low or very low certainty. More well-designed trials of oral stimulation interventions for preterm infants are warranted. Such trials should attempt to mask caregivers to treatment when possible, paying particular attention to blinding of outcome assessors. There are currently 32 ongoing trials. Outcome measures that reflect improvements in oral motor skill development as well as longer term outcome measures beyond six months of age need to be defined and used by researchers to capture the full impact of these interventions.
Infants born prematurely or with complex medical conditions often require treatment to facilitate safe and efficient feeding. Practice is based on evidence, so frontline clinicians look to the literature to make informed clinical decisions. The aim of this scoping review was to map and describe the literature base for infant feeding and swallowing interventions and to identify areas for further research. Four electronic databases were searched from the sources’ inceptions through April 2020 using a search strategy designed by a health sciences research librarian. Thirteen grey literature sources were searched and forward and backward citation chasing was performed. Inclusion criteria were English-language studies reporting non-pharmacological and non-surgical interventions for hospitalized infants. Exclusion criteria included interventions exclusively for infants with cleft lip or palate or for infants being fed exclusively though enteral feeding. Data were extracted using a form created a priori and data were reported descriptively. We reviewed 6654 abstracts: 725 were chosen for full-text review and 136 met inclusion. Most studies explored interventions for infants born prematurely (n = 128). Studies were stratified by intervention domain: bridging (n = 91) and feeding/swallowing (n = 45); intervention approach: direct (n = 72), indirect (n = 31), or combination (n = 33); and outcome: feeding performance (n = 125), physiologic stability (n = 40), and swallowing physiology (n = 12). The body of research in infant feeding has grown; however, a need remains for research focused on populations of infants with various medical complexities and for frequently used interventions that lack supporting evidence.
This study examined the relationship between prenatal maternal stress (PREMS) and non-nutritive suck (NNS) and tested its robustness across 2 demographically diverse populations.
The study involved 2 prospective birth cohorts participating in the national Environmental influences on Child Health Outcomes (ECHO) Program: Illinois Kids Development Study (IKIDS) and ECHO Puerto Rico (ECHO-PROTECT). PREMS was measured during late pregnancy via the 10-item Perceived Stress Scale (PSS-10). NNS was sampled from 1- to 8-week-olds using a custom pacifier for ~5 min.
Overall, 237 mother–infant dyads completed this study. Despite several significant differences, including race/ethnicity, income, education, and PREMS levels, significant PREMS-NNS associations were found in the 2 cohorts. In adjusted linear regression models, higher PREMS, measured through PSS-10 total scores, related to fewer but longer NNS bursts per minute.
A significant association was observed between PREMS and NNS across two diverse cohorts. This finding is important as it may enable the earlier detection of exposure-related deficits and, as a result, earlier intervention, which potentially can optimize outcomes. More research is needed to understand how NNS affects children’s neurofunction and development.
In this double-cohort study, we found that higher maternal perceived stress assessed in late pregnancy was significantly associated with fewer but longer sucking bursts in 1- to 8-week-old infants.
This is the first study investigating the association between prenatal maternal stress (PREMS) and infant non-nutritive suck (NNS), an early indicator of central nervous system integrity.
Non-nutritive suck is a potential marker of increased prenatal stress in diverse populations.
Non-nutritive suck can potentially serve as an early indicator of exposure-related neuropsychological deficits allowing for earlier interventions and thus better prognoses.
Objective
This review article aimed to explore the effect of oral motor intervention on oral feeding in preterm infants through a meta-analysis.
Method
Eligible studies were retrieved from four databases (PubMed, Embase, Cochrane Library, and Web of Science) up to July 2020 and screened based on established selection criteria. Thereafter, relevant data were extracted and heterogeneity tests were conducted to select appropriate effect models according to the chi-square test and I ² statistics. Assessment of risk of bias was performed among the included studies. Finally, a meta-analysis was carried out to evaluate the effect of oral motor intervention in preterm infants according to four clinical indicators: transition time for oral feeding, length of hospital stay, feeding efficiency, and weight gain.
Results
Eighteen randomized controlled trials with 848 participants were selected to evaluate the effect of oral motor intervention on preterm infants. The meta-analysis results revealed that oral motor intervention could effectively reduce the transition time to full oral feeds and the length of hospital stay as well as increase feeding efficiency and weight gain.
Conclusions
Oral motor intervention was an effective way to improve oral feeding in preterm infants. It is worthy to be used widely in hospitals to improve the clinical outcomes of preterm infants and reduce the economic burdens of families and society. Future studies should seek to identify detailed intervention processes and intervention durations for clinical application.
