Sensorized pacifier to evaluate non-nutritive sucking in newborns

Sensorimotor Oscillations in Human Infants during an Innate Rhythmic Movement

The relationship between cerebral rhythms and early sensorimotor development is not clear. In recent decades, evidence revealed a rhythmic modulation involving sensorimotor processing. A widely corroborated functional role of oscillatory activity is to coordinate the information flow across sensorimotor networks. Their activity is coordinated by event-related synchronisation and desynchronisation in different sensorimotor rhythms, which indicate parallel processes may be occurring in the neuronal network during movement. To date, the dynamics of these brain oscillations and early sensorimotor development are unexplored. Our study investigates the relationship between the cerebral rhythms using EEG and a typical rhythmic movement of infants, the non-nutritive sucking (NNS) behaviour. NNS is an endogenous behaviour that originates from the suck central pattern generator in the brainstem. We find, in 17 infants, that sucking frequency correlates with beta synchronisation within the sensorimotor area in two phases: one strongly anticipating (~3 s) and the other encompassing the start of the motion. These findings suggest that a beta synchronisation of the sensorimotor cortex may influence the sensorimotor dynamics of NNS activity. Our results reveal the importance of rapid brain oscillations in infants and the role of beta synchronisation and their possible role in the communication between cortical and deep generators.

Impact of intrapartum oxytocin administration on neonatal sucking behavior and breastfeeding

This study aimed to examine the effect of intrapartum oxytocin administration on neonatal sucking behavior and breastfeeding. A total of 64 pairs (29 in the group treated with intrapartum oxytocin and 35 in the control group) of normal infants within 24-48 h of birth and their mothers were recruited. Sucking ability was evaluated by measuring Non-Nutritive Sucking (NNS) for 5 min. Data on the rate of exclusive breastfeeding at 1 month postpartum were collected. In the adjusted multiple regression models, intrapartum oxytocin exposure was significantly associated with fewer total NNS bursts (95% confidence interval (CI), -7.02 to -0.22), longer pause times (95% CI, 1.33 to 10.21), and greater pause-time variability (95% CI, 3.63 to 63.92). Effects estimated using structural equation modeling revealed that intrapartum oxytocin exposure had a significant negative and direct effect on the practice of exclusive breastfeeding 1 month postpartum (β = -0.238, p = 0.047). However, no NNS-mediated indirect effects were observed. This report demonstrates that infants born to mothers who receive intrapartum oxytocin may have impaired sucking ability for at least the first 48 h after birth, and breastfeeding support should be provided.

Quantitative non-nutritive sucking measurement as a predictor of oral feeding readiness in newborns

Background and purpose

The purpose of this study is to examine the relationship between the parameters of a silver nanowire-based flexible pressure sensor developed to measure the non-nutritive sucking (NNS) performance and predict the nutritive sucking status in preterm infants.

Methods

Preterm infants who were referred for feeding difficulty during the transition period from tubal feeding to oral feeding were enrolled in our study. A flexible pressure sensor was used to measure the non-nutritive sucking parameters of neonates. The evaluator stimulated the infants' lips and tongue with a pacifier integrated with a sucking pressure sensor, to check whether non-nutritive sucking had occurred. When the sucking reflex was induced, it was measured. The infants' sucking characteristics were subdivided into classifications according to the NOMAS criteria and full oral feeding (FOF) status. Quantitative NNS measurement according to the feeding state was compared between groups.

Results

When comparing the quantitative NNS measurement by feeding characteristics, the average sucking pressure was significantly higher in infants in the FOF capable group than those in the incomplete FOF group. In addition, the maximum and average sucking pressure was significantly higher in infants with a normal sucking pattern compared to those with a disorganized sucking pattern. The average NNS pressure was divided over the range of 0-3 kPa and the same weight was assigned to each item. When the optimal cut-off value for the sensitivity and specificity of the average NNS pressure to estimate the FOF was set, a pressure of 1.5 kPa yielded the highest sensitivity (84.62%) and specificity (67.65%) on the receiver operating characteristic (ROC) curve. The area under the curve (AUC) was 0.786, and this result was statistically significant.

Conclusions

This study presents a quantitative parameter for non-nutritive sucking in preterm infants with the use of a flexible pressure sensor. Results show possible quantitative indicators that can aid in predicting when preterm infants can transition to oral feeding and their prognosis. This will serve as a basis for future research on determining the feeding transition period of newborns with health conditions that affect oral feeding.

