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Fucile S, Hennessey G, Meghji S, Dow K. Exploration of the Association Between Sucking Measures and Ability to Attain Independent Oral Feeds Among Infants Who Are Born Preterm. Am J Occup Ther 2024; 78:7803205120. [PMID: 38709676 DOI: 10.5014/ajot.2024.050581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
IMPORTANCE Infants who are born preterm often experience difficulty transitioning from full tube to independent oral feeds, which often prolongs their hospital stay. No clinical measures associated with attainment of independent oral feeds are currently available. OBJECTIVE To identify specific nutritive sucking measures associated with time to attainment of independent oral feeds among infants who are born preterm. DESIGN An observational cohort pilot study was undertaken. SETTING A Level 2 to Level 3 neonatal intensive care unit. PARTICIPANTS Fourteen infants (7 male, 7 female) born at or less than 34 wk gestation were enrolled. OUTCOMES AND MEASURES The monitored suck measures included average suck strength (millimeters of mercury), average sucking burst duration (seconds), average suck count (number of sucks), and average pause duration (seconds). Time to independent oral feeds (days) and baseline characteristics were also monitored. The nutritive sucking measures were recorded once, during the first 5 min of an oral feed, when infants were taking an average of three to four oral feeds per day using a nipple monitoring device. RESULTS An inverse relation was found among average suck burst duration (p = .04), gestational age (p = .03), and days to attainment of independent oral feeds. CONCLUSIONS AND RELEVANCE Study results suggest that average sucking burst duration, during the first 5 min of an oral feed, is associated with time to attain independent oral feeds. Plain-Language Summary: Sucking burst duration is a simple measure that may be used clinically to identify early on infants who may have trouble transitioning from full tube to independent oral feedings. The results of this study suggest that a suck burst duration in the first 5 min of an oral feeding is inversely associated with the length of time to achieve independent oral feeding. The results highlight the importance of considering an infant's nutritive sucking ability when evaluating their potential to achieve independent oral feedings.
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Affiliation(s)
- Sandra Fucile
- Sandra Fucile, PhD, OT Reg. (Ont), is Assistant Professor, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada;
| | - Grace Hennessey
- Grace Hennessey, MscOT, is Occupational Therapy Student, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Suraya Meghji
- Suraya Meghji, MscOT, is Occupational Therapy Student, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Kimberly Dow
- Kimberly Dow, MD, is Professor, Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
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Zhao S, Jiang H, Miao Y, Liu W, Li Y, Zhang Y, Wang A, Cui X. Effects of implementing non-nutritive sucking on oral feeding progression and outcomes in preterm infants: A systematic review and meta-analysis. PLoS One 2024; 19:e0302267. [PMID: 38626172 PMCID: PMC11020483 DOI: 10.1371/journal.pone.0302267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/29/2024] [Indexed: 04/18/2024] Open
Abstract
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.
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Affiliation(s)
- Shuliang Zhao
- Nursing Department, Affiliated Hospital of Shandong Second Medical University, Weifang, China
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Huimin Jiang
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Yiqun Miao
- School of Nursing, Capital Medical University, Beijing, China
| | - Wenwen Liu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yanan Li
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Yuanyuan Zhang
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Aihua Wang
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Xinghui Cui
- Nursing Department, Affiliated Hospital of Shandong Second Medical University, Weifang, China
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Morioka Y, Nonogaki M, Kobayashi D, Nishimoto J, Obayashi S. Effects of increased physical therapy staffing in the neonatal intensive care unit on oral feeding maturation and neurodevelopment of extremely low birth weight infants. Brain Dev 2024:S0387-7604(24)00053-6. [PMID: 38556384 DOI: 10.1016/j.braindev.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND It remains a matter of debate as to what extent early intervention may facilitate long-term functional outcomes of preterm infants in the neonatal intensive care unit (NICU). We aimed to examine the effect of increasing physical therapy (PT) staff dedicated to the NICU on temporal changes (initiation, duration) of PT interventions and functional outcomes (acquisition of full oral feeding and Hammersmith Neonatal Neurological Examination). METHODS Extremely low birth weight infants, retrospectively collected from an academic medical center, were allocated to two subgroups, either a baseline period (N = 48) without NICU-dedicated PT staff (non-dedicated group) or a quality improvement period (N = 42) with additional dedicated staff (dedicated group). RESULTS Compared to those in the non-dedicated group, NICU infants in the dedicated group started PT earlier and had increased PT treatment for additional 14 min per day when achieving full oral feeding. The infants in the dedicated group significantly achieved full oral feeding earlier than the non-dedicated group. As for Hammersmith Neonatal Neurological Examination, there were significant differences in two items (total and tone) between the groups. CONCLUSIONS Additional NICU-dedicated PT staff facilitated earlier intervention and increased PT treatment in terms of daily duration. Moreover, the dedication shortened the completion of full oral feeding and improved neurological development, presumably resulting in better developmental outcome.
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Affiliation(s)
- Yoshinori Morioka
- Department of Rehabilitation Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, 350-8550, Japan.
| | - Masayuki Nonogaki
- Department of Rehabilitation Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, 350-8550, Japan
| | - Daiyu Kobayashi
- Department of Rehabilitation Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, 350-8550, Japan
| | - Junji Nishimoto
- Department of Rehabilitation Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, 350-8550, Japan; Graduate School of Humanities and Social Sciences, Hiroshima University, Higashi-Hiroshima, Hiroshima, 739-8521, Japan
| | - Shigeru Obayashi
- Department of Rehabilitation Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, 350-8550, Japan
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Verma RP, Sahni D, Fogel J. Bolus Feeding Via Gastric Versus Oral Routes in Very Preterm Neonates. JOURNAL OF MOTHER AND CHILD 2024; 28:1-7. [PMID: 38411990 PMCID: PMC10898621 DOI: 10.34763/jmotherandchild.20242801.d-23-00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/01/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND We intend to investigate the association of bolus orogastric tube (BOG) and nipple bottle (N) feedings with postnatal growth in very premature neonates (VPN: gestational age between 28 and 33 weeks). MATERIAL AND METHODS The days of life (DOL) to achieve full combined oral and gastric enteral nutrition (FEN) and attain body weight (BW) of 2200 g (Wt22) and the length of hospitalization (LOH) were retrospectively associated with clinical and BOG and N feeding-related variables via multivariate regression analyses. Correlations were performed to ascertain the strength of associations. RESULTS In a cohort of 127 VPN, FEN demonstrated negative associations with gestational age (GA) and LOH and Wt22 with birth weight (BW). FEN showed positive associations with nil by mouth and intravenous fluid-nutrition days and with DOL to start and achieve full nipple feeding. LOH was associated with days on antibiotics and DOL to start and achieve full nipple feeding. Wt22 was associated with DOL to achieve full nipple feeding. The start day of BOG feeding had no independent associations and weak, highly significant positive correlations with Wt22, LOH, and FEN. CONCLUSION Bolus orogastric tube feeding has no independent implications for postnatal growth, duration of hospitalization, or chronological age to attain full enteral nutrition in VPN unless combined with nipple feeding to provide enteral nutrition. Oral bottle feeding accelerates postnatal catch-up growth and full enteral nutrition acquisition while reducing hospitalization duration. Initiating nipple feeding at 32 weeks of postmenstrual age may be safe in stable VPN. Antibiotic therapy increases hospitalization duration.