Background
The Uni-modal OroFacial Stimulation (OFS) for preventing very preterm infants’ oral disorders is highly controversial. Our study sought to demonstrate that OFS reduced cardio-respiratory events and improved food autonomy in a population of very preterm infants.Methods
Randomized, controlled, prospective, and unicentric study. Preterm included were born between 26-29 week‘s gestational age (GA) and with a corrected postnatal age <33 week’s GA. They were randomized in two groups: experimental group underwent an OFS according to a protocol established over 10 consecutive days, and the control group underwent no OFS. The primary outcome were the number of cardiorespiratory events: apnea-bradycardia (with or without desaturations) or number of isolated desaturations which were evaluated at four separate times. The measurement occurred during a first, four and eight independent feedings. Results17 patients in the experimental group and 18 in the control group were included. The number of cardiorespiratory events for all independent- feedings time was significantly reduced in the OFS group (p = 0.003) in the univariate analysis but not in multivariable analysis. There were no signs of poor tolerance noted in the protocol. The quantity of milk ingested during the first autonomous feeding was higher in the experimental group. The acquisition of food autonomy and the duration of the hospitalization stay were similar in the two groups.Conclusions
While our study does not affirm that an early unimodal OFS improves the premature infants’ cardiorespiratory evolution and/or the acquisition of food autonomy, it does indicate an improved food efficiency during their first autonomous feedings.The ClinicalTrials.gov identifier is NCT01116765, on May 2010.
Purpose To evaluate the efficacy of oral rehabilitation therapy (ORT) in terms of prematurity-associated morbidities in preterm infants born before a gestational age of 33 weeks. Methods This was a single-institution retrospective case-control study including 78 high-risk preterm infants born between January 2015 and December 2016, who were administered with ORT for at least 15 minutes, 2 to 5 times/week by an occupational therapist. Various factors associated with feeding progression and neonatal morbidities were compared between the two groups. Results Seventy-eight subjects, of whom 39 were cases and 39 controls, were included in this study. Infants in the case group achieved a greater total feeding volume (122.9±85.3 mL vs. 48.9±25.7 mL, P
Background:
Preterm infants often experience difficulty with the transition from tube to oral feeding. While many unimodal and multimodal sensorimotor interventions have been generated to optimize oral feeding skills, there has been little cohesion between interventions.
Purpose:
The aims of this systematic review were to examine the effect of sensorimotor interventions on oral feeding outcomes and to determine whether multimodal interventions lead to better oral feeding performances than unimodal interventions.
Search strategy:
A systematic search of CINAHL, Embase, MEDLINE, and PsycINFO databases was conducted. Studies were reviewed to assess the types of interventions used to improve transition to full oral feeding, volume intake, weight gain, and length of hospital stay.
Results:
The search identified 35 articles. Twenty-six studies examined a unimodal intervention, with the majority focusing on oral sensorimotor input and the others on tactile, auditory, and olfactory input. Nine studies assessed multimodal interventions, with the combination of tactile and kinesthetic stimulation being most common. Results varied across studies due to large differences in methodology, and caution is warranted when interpreting results across studies. The heterogeneity in the studies made it difficult to make any firm conclusions about the effects of sensorimotor interventions on feeding outcomes. Overall, evidence on whether multimodal approaches can lead to better oral feeding outcomes than a unimodal approach was insufficient.
Implications for practice:
The use of sensorimotor interventions to optimize feeding outcomes in preterm infants varies based on methods used and modalities. These factors warrant caution by clinicians who use sensorimotor interventions in the neonatal intensive care unit.
Implications for research:
Large randomized clinical trials using a standardized approach for the administration of sensorimotor input are needed to further establish the effects on feeding outcomes in preterm infants.
In dit hoofdstuk geven we een overzicht van de ontwikkeling van de orale sensomotoriek en de mondfuncties bij normaal geboren baby’s en kinderen die zich normaal ontwikkelen.
Background:
Non-nutritive sucking (NNS) is used during gavage feeding and in the transition from gavage to breast/bottle feeding in preterm infants to improve the development of sucking behavior and the digestion of enteral feedings.
Objectives:
To assess the effects of non-nutritive sucking on physiologic stability and nutrition in preterm infants.
Search methods:
We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 1), MEDLINE via PubMed (1966 to 25 February 2016), Embase (1980 to 25 February 2016), and CINAHL (1982 to 25 February 2016). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials.
Selection criteria:
Randomised controlled trials and quasi-randomised trials that compared non-nutritive sucking versus no provision of non-nutritive sucking in preterm infants. We excluded cross-over trials.
Data collection and analysis:
Two review authors assessed trial eligibility and risk of bias and undertook data extraction independently. We analysed the treatment effects in the individual trials and reported mean differences (MD) for continuous data, with 95% confidence intervals (CIs). We used a fixed-effect model in meta-analyses. We did not perform subgroup analyses because of the small number of studies related to the relevant outcomes. We used the GRADE approach to assess the quality of evidence.