Correlation between Pacifier Use in Preterm Neonates and Breastfeeding in Infancy: A Systematic Review

Background: Breastfeeding is very important for the proper nutrition and growth of the child, as well as, the health of the mother. To start breastfeeding, the neonate must have extensive oral capacities for sucking functions but, premature neonates may not have the muscle strength needed to suck successfully. However, the non-nutritive sucking achieved by using a pacifier, has been identified by previous research as a factor associated with shorter duration and exclusivity of breastfeeding. This study aims to perform a systematic review to investigate the relationship between pacifier use in preterm neonates and breastfeeding in infancy. Methods: We included prospective studies, as well as randomized controlled studies that evaluated the association between pacifier use by preterm neonates and of breastfeeding in infancy. Ten research articles from PubMed/Medline, Google Scholar and Crossref were included in the review from a total of 1455 articles. The results differ depending on the type of study.Most prospective studies have shown a negative correlation between pacifier use and breastfeeding, while the randomized controlled studies found a positive correlation. Conclusions: Pacifier use in preterm infants helps transition from tube to oral feeding, breastfeeding, faster weight gain and earlier discharge from the NICU. However, the relationship between pacifiers and breastfeeding is more complicated, as it appears to be influenced by additional risk factors.

Predicting Feeding Conditions of Premature InfantsThrough Non-Nutritive Sucking Skills Using a Sensitized Pacifier

Due to the lack of enough physical or suck central pattern generator (SCPG) development, premature infants require assistance in improving their sucking skills as one of the first coordinated muscular activities in infants. Hence, we need to quantitatively measure their sucking abilities for future studies on their sucking interventions. Here, we present a new device that can measure both intraoral pressure (IP) and expression pressure (EP) as ororhithmic behavior parameters of non-nutritive sucking skills in infants. Our device is low-cost, easy-to-use, and accurate, which makes it appropriate for extensive studies. To showcase one of the applications of our device, we collected weekly data from 137 premature infants from 29 week-old to 36 week-old. Around half of the infants in our study needed intensive care even after they were 36 week-old. We call them full attainment of oral feeding (FAOF) infants. We then used the Non-nutritive sucking (NNS) features of EP and IP signals of infants recorded by our device to predict FAOF infants' sucking conditions. We found that our pipeline can predict FAOF infants several weeks before discharge from the hospital. Thus, this application of our device presents a robust and inexpensive alternative to monitor oral feeding ability in premature infants.

Influence of taste stimulation on sucking pressure in newborn infants at term

PURPOSE

To verify the influence of a taste stimulus on the suction pressure, during the non-nutritive sucking (SNN), in newborns, healthy and with weight appropriate to the gestational age.

METHODS

Quasi-experimental study of the non-randomized clinical trial type with a convenience sample of 60 newborns (NB), 30 allocated in the study group (EG) and 30 in the control group (CG). The NB were evaluated for sucking pressure during the SNN in a pacifier. For the EG, a gustatory stimulus was added to the pacifier, moistened with colostrum. The CG did not receive any stimulus, other than the pacifier itself. The average, minimum and maximum pressures were measured with the equipment S-Flex®.

RESULTS

The SG presented mean and maximum sucking pressure significantly higher than the CG. In addition, there was a statistically significant difference between the groups for the second measurement of mean sucking pressure.

CONCLUSION

The results showed that the NB of the SG presented sucking pressures, average and maximum, significantly higher, when compared to the CG. The use of a taste stimulus associated with SNN modified the sucking pressure and seems to enhance oral skills.

Consequences of Using Artificial Nipples in Exclusive Breastfeeding: An Integrative Review

Objective: To describe the consequences of using artificial nipples to exclusive breastfeeding. Materials and method: An integrative review carried out in the Medline®, Cinahl, Lilacs, Web of Science, and Scopus databases to answer the following question: What are the consequences of using artificial nipples to exclusive breastfeeding? Results: 38 articles were analyzed; the analysis gave rise to two categories: neonatal factors and maternal factors influencing exclusive breastfeeding. Breastfeeding interruption was the neonatal factor most associated with the use of artificial nipples, while the level of maternal education stood out as an intervening factor in exclusive breastfeeding. Pacifiers were the dummy type more commonly mentioned, followed by feeding bottles and nipple shields. Conclusions: The consequences of offering artificial nipples to breastfed infants are mostly negative and associated with the newborn, such as early weaning, refusal to breastfeed, impaired suction technique, incorrect latch-on, interference with orofacial development, and interruption of exclusive breastfeeding. Mothers who offered artificial nipples to their infants are more likely to experience pain, nipple fissures, frustration, and reduced interaction with their infants.

A silver nanowire-based flexible pressure sensor to measure the non-nutritive sucking power of neonates