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Affiliation(s)
- Rita P. Verma
- Nassau University Medical Center, East Meadow, NY11554, NYC Health+ Hospitals/South Brooklyn Hospital, Coney Island, NY11235
| | - Deepank Sahni
- Nassau University Medical Center, East Meadow, New York, 11554
| | - Joshua Fogel
- Nassau University Medical Center, New York, NY 11210
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Hübl N, Riebold B, Schramm D, Seidl RO. Differences in the swallowing process of newborns and healthy preterm infants: first results with a non-invasive bioimpedance and electromyography measurement system. Eur Arch Otorhinolaryngol 2024; 281:843-854. [PMID: 37996534 PMCID: PMC10796423 DOI: 10.1007/s00405-023-08344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE Preterm infants (PI) have difficulty coordinating sucking, swallowing and breathing, and there is a risk of aspiration. The causes of this are not yet sufficiently understood. The aim of this study was to test a novel measurement device to measure breathing and pharyngeal processes involved in swallowing externally in everyday life to identify possible differences in neonates (NB) and PI. METHODS Forty healthy NB were studied at 4-8 weeks of age (mean: 6.7 weeks) and 20 healthy PI (mean gestational age 30.5 weeks) at postmenstrual age (PMA) 34/35 weeks (mean PMA 35.1 weeks) during a single feeding. Surface electrodes were used to measure bioimpedance and electromyography reflecting swallow-related changes in the pharynx and muscle activation of the tongue and submental muscles. A respiratory belt was combined with recording of the depth of chest movements and the occurrence of pauses in breathing. RESULTS Velocity and extent of pharyngeal closure did not differ significantly across the feeding period (velocity: p=0.09, closure: p=0.17), but during the first two suck-swallow bursts PI had greater velocity (p<0.001*) and extent of pharyngeal closure (p=0.004*) than NB. The duration of swallowing phases was significantly longer in PIs (p<0.001*), their muscle activation decreased faster (p<0.001*), and they had more pauses in breathing than NBs. CONCLUSIONS The novel measurement device allowed, for the first time in everyday life, the measurement of factors influencing swallowing and breath-swallow coordination in NBs and PIs. PIs showed differences from NBs most likely due to differences in muscle strength and condition.
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Affiliation(s)
- Nicole Hübl
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Benjamin Riebold
- TU Berlin, Control Systems Group, Einsteinufer 17, 10587, Berlin, Germany
| | - Dirk Schramm
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Rainer O Seidl
- Ear-Nose and Throat, Unfallkrankenhaus Berlin, UKB, Warener Str.7, 12683, Berlin, Germany
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Cresi F, Maggiora E, Capitanio M, Bovio C, Borla F, Cosimi S, Enrietti D, Faggiano F, Loro S, Rovei SM, Runfola F, Scrufari M, Taglianti MV, Vignali F, Peila C, Coscia A. Effects of a valved infant-bottle with ergonomic teat on the coordination of sucking, swallowing, and respiration in late-preterm infants. The Safe Oral Feeding randomized Trial. Front Pediatr 2024; 12:1309923. [PMID: 38283629 PMCID: PMC10808751 DOI: 10.3389/fped.2024.1309923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Introduction Breastfeeding naturally enables the coordination of sucking, swallowing, and respiration patterns for safe feeding. When breastfeeding is not possible a feeding device that releases milk in response to intra-oral vacuum could potentially offer improved coordination of sucking, swallowing, and breathing patterns compared to conventional devices. The aim of the study is to evaluate the effect of a valved infant-bottle with an ergonomic teat compared to a standard infant-bottle. Methods This unblinded randomized controlled trial focused on late preterm infants fed by bottle for at least three meals over the day, admitted to the Neonatal Unit of Sant'Anna Hospital (Turin, Italy). Infants were randomized to be fed with a valved infant-bottle with an ergonomic teat (B-EXP arm) or with a standard infant-bottle (B-STD arm). Monitoring included a simultaneous synchronized recording of sucking, swallowing and respiration. The main outcome was the swallowing/breathing ratio. Results Forty infants (20 B-EXP arm; 20 B-STD arm) with a median gestational age of 35.0 weeks (IQR 35.0-36.0 weeks) completed the study. Four infants were censored for the presence of artifacts in the polygraphic traces. The median swallowing/breathing ratio was 1.11 (1.03-1.23) in the B-EXP arm and 1.75 (1.21-2.06) in the B-STD (p = .003). A lower frequency of swallowing events during the inspiratory phase of breathing was observed in B-EXP arm compared with B-STD arm (p = 0.013). Discussion The valved infant-bottle with an ergonomic teat improves the coordination of sucking-swallowing-respiration and limits the risk of inhalation reducing the frequency of swallowing during the inspiratory phase.
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Affiliation(s)
- Francesco Cresi
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Elena Maggiora
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Martina Capitanio
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Cecilia Bovio
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Federica Borla
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Sara Cosimi
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Desirèe Enrietti
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Francesca Faggiano
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Sara Loro
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Serena Maria Rovei
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Federica Runfola
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Mariangela Scrufari
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Michela Vigna Taglianti
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Federica Vignali
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Chiara Peila
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Alessandra Coscia
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
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裘 梦, 胡 晓. [Latest Findings on the Suck-Swallow-Breathe Mechanism of Direct Breastfeeding From the Breast to an Infant]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:1306-1311. [PMID: 38162076 PMCID: PMC10752769 DOI: 10.12182/20231160503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Indexed: 01/03/2024]
Abstract
A mother's breast milk is the best nourishing food for infants. No only does it provide sufficient nutrition, but it is also well suited to infants' immature digestive function, thus promoting their growth and organ maturation. A 6-month period of breastfeeding can provide infants with the necessary nutrients, energy, and fluids. The best feeding method is direct breastfeeding from the breast to an infant, yet the difficulties involved in breastfeeding should not be overlooked. Approximately 1/3 the mothers who are performing direct breastfeeding from the breast to an infant experience moderate or higher levels of feeding difficulties. Difficulties in direct breastfeeding from the breast to an infant can lead to decreased feeding efficiency, hamper the growth and development of infants, and affect the emotional communication between mothers and infants. At present, many relevant studies have focused on topics such as the mothers' psychology, family and social support, and the immature development of infants. However, little research has been done to investigate suck-swallow-breathe, a physiological mechanism that infants undertake during the process of direct breastfeeding from the breast to an infant. In this paper, we summarized published literature, research parameters, measurement instruments, and physical intervention methods of the suck-swallow-breathe mechanism in infants, aiming to facilitate the early identification of breastfeeding difficulties and the subsequently provision of early intervention measures and to promote the early identification of neurodevelopmental abnormalities and other developmental abnormalities in infants.