Main results:
We identified 12 eligible trials enrolling a total of 746 preterm infants. Meta-analysis, though limited by data quality, demonstrated a significant effect of NNS on transition from gavage to full oral feeding (MD -5.51 days, 95% CI -8.20 to -2.82; N = 87), transition from start of oral feeding to full oral feeding (MD -2.15 days, 95% CI -3.12 to -1.17; N = 100), and the length of hospital stay (MD -4.59 days, 95% CI -8.07 to -1.11; N = 501). Meta-analysis revealed no significant effect of NNS on weight gain. One study found that the NNS group had a significantly shorter intestinal transit time during gavage feeding compared to the control group (MD -10.50 h, 95% CI -13.74 to -7.26; N = 30). Other individual studies demonstrated no clear positive effect of NNS on age of infant at full oral feeds, days from birth to full breastfeeding, rates and proportion of infants fully breastfeeding at discharge, episodes of bradycardia, or episodes of oxygen desaturation. None of the studies reported any negative outcomes. These trials were generally small and contained various methodological weaknesses including lack of blinding of intervention and outcome assessors and variability on outcome measures. The quality of the evidence on outcomes assessed according to GRADE was low to very low.
Authors' conclusions:
Meta-analysis demonstrated a significant effect of NNS on the transition from gavage to full oral feeding, transition from start of oral feeding to full oral feeding, and length of hospital stay. None of the trials reported any adverse effects. Well-designed, adequately powered studies using reliable methods of randomisation, concealment of treatment allocation and blinding of the intervention and outcome assessors are needed. In order to facilitate meta-analysis of these data, future research should involve outcome measures consistent with those used in previous studies.
Background:
Preterm infants (< 37 weeks' postmenstrual age) are often delayed in attaining oral feeding. Normal oral feeding is suggested as an important outcome for the timing of discharge from the hospital and can be an early indicator of neuromotor integrity and developmental outcomes. A range of oral stimulation interventions may help infants to develop sucking and oromotor co-ordination, promoting earlier oral feeding and earlier hospital discharge.
Objectives:
To determine the effectiveness of oral stimulation interventions for attainment of oral feeding in preterm infants born before 37 weeks' postmenstrual age (PMA).To conduct subgroup analyses for the following prespecified subgroups.? Extremely preterm infants born at < 28 weeks' PMA.? Very preterm infants born from 28 to < 32 weeks' PMA.? Infants breast-fed exclusively.? Infants bottle-fed exclusively.? Infants who were both breast-fed and bottle-fed.
Search methods:
We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed (1966 to 25 February 2016), Embase (1980 to 25 February 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 25 February 2016). We searched clinical trials databases, conference proceedings and the reference lists of retrieved articles.
Selection criteria:
Randomised and quasi-randomised controlled trials comparing a defined oral stimulation intervention with no intervention, standard care, sham treatment or non-oral intervention in preterm infants and reporting at least one of the specified outcomes.
Data collection and analysis:
One review author searched the databases and identified studies for screening. Two review authors screened the abstracts of these studies and full-text copies when needed to identify trials for inclusion in the review. All review authors independently extracted the data and analysed each study for risk of bias across the five domains of bias. All review authors discussed and analysed the data and used the GRADE system to rate the quality of the evidence. Review authors divided studies into two groups for comparison: intervention versus standard care and intervention versus other non-oral or sham intervention. We performed meta-analysis using a fixed-effect model.
Main results:
This review included 19 randomised trials with a total of 823 participants. Almost all included trials had several methodological weaknesses. Meta-analysis showed that oral stimulation reduced the time to transition to oral feeding compared with standard care (mean difference (MD) -4.81, 95% confidence interval (CI) -5.56 to -4.06 days) and compared with another non-oral intervention (MD -9.01, 95% CI -10.30 to -7.71 days), as well as the duration of initial hospitalisation compared with standard care (MD -5.26, 95% CI -7.34 to -3.19 days) and compared with another non-oral intervention (MD -9.01, 95% CI -10.30 to -7.71 days).Investigators reported shorter duration of parenteral nutrition for infants compared with standard care (MD -5.30, 95% CI -9.73 to -0.87 days) and compared with another non-oral intervention (MD -8.70, 95% CI -15.46 to -1.94 days). They could identify no effect on breast-feeding outcomes nor on weight gain.