Preterm infants are prone to have higher risks of morbidity, disability and developmental delay compared to term infants. The primitive reflexes, inborn behaviors found in early life development, are shown to be a good tool to assess the integrity of the central nervous system of infants and to predict potential malfunctions. Among these reflexes, the non-nutritive sucking reflex plays an important role in indicating congenital abnormalities in brain development and feeding readiness, especially for premature infants. Conventionally, pediatricians evaluate the oral sucking power qualitatively based on their experiences, by using a gloved finger put inside the infant’s mouth. Thus, more quantitative solutions to assess the sucking power of preterm infants are necessary to support healthcare professionals in their evaluation procedures. Here, we developed a silver nanowire (AgNW)-based flexible pressure sensor to measure the non-nutritive sucking power of infants. The flexible sensor was fabricated using silver nanowires deposited on polydimethylsiloxane (PDMS) in a sandwich-like structure. The sensor based on the principle of strain gauge was attached to a ring-shaped connecting module, and then to a pacifier. The negative sucking pressure exerted by the infant deformed the sensor membrane, causing its electrical resistance to change without any contact between the infant’s mouth and the sensing element. The fabricated sensor was characterized and optimized to achieve both the suitable sensitivity and stability. Thanks to the excellent long-term electro-mechanical stability and high sensitivity, the developed sensor is expected to provide the means to quantitatively assess the non-nutritive sucking of infants, with a portable, low-cost, non-invasive and light-weight solution.

Evaluation of Apgar Scores and Non-Nutritive Sucking Skills in Infants Using a Novel Sensitized Non-Nutritive Sucking System

One of the challenges in examining development of newborns is measuring activities which are correlated to their health. Oral feeding is the most important factor in an infant's healthy development. Here, we present a new device that can measure intraoral and expression pressures produced in a newborn's mouth by non-nutritive sucking. We then develop a method to extract time-intervals that a sucking has occurred. To show an application of this device, we use Apgar score as a reference of the general health of newborns, and we evaluate these scores with the non-nutritive sucking patterns demonstrated by the infants. We show that for the pairs of infant with the same background but different Apgar scores, those with lower Apgar scores have lower pressure amplitudes while sucking. Importance of non-nutritive sucking skills in the development of newborns and ease of using our device make it useful for clinical studies of infantile health.

Nutritive and non-nutritive sucking patterns associated with pacifier use and bottle-feeding in full-term infants

BACKGROUND

The current literature does not provide accurate information about the association between use of artificial nipples and sucking patterns in infants.

AIMS

We aimed to investigate whether pacifier use and/or bottle-feeding were associated with nutritive sucking (NS) and non-nutritive sucking (NNS) patterns.

STUDY DESIGN

Cross-sectional study.

SUBJECTS

429 full-term infants/mothers.

OUTCOME MEASURES

Data were collected through a questionnaire and observations of NS during breastfeeding and NNS (finger sucking). Multivariate logistic regression was used to analyze the adjusted associations between artificial nipple use and between NS and NNS changes.

RESULTS

There were higher frequencies of changes in the NNS and NS patterns in the group that used artificial nipples. Regarding the type of artificial nipple, pacifier use had a greater influence on changes in the NNS pattern whereas the use of a baby bottle presented a greater number of associations with changes in the NS pattern.

CONCLUSION

The findings suggest that the use of artificial nipples may be associated with changes in the sucking patterns of infants, demonstrating the possible existence of nipple confusion and its effect on breastfeeding.

Effects of Pacifier Use on Transition Time from Gavage to Breastfeeding in Preterm Infants: A Randomized Controlled Trial

BACKGROUND

Nonnutritive sucking (NNS) has been identified as having many benefits for preterm infants. NNS may improve the efficacy of oral feeding, reduce the length of time spent in orogastric (OG) tube feeding, and shorten the length of hospital stays for preterm infants.

AIM

This study aimed to assess the effect of pacifiers on preterm infants in the transition from gavage to oral feeding, their time to discharge, weight gain, and time for transition to full breastfeeding.

METHODS

A prospective, randomized controlled trial was conducted in our center. Ninety infants were randomized into two groups: a pacifier group (PG) (n = 45) and a control group (n = 45). Eligibility criteria included body weight less than or equal to 1,500 g, gestational age (GA) younger than 32 weeks, tolerating at least 100 kcals/kg/day by OG feeding, growth parameters appropriate for GA, and a stable clinical condition.

RESULTS

Mean GAs were 29.2 ± 1.86 versus 28.4 ± 1.84 weeks (p = 0.46), and birth weights were 1,188.2 ± 272 versus 1,112.8 ± 267 g (p = 0.72) in the PG and CG groups, respectively. The time for transition to full oral feeding (38 ± 19.2 days), time to transition to full breastfeeding (38.1 ± 20 days), and time to discharge (48.4 ± 19.2 days) in the PG were significantly shorter compared with the control group (49.8 ± 23.6, 49.1 ± 22, 65.3 ± 30.6 days, respectively) (p < 0.05). For preterm infants with gastrointestinal motility disturbance, similar symptoms (regurgitation, vomiting, abdominal distension) (n = 6, 22%) in the PG were significantly lower than the control group (n = 21, 77.8%) (p < 0.05).

CONCLUSION

In this study, we determined that the method of giving pacifiers to preterm infants during gavage feeding reduced the infants' transition period to oral feeding and the duration of hospital stay. In addition, the pacifiers could be used during gavage feeding and in the transition from gavage to oral/breastfeeding in preterm infants to encourage the development of sucking ability.