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Affiliation(s)
- 梦凡 裘
- 复旦大学护理学院 (上海 200032)School of Nursing, Fudan University, Shanghai 200032, China
- 复旦大学附属儿科医院 (上海 201102)Children's Hospital of Fudan University, Shanghai 201102, China
| | - 晓静 胡
- 复旦大学护理学院 (上海 200032)School of Nursing, Fudan University, Shanghai 200032, China
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Sheikh-Mohamed SO, Wilson H, Fucile S. Interventions to Enhance Achievement to Independent Oral Feeds in Premature Infants: A Scoping Review. Phys Occup Ther Pediatr 2023; 44:295-315. [PMID: 37867325 DOI: 10.1080/01942638.2023.2271064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
AIM To assess the effectiveness of interventions aimed at facilitating the transition from full tube to independent oral feeds in premature infants. METHODS Scoping review methodology using the Preferred Reporting items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA_ScR). A search of six databases (EMBASE, MEDLINE, CINAHL, Web of Science, COCHRANE, and OT Seeker), using keywords related to oral feeding and premature infants retrieved 11,870 articles. Full-text screening was completed for 36 articles, and 21 articles were included in this review. RESULTS Review of the 21 articles revealed five intervention types: oral stimulation (n = 14), swallow/gustatory stimulation (n = 3), olfactory stimulation (n = 2), tactile/kinesthetic stimulation (n = 1), and auditory stimulation (n = 1). Oral stimulation had the most studies with consistent evidence supporting its beneficial effect to facilitate achievement to independent oral feeds, swallow/gustatory stimulation appeared to have some benefit, but evidence for olfactory, tactile/kinesthetic, and auditory stimulation was sparse. CONCLUSION Oral stimulation has the most studies with consistent evidence, and thus is suggested as a suitable early intervention strategy that can be used by health providers to facilitate the achievement to independent oral feeds in premature infants. The alternate forms of stimulation have limited evidence and necessitate further studies to confirm their benefits.
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Affiliation(s)
| | - Hillary Wilson
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Sandra Fucile
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
- Department of Pediatrics, Queen's University, Kingston, Canada
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Smith JB, Kamarunas E, O'Donoghue C. The Influence of Side-Lying Position on Oropharyngeal Swallow Function in At-Risk Infants: An Exploratory Study. Clin Pediatr (Phila) 2023; 62:1087-1100. [PMID: 36919839 DOI: 10.1177/00099228231159158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
This investigation assessed the effect of side-lying position on infant oropharyngeal swallow physiology. Infant modified barium swallow studies (MBS) recordings were retrospectively examined in matched-pairs comparing at-risk infants swallowing in both an upright/cradled position and a side-lying position. Swallow parameters were measured independently and through a consensus coding approach. Infants fed in side-lying position showed a decrease in airway invasion severity as compared with when those same infants were fed in an upright/cradled position (P = .009). Bolus location at the time of swallow initiation was higher when infants were fed in side-lying position as compared with cradle position (P = .024), representing decreased risk of airway invasion. Infants fed in side-lying position demonstrated fewer swallows per breaths (P = .032). This pilot study validates the need for additional research to further define the mechanisms related to this improvement, and to determine how diagnosis and medical stability moderate these findings.
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Affiliation(s)
- Julian B Smith
- Department of Communication Disorders, College of Health and Human Services, Southern Connecticut State University, New Haven, CT, USA
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA, USA
- Speech-Language Pathology, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Erin Kamarunas
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA, USA
| | - Cynthia O'Donoghue
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA, USA
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10
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Fucile S, Dow K. A Unique Clinical Tool for the Evaluation of Oral Feeding Skills in Infants. Can J Occup Ther 2023; 90:240-248. [PMID: 36314405 PMCID: PMC10422857 DOI: 10.1177/00084174221134738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background. Occupational therapy practice for oral feeding assessment is based on clinical observation of infants' sucking, swallowing, and breathing ability, which is influenced by clinical experience and provides poor evidence on explanatory factors. Purpose. To test the clinical utility and safety of a nipple monitoring device for the quantitative evaluation of oral feeding skills. Method. Sixteen infants, with no severe medical complications, participated in a pre-experimental pilot study. Oral feeding performances (duration, intake volume, and rate of transfer), and occurrence of adverse events (apnea, bradycardia, and oxygen desaturations) were recorded to ensure the tool does not interfere with infant's feeding ability or does not create any adverse effects. Findings. There was no significant difference in duration, intake volume, rate of transfer between the two monitored sessions, and no occurrence in adverse events. Implications. The findings suggest that the nipple monitoring device may be used for quantitative assessment and intervention planning of oral feeding difficulties in infants.
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Affiliation(s)
- Sandra Fucile
- Sandra Fucile, Watkins 4.4.321, 76 Stuart Street, Kingston, Ontario K7L 2V7.
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Krebs NF, Belfort MB, Meier PP, Mennella JA, O'Connor DL, Taylor SN, Raiten DJ. Infant factors that impact the ecology of human milk secretion and composition-a report from "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Working Group 3. Am J Clin Nutr 2023; 117 Suppl 1:S43-S60. [PMID: 37173060 PMCID: PMC10356564 DOI: 10.1016/j.ajcnut.2023.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/08/2022] [Accepted: 01/03/2023] [Indexed: 05/15/2023] Open
Abstract
Infants drive many lactation processes and contribute to the changing composition of human milk through multiple mechanisms. This review addresses the major topics of milk removal; chemosensory ecology for the parent-infant dyad; the infant's inputs into the composition of the human milk microbiome; and the impact of disruptions in gestation on the ecology of fetal and infant phenotypes, milk composition, and lactation. Milk removal, which is essential for adequate infant intake and continued milk synthesis through multiple hormonal and autocrine/paracrine mechanisms, should be effective, efficient, and comfortable for both the lactating parent and the infant. All 3 components should be included in the evaluation of milk removal. Breastmilk "bridges" flavor experiences in utero with postweaning foods, and the flavors become familiar and preferred. Infants can detect flavor changes in human milk resulting from parental lifestyle choices, including recreational drug use, and early experiences with the sensory properties of these recreational drugs impact subsequent behavioral responses. Interactions between the infant's own developing microbiome, that of the milk, and the multiple environmental factors that are drivers-both modifiable and nonmodifiable-in the microbial ecology of human milk are explored. Disruptions in gestation, especially preterm birth and fetal growth restriction or excess, impact the milk composition and lactation processes such as the timing of secretory activation, adequacy of milk volume and milk removal, and duration of lactation. Research gaps are identified in each of these areas. To assure a sustained and robust breastfeeding ecology, these myriad infant inputs must be systematically considered.
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Affiliation(s)
- Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Mandy B Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Paula P Meier
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA
| | | | - Deborah L O'Connor
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; The Hospital for Sick Children, Toronto, ON, Canada
| | - Sarah N Taylor
- Division of Neonatology, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Daniel J Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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12
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Ramdas D, Drury N, Jordan C, Panda S, Singh AP. Effects of Infant Driven Feeding Program on Provision of Breast Milk in Very Low Birth Weight Infants. Breastfeed Med 2023; 18:272-278. [PMID: 36848267 DOI: 10.1089/bfm.2022.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Background: The ability to complete nipple feedings is one of the discharge criteria for most premature neonates. The Infant Driven Feeding (IDF) program suggests a system of objective promotion of oral feeds in premature infants. There is a lack of studies systematically studying the effects of IDF on the provision of breast milk. Methods: This was a retrospective study of all premature infants born before 33 weeks and birth weight of <1,500 g admitted to a level IV neonatal intensive care unit. Infants on IDF were compared with those not on IDF. Results: A total of 46 infants in the IDF group and 52 in the non-IDF group met the inclusion criteria. A higher number of infants in the IDF group breastfed at first oral attempt (54% versus 12%). Forty-five percent of IDF mothers completed a full 72 hours of protected breastfeeding at the start of oral feeds, and IDF infants had earlier removal of nasogastric (NG) tube. There was no difference in the provision of breast milk and/or breastfeeding on discharge between the two groups. There was no difference in the length of stay between the two groups. Conclusion: The IDF program attempts to streamline the promotion of oral feeds in very low birth weight infants. Higher incidence of breastfeeding at the start of oral feeds and earlier removal of NG tube did not translate into higher provision of breast milk on discharge in very low birth weight infants in the IDF group. Prospective randomized trials are needed to validate cue-based infant driven feeding programs and their effects on the provision of breast milk.