Authors' conclusions:
Although the included studies suggest that oral stimulation shortens hospital stay, days to exclusive oral feeding and duration of parenteral nutrition, one must interpret results of these studies with caution, as risk of bias and poor methodological quality are high overall. Well-designed trials of oral stimulation interventions for preterm infants are warranted. Such trials should use reliable methods of randomisation while concealing treatment allocation, blinding caregivers to treatment when possible and paying particular attention to blinding of outcome assessors.
Care of the patient in the pediatric cardiac intensive care involves focus on the whole patient. This chapter describes nursing care and assessment related to the impact of congenital heart disease on the other organ systems. Transition of the patient to the ward and then home is discussed, together with care of the patient undergoing cardiac catheterization. It is important that cardiovascular nurses have a broad understanding of patient progression through the cardiac care continuum. This chapter will assist staff in the education of patients and their families on the healing process and aid in setting appropriate expectations.
In dit hoofdstuk geven we een overzicht van de ontwikkeling van de orale sensomotoriek en de mondfuncties bij normaal geboren baby's en kinderen die zich normaal ontwikkelen.
Despite stabilization of initial physiologic processes, the smallest and highest risk Newborn Intensive Care Unit (NICU) patients are likely to spend a long time in the hospital, in order to gain weight and pass through several stages of neurobehavioral development. The NICU logistically then becomes an important site for early intervention strategies to help optimize an infant’s development and a family’s adaptation.
Das Ziel neonatologischer Intensivmedizin besteht einerseits darin, das körperlich unversehrte Überleben der Frühgeborenen mit allen Möglichkeiten der heutigen Intensivmedizin zu sichern und andererseits der Prävention psychosozialer Probleme, die sich aus der Trennung von Mutter bzw. Familie und Kind ergeben, größte Aufmerksamkeit zu schenken.
Elternberatung, Handling des Kindes, Maßnahmen zur Vorbereitung auf die orale Nahrungsaufnahme und nonnutritives Saugen sind die Basis für eine Therapie von Kindern mit Schluckstörungen. Die orofaziale und intraorale Stimulation stellt einen Schwerpunkt vor allem bei Kindern mit neurologischen Auffälligkeiten dar. In diesem Kapitel wird praxisnah auf die verschiedenen Elemente der logopädischen Therapie von frühkindlichen Schluckstörungen und Trinkschwächen eingegangen.
An understanding of the physiology of metabolism, nutrition and growth in the newborn infant and especially of the implications of pathological deviations in the very low birth weight or sick neonate is of the greatest importance to management directed at intact survival.
There is a growing body of evidence that strongly suggests that the optimal approach to a preterm infant's oral feeding journey should be based on their maturing behavioural cues rather than just their gestational age. This article describes attempts to introduce and develop this cue-based approach onto a level 3 neonatal unit in the West Midlands. The article discusses the research-base, staff and parent education as well as the challenges of implementing such a new approach to the oral feeding of preterm babies. It invites more research into the aspects of this approach that create the greatest challenges.
The ongoing progress in neonatal intensive care is modifying the psychic context of prematurity for all the partners, infants as well as parents and physicians. Comfort and prognosis of preterm infants have much improved. Since newborns under 24 weeks of gestational age are now surviving, they spend approximately half the duration of pregnancy out of the maternal uterus. All the psychological issues of such an early separation have to be considered, including the developmental outcome of a sensorial environment which is quite different from the intra-uterine one. Research has been developing in this field. The cooperation between neonatalogists and psychologists has been profitable to parents. Problems linked to the separation, such as difficulty in representing the infant, are no more frequent owing to the attention paid to the motherchild bond and subsequent early contacts. What is forward now is the impact of an hyper technical world of intensive care on the parents, and of the strange aspect of the tiny baby surrounded by engines and tubes. Such an overpresence of reality often results in a reaction of traumatic daziness among parents. The cooperation of the whole staff is necessary for the resumption of an imaginary process of psychic functioning. Finally, the survival of very-low-birth-weight infants confronts the neonatalogists with some delicate ethical questions. Psychiatrists and psychologists might have an important part to play in aiding the profession in its sorting out of these ethical issues.
To assess how non-nutritive sucking (NNS) using a pacifier affected physiological and behavioral outcomes of preterm infants.
Short-term longitudinal, experimental design.
The study took place at the neonatal intensive care unit at Al-Mansoura, Egypt.
Forty-seven preterm infants were divided into intervention and control groups. Preterm infants in the intervention group received NNS during nasogastric tube feeding while infants in the control group never received NNS. During 10 days, behavioral responses were videotaped and physiological responses were monitored.
Significantly higher oxygen saturation occurred during and after nasogastric feeding for the intervention infants as compared to the control group. No significant group differences occurred in heart rate. The NNS group showed an accelerated transition to nipple feeding and had better weight gain and earlier discharge.
Non-nutritive sucking was found to improve physiological and behavioral responses of preterm infants.
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