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Affiliation(s)
- Divya Ramdas
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, Texas, USA
| | - Nicole Drury
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, Texas, USA
| | - Carmesha Jordan
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, Texas, USA
| | - Sanjeet Panda
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, Texas, USA.,El Paso Children's Hospital, El Paso, Texas, USA
| | - Ajay Pratap Singh
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, Texas, USA.,El Paso Children's Hospital, El Paso, Texas, USA
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13
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Şengun Z, Şener DK. The effect of feeding methods of bottle and injector on the transition to full breastfeeding and sucking success in preterm newborns: A randomized controlled trial. J Pediatr Nurs 2022; 67:e65-e70. [PMID: 36336532 DOI: 10.1016/j.pedn.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/11/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE This study was conducted to investigate the effects of feeding methods of bottle and injector on the transition to full breastfeeding and sucking success in preterm newborns. DESIGN AND METHODS This study was a randomized controlled type experimental study. The study sample included 62 preterm newborns, resulting from the strength analysis, who were treated in the neonatal intensive care unit of a university hospital (31 bottle-feeding group, 31 injector feeding group). Data were collected using the Descriptive Information Form, Preterm Infant Follow-up Form and LATCH Breastfeeding Diagnostic Scale. The infants in the syringe and the bottle-feeding group were fed, and the sucking successes and transition times to breastfeeding were evaluated during the first breastfeeding, after 48 h and before discharge. RESULTS When sucking successes and transition times to breastfeeding were evaluated, LATCH scores of the mothers in the syringe feeding group were significantly higher than the mothers in the bottle-feeding group, and infants switched to full breastfeeding in a shorter time (p < 0.05). When the physical parameter results were evaluated, the mean heart rate of the babies in the bottlefed group was significantly higher than the injector-fed group (p < 0.05). CONCLUSIONS It has been seen that injecting feeding method has a positive effect on the success of the newborn, the time of transition to full breastfeeding and life signs according to the bottle-feeding method. The findings obtained in this study suggest that to increase the success of sucking, shortening the transition time to full breastfeeding and using the injector feding method to maintain stabile physical parameters. APPLICATION TO PRACTICE The findings obtained in this study suggest that to increase the success of sucking, shortening the transition time to full breastfeeding and using the injector feding method to maintain stabile physical parameters.
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Affiliation(s)
- Zehra Şengun
- Duzce University Hospital, Neonatology Clinic, Konuralp, Düzce 81100, Turkey.
| | - Dilek Konuk Şener
- Duzce University, Faculty of Health Sciences, Department of Pediatric Nursing, Konuralp, Düzce 81100, Turkey.
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14
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Wahyuni LK, Mangunatmadja I, Kaban RK, Rachmawati EZK, Harini M, Laksmitasari B, Geraldyne A, Sangwidjojo IA, Utami DP, Poernomo VP, Sudjono AP. Non-nutritive sucking milestones of preterm infants in Indonesia: a descriptive study. PAEDIATRICA INDONESIANA 2022. [DOI: 10.14238/pi62.5.2022.311-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Non-nutritive sucking (NNS) maturity has been used as one of the markers of oral feeding readiness in infants. Prematurity may hinder the attainment of NNS milestones. Depending on gestational age (GA) at birth, preterm infants may display various degrees of immaturity, potentially affecting the strength, coordination, and efficiency of skills required for NNS.
Objective To identify the progression of NNS patterns across gestational age groups of preterm infants in Indonesia by comparing NNS parameters between moderate-to-late preterm and very preterm infants.
Methods NNS evaluation was conducted in 120 preterm infants born at 28-34 weeks gestational age in five tertiary hospitals in Jakarta, Indonesia. Three aspects of NNS (suction pressure, number of suctions per burst, and time between bursts) were documented and arranged to present a descriptive overview. A suction pressure measurement device was used to record, identify, and analyze NNS parameters. We hypothesize that maturity, as determined by GA, positively affected the attainment of NNS milestones.
Results Moderate-to-late preterm infants (GA 32 to <37 weeks), compared to very preterm infants (GA 28 to <32 weeks), had higher mean NNS pressure (-79.8 vs. -72.7 mmHg, respectively, P=0.041) and shorter mean time between bursts (6.63 vs. 7.36 s, respectively, P=0.030). Mean number of suctions per burst were also significantly different between the two GA groups (8.90 vs. 8.99 sucks/burst, respectively, P=0.048).
Conclusion Maturity, as reflected by GA, had a positive effect on the attainment of NNS milestones in preterm infants in Indonesia. Significant differences in the three NNS parameters: number of suctions per burst, time between bursts, and suction pressure were found between moderate-to-late preterm and very preterm infants.
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15
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Rinat S, Mackay M, Synnes A, Holsti L, Zwicker JG. Early feeding behaviours of extremely preterm infants predict neurodevelopmental outcomes. Early Hum Dev 2022; 173:105647. [PMID: 36029558 DOI: 10.1016/j.earlhumdev.2022.105647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/31/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Infants born extremely preterm are at high risk for early feeding difficulties, as well as poor neurodevelopmental outcomes in childhood. Feeding, a complex motor skill, may be predictive of later neuromotor outcomes. AIMS To determine the relationship between feeding behaviours of extremely preterm-born infants (<28 weeks gestational age) at 4-months corrected age (CA) and neurodevelopmental outcomes at 4-5 years. STUDY DESIGN Retrospective cohort design with prospectively collected data. SUBJECTS Infants born extremely preterm from September 1999 - October 2013 [n = 412, mean gestational age 25.4 (1.3) weeks; mean birth weight 771 (168) grams]. Oral feeding was assessed at 4-months CA by an experienced occupational therapist; infants were classified as either having poor suck-swallow ('feeding difficulties') or no feeding difficulties. OUTCOME MEASURES Motor outcomes were assessed at 4-5 years using the Movement Assessment Battery for Children (MABC). Children were categorized as: (1) typical motor development (TMD; n = 214); (2) Developmental Coordination Disorder (DCD; n = 116); or (3) major neurodevelopmental disorder (MND; n = 82). RESULTS Feeding behaviour at 4-months CA predicted DCD (OR = 2.95, CI 1.13-7.68) and MND (OR = 3.67, CI 1.35-9.96) after controlling for confounders. Infants with feeding difficulties were more likely to be diagnosed with DCD (40 % of poor feeders) or MND (36 %) at 4-5 years, compared to infants without feeding issues. CONCLUSIONS Early feeding behaviours significantly predicted motor outcomes at 4-5 years. Infants born extremely preterm with early feeding difficulties should be identified as at high risk for poor motor outcomes later in childhood and screened for early diagnosis and intervention.
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Affiliation(s)
- Shie Rinat
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Margot Mackay
- Neonatal Follow-Up Program, BC Women's Hospital, Vancouver, Canada
| | - Anne Synnes
- Neonatal Follow-Up Program, BC Women's Hospital, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada; Brain, Behaviour, & Development Theme, BC Children's Hospital Research Institute, Vancouver, Canada
| | - Liisa Holsti
- Department of Pediatrics, University of British Columbia, Vancouver, Canada; Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada
| | - Jill G Zwicker
- Department of Pediatrics, University of British Columbia, Vancouver, Canada; Brain, Behaviour, & Development Theme, BC Children's Hospital Research Institute, Vancouver, Canada; Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, Canada.
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16
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What babies need: accelerating access to current and novel antiretroviral drugs in neonates through pharmacokinetic studies. Lancet HIV 2022; 9:e649-e657. [PMID: 35863363 DOI: 10.1016/s2352-3018(22)00121-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/06/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022]
Abstract
Although 23 antiretroviral drugs are approved for use in adults, only six are approved by regulatory authorities for use in term neonates born to women with HIV, with even fewer options for preterm neonates. A major hurdle for approvals is the delay in the generation of pharmacokinetic and safety data for antiretrovirals in neonates. The median time between the year of approval from the US Food and Drug Administration of an antiretroviral agent for adults and the first publication date for pharmacokinetic data in neonates less than 4 weeks old is 8 years (range 2-23 years). In this Viewpoint, we address pharmacokinetic research gaps and priorities for current and novel antiretroviral use in neonates. We also consider the challenges and provide guidance on neonatal clinical pharmacology research on antiretroviral agents with the goal of stimulating research and expediting the availability of safe medications for the prevention and treatment of HIV in this vulnerable population.
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17
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Factors Affecting Oral Feeding Ability in Indonesian Preterm Infants. Pediatr Rep 2022; 14:233-243. [PMID: 35645368 PMCID: PMC9149927 DOI: 10.3390/pediatric14020031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 12/10/2022] Open
Abstract
Most preterm infants exhibit atypical and immature feeding skills. Even though preterm infants have fulfilled the oral feeding readiness criteria, they still do not have optimal oral feeding ability. This study aimed to determine various factors affecting oral feeding ability in Indonesian preterm infants who have fulfilled oral feeding readiness criteria but still have not been able to feed orally. A cross-sectional study included 120 preterm infants admitted to five tertiary hospitals in Jakarta, Indonesia. Participants were preterm infants born at 28-34 weeks gestational age who had fulfilled the oral feeding readiness as the inclusion criteria: (1) stable cardiorespiratory status, (2) have achieved full enteral feeding via orogastric tube (OGT) 120 mL/kg/day without vomiting or bloating, and (3) strong and rhythmic non-nutritive sucking (NNS) through objective measurement. Infants' oral feeding ability and various factors that were assumed to affect oral feeding ability, including physiological flexion postural tone, physiological stability, rooting reflex, self-regulation, behavioral state, and level of morbidity were evaluated. Chi-square and multivariate analysis with Poisson regression were performed. Results indicated that postural tone, rooting reflex, physiological stability, self-regulation, behavioral state, and level of morbidity were significantly related to oral feeding ability in preterm infants. The most influencing factors were self-regulation with a prevalence ratio (PR) of 1.96 (1.16-3.34; CI 95%) and p = 0.012, followed by postural tone, high morbidity, and behavioral state (PR 1.91; 1.59; 1.56; CI 95%, respectively). In conclusion, despite meeting the oral feeding readiness criteria, most preterm infants were still not able to feed orally. There are other factors affecting oral feeding ability in Indonesian preterm infants.
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18
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Hernández Gutiérrez MF, Díaz-Gómez NM, Jiménez Sosa A, Díaz Gómez JM, Domenech Martinez E. Effectiveness of 2 interventions for independent oral feeding in preterms. An Pediatr (Barc) 2022; 96:97-105. [DOI: 10.1016/j.anpede.2020.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/10/2020] [Indexed: 10/19/2022] Open
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19
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Akbarzadeh S, Lyu T, Farhoodi R, Awais M, Abbasi SF, Zhao X, Chen C, Amara A, Akay Y, Akay M, Chen W. Predicting Feeding Conditions of Premature InfantsThrough Non-Nutritive Sucking Skills Using a Sensitized Pacifier. IEEE Trans Biomed Eng 2022; 69:2370-2378. [PMID: 35044910 DOI: 10.1109/tbme.2022.3144094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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20
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Elsedawi BF, Samson N, Nadeau C, Vanhaverbeke K, Nguyen N, Alain C, Fortin-Pellerin E, Praud JP. Safety of Bottle-Feeding Under Nasal Respiratory Support in Preterm Lambs With and Without Tachypnoea. Front Physiol 2022; 12:785086. [PMID: 35046837 PMCID: PMC8762202 DOI: 10.3389/fphys.2021.785086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022] Open
Abstract
Aim: Convalescing preterm infants often require non-invasive respiratory support, such as nasal continuous positive airway pressure or high-flow nasal cannulas. One challenging milestone for preterm infants is achieving full oral feeding. Some teams fear nasal respiratory support might disrupt sucking–swallowing–breathing coordination and induce severe cardiorespiratory events. The main objective of this study was to assess the safety of oral feeding of preterm lambs on nasal respiratory support, with or without tachypnoea. Methods: Sucking, swallowing and breathing functions, as well as electrocardiogram, oxygen haemoglobin saturation, arterial blood gases and videofluoroscopic swallowing study were recorded in 15 preterm lambs during bottle-feeding. Four randomly ordered conditions were studied: control, nasal continuous positive airway pressure (6 cmH2O), high-flow nasal cannulas (7 L•min–1), and high-flow nasal cannulas at 7 L•min–1 at a tracheal pressure of 6 cmH2O. The recordings were repeated on days 7–8 and 13–14 to assess the effect of maturation. Results: None of the respiratory support impaired the safety or efficiency of oral feeding, even with tachypnoea. No respiratory support systematically impacted sucking–swallowing–breathing coordination, with or without tachypnoea. No effect of maturation was found. Conclusion: This translational physiology study, uniquely conducted in a relevant animal model of preterm infant with respiratory impairment, shows that nasal respiratory support does not impact the safety or efficiency of bottle-feeding or sucking–swallowing–breathing coordination. These results suggest that clinical studies on bottle-feeding in preterm infants under nasal continuous positive airway pressure and/or high-flow nasal cannulas can be safely undertaken.
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Affiliation(s)
- Basma Fathi Elsedawi
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
- Department of Human Anatomy and Embryology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nathalie Samson
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Charlène Nadeau
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Kristien Vanhaverbeke
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
- Laboratory of Experimental Medicine and Pediatrics, Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Nam Nguyen
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
- Faculty of Human Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Charles Alain
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Etienne Fortin-Pellerin
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Paul Praud
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
- *Correspondence: Jean-Paul Praud,
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Gehle DB, Chapman A, Gregoski M, Brunswick M, Anderson E, Ramakrishnan V, Muhammad LN, Head W, Lesher AP, Ryan RM. A predictive model for preterm babies born < 30 weeks gestational age who will not attain full oral feedings. J Perinatol 2022; 42:126-131. [PMID: 34628479 PMCID: PMC8501923 DOI: 10.1038/s41372-021-01219-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/17/2021] [Accepted: 09/21/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Develop a model to predict gastrostomy tube (GT) for feeding at discharge in infants born < 30 weeks' (w) gestational age (GA). STUDY DESIGN A single-center retrospective study at academic NICU. Total of 391 (78 GT, 313 non-GT) infants < 30 w GA admitted in 2015-2018 split into test (15-16) and validation (17-18) cohorts. Classification and regression tree analysis was used to identify predictive factors for GT. RESULTS Several factors were associated with GT requirements. Four factors included in the model were postmenstrual age (PMA) at first oral feeding, birth GA, high-frequency ventilation exposure, necrotizing enterocolitis stage II/III. Area under the receiver operator characteristic curve was 0.944 in the test cohort, 0.815 in the validation cohort. Implementation plan based on the model was developed. CONCLUSIONS We developed a predictive model to risk-stratify infants born < 30 w GA for failing full oral feeding. We hope implementation at 38 w PMA will result in earlier placement of needed GT and discharge.
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Affiliation(s)
| | - Alison Chapman
- Department of Pediatrics (Neonatology), Charleston, SC USA
| | | | - Meghan Brunswick
- grid.16416.340000 0004 1936 9174Department of Pediatrics (Gastroenterology), University of Rochester, Rochester, NY USA
| | - Emily Anderson
- grid.410427.40000 0001 2284 9329Augusta University Medical College of Georgia, AU/UGA Medical Partnership, Athens, GA USA
| | | | - Lutfiyya N. Muhammad
- grid.16753.360000 0001 2299 3507Department of Preventive Medicine (Division of Biostatistics), Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - William Head
- grid.259828.c0000 0001 2189 3475Department of Surgery (Pediatric Surgery), Medical University of South Carolina, Charleston, SC USA
| | - Aaron P. Lesher
- grid.259828.c0000 0001 2189 3475Department of Surgery (Pediatric Surgery), Medical University of South Carolina, Charleston, SC USA
| | - Rita M. Ryan
- Department of Pediatrics (Neonatology), Charleston, SC USA ,grid.415629.d0000 0004 0418 9947Department of Pediatrics (Neonatology), Case Western Reserve University, Rainbow Babies & Children’s Hospital, Cleveland, OH USA
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22
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Wener E, Dow KE, Fucile S. Evaluation of Methods of Breast or Bottle Feeding on Length of Hospitalization of Preterm Infants. Breastfeed Med 2021; 16:899-903. [PMID: 34370592 DOI: 10.1089/bfm.2021.0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Direct breastfeeding is the optimal method of nourishing preterm infants. Preconceived notions exist among health practitioners that establishment of direct breastfeeding lengthens hospitalization. Thus far, the aforementioned association remains unknown. Research Aim: The objective of this study was to assess the impact of direct breastfeeding establishment on length of hospital stay in preterm infants. Methods: A retrospective chart review on a sample of 101 mother-infant dyads was conducted in the neonatal intensive care unit at Kingston Health Sciences Center (KHSC) in Ontario, Canada. The sample consisted of three groups: (1) modified direct breastfeeding group, defined as infants receiving ≥50% direct breastfeeds during hospitalization, (2) partial breastfeeding group, defined as infants receiving <50% breastfeeds during hospitalization, and (3) bottle feeding group, defined as infants only receiving bottle feeds during hospitalization. A multiple linear regression model was performed to assess the relationship between length of hospitalization and method of oral feeds (modified direct breastfeeds vs. partial breastfeeds vs. bottle feeds) while controlling for infant (gestational age [GA], birth weight, 5 minutes Apgar score, ventilator support) and maternal (age, first-time mother, mental health conditions) factors. Results: GA was inversely associated with length of hospitalization. The number of days on ventilator support was positively associated with length of hospitalization. Method of oral feed, birth weight, 5 minutes Apgar score, maternal age, first-time mother status, and maternal mental health conditions were not associated with duration of hospitalization. Conclusions: Direct breastfeeding establishment does not lengthen hospitalization in preterm infants. This finding may aid health practitioners in increasing direct breastfeeding success in this population.
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Affiliation(s)
- Emily Wener
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Kimberly E Dow
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Sandra Fucile
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada.,School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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23
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Li L, Wang L, Niu C, Liu C, Lv T, Ji F, Yu L, Yan W, Dou YL, Wang Y, Cao Y, Huang G, Hu X. Early skin contact combined with mother's breastfeeding to shorten the process of premature infants ≤ 30 weeks of gestation to achieve full oral feeding: the study protocol of a randomized controlled trial. Trials 2021; 22:637. [PMID: 34535164 PMCID: PMC8447630 DOI: 10.1186/s13063-021-05605-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most hospitalized preterm infants experience difficulties in transitioning from tube feeding to full oral feeding. Interventions to promote full oral feeding in preterm infants in the neonatal intensive care unit (NICU) are limited to pacifier use or bottle-feeding exercises. Skin contact has been shown to be beneficial to start and maintain lactation and provide preterm infants with the opportunity to suck on the mother's breast, which may promote further development of the preterm infant's suckling patterns. The objective of this study is to compare and evaluate the effects of skin contact combined with breastfeeding (suck on the mother's empty breast) as compared to the routine pacifier suckling training model in achieving full oral feeding for infants whose gestational age are ≤ 30 weeks. METHODS This is a single-center, randomized controlled clinical trial conducted in the NICU and designed according to the SPIRIT Statement. The subjects included in the study are premature infants born between April 2020 and July 2021 with a gestational age of ≤30 weeks, birth weight of <1500 g, admission age of <72 h, and absence of congenital malformations. Those with oxygenation indices of >40 and those born to mothers with poor verbal communication skills will be excluded. A sample of 148 infants is needed. The infants will be randomized to the intervention (skin contact combined with mother's breastfeeding model) or control group (routine pacifier sucking training model). The primary outcome is the time required to achieve full oral feeding. The secondary outcomes are the breastfeeding abilities of preterm infants as assessed by the Preterm Infant Breastfeeding Behavior Scale (PIBBS), breastfeeding rates at 3 and 6 months corrected gestational age, complication rates, duration of oxygen requirement, days of hospital stay, and satisfaction of parents. DISCUSSION This paper describes the first single-center, open-label, randomized clinical trial on this topic and will provide crucial information to support the implementation of skin contact combined with the breastfeeding model in the NICU setting. TRIAL REGISTRATION ClinicalTrials.gov NCT04283682. Registered on 8 February 2020.
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Affiliation(s)
- Liling Li
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Li Wang
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Conway Niu
- King Edward Memorial Hospital, Western Australia, Subiaco, Australia
| | - Chan Liu
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Tianchan Lv
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Futing Ji
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Ling Yu
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Weili Yan
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Ya Lan Dou
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Yin Wang
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Yun Cao
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Guoying Huang
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Xiaojing Hu
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China.
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Eating Behaviors of Children with Autism-Pilot Study. Nutrients 2021; 13:nu13082687. [PMID: 34444847 PMCID: PMC8398283 DOI: 10.3390/nu13082687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 12/18/2022] Open
Abstract
Autism Spectrum Disorder (ASD) is the most recognized neuropsychiatric disorder of childhood. Comorbid conditions (such as feeding disorders) are more common among people with autism than among the general population. The most frequent somatic disorders in autistic children include the gastrointestinal disorders observed in 46–91% of patients. The purpose of this study was the evaluation of the nutrition of children with autism, with particular emphasis placed on feeding in the first year of life, in comparison to the group of healthy peers. Participants included 75 Caucasian children (41 children diagnosed with pure autism, and the control group consisting of 34 children without autistic traits). The analysis was performed based on a questionnaire of own design with the first part devoted to the eating practices of the early infancy. Results: Autistic children, as compared to the healthy peers, presented a shortened time of breastfeeding (the children fell asleep at the breast) (p = 0.04), a delayed introduction of dairy products (p = 0.001), the need of more trials to introduce new foods (p = 0.006), a delayed introduction of foods with solid and lumpy structure (p = 0.004), a longer duration of bottle feeding (p = 0.005), delayed attempts to eating using own hands (p = 0.006) and needed a greater support of parents to divert their attention from food during eating (p = 0.05). Conclusions: 1. The dietary problems are more common among children with the autism spectrum disorder than among the population of healthy children, during the first year of life from the time of introducing the complementary foods. 2. The autistic children experience difficulties with eating and require their parents’ additional involvement significantly more often than their healthy peers.
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Lane A, Pacella J, Beal JR, Sahmoun AE, Fedo-Rosvold S, Bellas WM, Brower-Breitwieser C. A cross-sectional analysis of infant-driven and traditional feeding outcomes for neonatal intensive care unit infants. J Perinatol 2021; 41:1865-1872. [PMID: 34012051 DOI: 10.1038/s41372-021-01084-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/31/2021] [Accepted: 04/29/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The goal of this study was to assess the impact of infant-driven feeding (IDF) compared to traditional feeding protocols in promoting earlier successful feeding outcomes. STUDY DESIGN We performed a cross-sectional analysis of infants admitted to a level three neonatal intensive care unit (NICU) over a 2-year period. We compared infants fed with the traditional protocol to those under the IDF protocol. RESULTS Infants in the IDF group were younger at first feed (p < 0.001). There was no difference in age at nasogastric (NG) tube removal or at discharge, length of stay, or percentage breastfeeding at discharge. There were no differences in outcomes within two subgroups born at <35 and <32 weeks gestation, respectively. CONCLUSION The IDF program led to earlier initiation of oral feeding. However, this did not lead to earlier NG tube removal or discharge, a shorter length of stay, or increase in the rates of breastfeeding.
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Affiliation(s)
- Audrey Lane
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Jonathan Pacella
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA.
| | - James R Beal
- Department of Family Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Abe E Sahmoun
- Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Susan Fedo-Rosvold
- Neonatal Intensive Care Unit, Sanford Children's Hospital Fargo, Fargo, ND, USA
| | - William M Bellas
- Neonatal Intensive Care Unit, Sanford Children's Hospital Fargo, Fargo, ND, USA
| | - Carrie Brower-Breitwieser
- Sanford Health Eating Disorders and Weight Management Center, Fargo, ND, USA. .,Department of Psychiatry and Behavioral Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA.
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Marshall J, Clarke S, Escott C, Pados BF. Assessing the flow rate of different bottles and teats for neonates with feeding difficulties: An Australian context. ACTA ACUST UNITED AC 2021. [DOI: 10.1016/j.jnn.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chang YJ, Hao G, Huang JY, Yang SF, Huang CC, Chen SC. Clinical Validation of the Preterm Oral Feeding Readiness Assessment Scale in Taiwan. J Pediatr Nurs 2021; 59:e84-e92. [PMID: 33648837 DOI: 10.1016/j.pedn.2021.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE A successful transition from gavage to full oral feeding is a decisive indicator for discharging premature infants from the neonatal intensive care unit. A clinically useful measure of oral feeding readiness would help nurses initiate implementation of the cue-based feeding model in Taiwan. The study aimed to assess the validity and reliability of the Traditional Chinese Preterm Oral Feeding Readiness Assessment Scale (TC-POFRAS). DESIGN AND METHODS 81 preterm infants were enrolled and assessed by TC-POFRAS regarding their oral feeding readiness. This study included two phases. Phase 1 conducted a cross language validation procedure and item-level content validity indices (I-CVIs) for content validity were estimated. In phase 2, Cronbach's alpha for internal consistency at each category and total scale levels were estimated. A receiver operating characteristic (ROC) curve was estimated to explore the scale's performance. The optimal cut-off value of TC-POFRAS was identified by the best Youden's Index [maximum (sensitivity + specificity - 1)]. RESULTS All of the I-CVIs were 1.00. The whole Cronbach's alpha for internal consistency was 0.804 (95% CI = 0.736-0.862), and Cronbach's alpha values were between 0.538 (95% = 0.332-0.689) and 0.687 (95%CI = 0.572-0.781) for categories. The area under ROC was 92.2%, and an optimal cut-off value of TC-POFRAS was 29 (sensitivity: 0.938, specificity: 0.941). CONCLUSIONS The TC-POFRAS has been verified to be an effective and accurate instrument to determine the initiation of oral feeding in preterm infants. PRACTICE IMPLICATIONS The TC-POFRAS is an appropriate and complementary assessment instrument for professionals to conveniently use in clinical practice.
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Affiliation(s)
- Yu-Jung Chang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan; Speech and Language Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Grace Hao
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham NC, USA.
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Center for health data science, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Chia-Chen Huang
- Department of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Shiuan-Chih Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
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Enhancing breastfeeding establishment in preterm infants: A randomized clinical trial of two non-nutritive sucking approaches. Early Hum Dev 2021; 156:105347. [PMID: 33714801 DOI: 10.1016/j.earlhumdev.2021.105347] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Preterm infants and their mothers face many barriers to the establishment of exclusive breastfeeding in the neonatal intensive care unit. OBJECTIVE The objective of this study was to assess and compare the effect of maternally administered non-nutritive sucking (NNS) on an emptied breast versus a pacifier on exclusive breastfeeding establishment at hospital discharge. STUDY DESIGN A block randomized study design was performed. TRIAL REGISTRATION NUMBER NCT03434743. METHODS A total of 33 preterm infants born less than or equal to 34 weeks gestation participated in the study. The NNS on an emptied breast or pacifier interventions were administered by mothers, once a day for 15 min. Outcomes included: exclusive breastfeeding acquisition, described as infants who received greater than or equal to 50% of direct breastfeeds at hospital discharge; time to achieve independent oral feeding, defined as the number of days to transition from complete tube feeds to full oral feeds (full breast, partial breast/bottle, or full bottle); length of hospitalization, described as the number of days from admission to hospital discharge. RESULTS A significantly greater number of infants in the NNS emptied breast group acquired exclusive breastfeeds at hospital discharge as compared with those in the NNS pacifier group (63% vs. 24%, p = 0.037). There was no difference between groups in time to achieve independent oral feeds (14.4 ± 8.0 vs. 14.4 ± 6.4 days, p = 0.683) and length of hospital stay (48.7 ± 33.7 vs. 53.1 ± 30.6 days, p = 0.595). CONCLUSION Provision of NNS on an emptied breast is a safe and low-cost infant and mother targeted intervention which can increase exclusive breastfeeding rates and its well-recognized advantages in a highly vulnerable population.
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Sullivan BA, Slevin CC, Ahmad SM, Sinkin RA, Fairchild KD. Achievement of maturational milestones among very low birth weight infants. J Neonatal Perinatal Med 2021; 15:155-163. [PMID: 33967061 DOI: 10.3233/npm-200698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Very low birth weight (VLBW) infants must achieve several maturational milestones to be discharged home from the NICU. OBJECTIVE Describe the timing of maturational milestones in VLBW infants and the impact of clinical variables and milestone achievement on postmenstrual age (PMA) at discharge. METHODS For VLBW infants without severe lung disease discharged home from a level IV NICU, we assessed PMA at the achievement of thermoregulation, cardiorespiratory stability, feeding, and discharge. RESULTS In 400 infants (median GA 28.4 weeks), lower birth weight, white race, and having multiple comorbidities of prematurity predicted later discharge PMA. The most common milestone sequence was CPAP discontinuation, caffeine discontinuation, thermoregulation, apnea resolution, and full oral feeds. PMA at apnea resolution and full oral feeds correlated highly with discharge PMA. CONCLUSIONS In a single-center VLBW cohort, comorbidities of prematurity impacted the timing of NICU discharge through delay in oral feeding and cardiorespiratory stability.
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Affiliation(s)
- B A Sullivan
- Department of Pediatrics, Division of Neonatology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - C C Slevin
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - S M Ahmad
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - R A Sinkin
- Department of Pediatrics, Division of Neonatology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - K D Fairchild
- Department of Pediatrics, Division of Neonatology, University of Virginia School of Medicine, Charlottesville, VA, USA
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The Effect of Intermittent and Continuous Feeding on Growth and Discharge Time in Very Low Birth Weight Preterm Infants. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:115-121. [PMID: 33935545 PMCID: PMC8085447 DOI: 10.14744/semb.2020.31549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/06/2020] [Indexed: 11/20/2022]
Abstract
Objectives The aim of this study was to determine the effect of intermittent bolus feeding and continuous feeding models on early growth and discharge time in very low birth weight infants. Methods The study was designed as a prospective, randomized, and controlled study. Infants born in our hospital with birth weight below 1500 g within a 1 year period were included in the study. The number of samples was determined by power analysis. Babies were randomized according to birth weight and fed with intermittent bolus feeding and continuous feeding models. Demographic characteristics, clinical findings, diagnosis, nutritional status, and length of hospital stay were compared. Results The study was conducted with 80 preterm infants, which consisted of continuous feeding (n=41) and intermittent bolus feeding (n=39). There was no significant difference in gender, gestational week, birth weight, height, and head circumference distribution of the babies between groups. The difference between the reach time to birth weight and maximum weight loss rates, parenteral feeding time, transition time to full enteral feeding, transition time to oral feeding, development of feeding intolerance, mechanical ventilation time, and hospitalization time in intensive care unit were not statistically significant. Necrotizing enterocolitis (NEC) Stage I and II developed in 34.1% of babies fed with continuous feeding model and 28.2% of babies fed intermittently; NEC was detected to start in 4.5±2.8 days in the continuous feeding group and in 2.8±5.2 days in the intermittent group. These differences were found to be insignificant between the two groups (p=0.634 and p=0.266, respectively). Conclusion There was no difference between growth parameters and discharge time of preterm babies who were applied continuous and intermittent bolus feeding model. Although there was no statistically significant difference on the development of NEC, it was determined that NEC developed earlier in the intermittent bolus feeding model.
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Hernández Gutiérrez MF, Díaz-Gómez NM, Jiménez Sosa A, Díaz Gómez JM, Domenech Martinez E. [Effectiveness of 2 interventions for independent oral feeding in pre-terms]. An Pediatr (Barc) 2021; 96:S1695-4033(20)30520-8. [PMID: 33487564 DOI: 10.1016/j.anpedi.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Oral feeding of pre-term newborns (PTNB) is hampered by their immaturity and intercurrent diseases, which can prolong their hospital stay. The objective of this study was to assess the effectiveness of a program that combines tactile, kinesthetic and oral stimulation (T+K+OS) compared to another intervention based on exclusively oral stimulation (OS), in the time necessary to achieve independent feeding and hospital discharge. PATIENTS AND METHODS A clinical study of 2 randomized groups (OS vs. T+K+OS) was carried out on 42 PTNB with gestational age between 27-32 weeks and birth weight>900g. The stimulation programs were carried out in sessions of 15min, for 10 days. RESULTS The PTNBs in the T+K+OS group achieved independent oral feeding earlier, compared to the OS group (24.9±10.1 vs. 34.1±15.6 days, P=.02). An analysis of covariance was performed, which confirmed that the birth weight and gestational age covariates had significant effects on time to reach suction feeding (birth weight: F[1, 38]=5.79; P=.021; gestational age: F[1, 38]=14.12; P=.001) and that once its effect was controlled, the intervention continued to have a significant effect (F[1, 38]=6.07; P=.018). The T+K+OS group, compared to the OS group, achieved an earlier hospital discharge (39±15 vs. 45±18 days), although the differences were not significant (P=.21). CONCLUSIONS Combined therapies that include T+K+OS are more effective than OS alone, in order to achieve independent oral feeding in PTNBs.
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Affiliation(s)
- María Fernanda Hernández Gutiérrez
- Servicio de Rehabilitación y Fisioterapia, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España
| | - N Marta Díaz-Gómez
- Facultad de Ciencias de la Salud, Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España.
| | - Alejandro Jiménez Sosa
- Unidad de Investigación, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España
| | - José Miguel Díaz Gómez
- Facultad de Psicología, Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España
| | - Eduardo Domenech Martinez
- Profesor Honorario, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España
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Shandley S, Capilouto G, Tamilia E, Riley DM, Johnson YR, Papadelis C. Abnormal Nutritive Sucking as an Indicator of Neonatal Brain Injury. Front Pediatr 2021; 8:599633. [PMID: 33511093 PMCID: PMC7835320 DOI: 10.3389/fped.2020.599633] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/24/2020] [Indexed: 12/27/2022] Open
Abstract
A term neonate is born with the ability to suck; this neuronal network is already formed and functional by 28 weeks gestational age and continues to evolve into adulthood. Because of the necessity of acquiring nutrition, the complexity of the neuronal network needed to suck, and neuroplasticity in infancy, the skill of sucking has the unique ability to give insight into areas of the brain that may be damaged either during or before birth. Interpretation of the behaviors during sucking shows promise in guiding therapies and how to potentially repair the damage early in life, when neuroplasticity is high. Sucking requires coordinated suck-swallow-breathe actions and is classified into two basic types, nutritive and non-nutritive. Each type of suck has particular characteristics that can be measured and used to learn about the infant's neuronal circuitry. Basic sucking and swallowing are present in embryos and further develop to incorporate breathing ex utero. Due to the rhythmic nature of the suck-swallow-breathe process, these motor functions are controlled by central pattern generators. The coordination of swallowing, breathing, and sucking is an enormously complex sensorimotor process. Because of this complexity, brain injury before birth can have an effect on these sucking patterns. Clinical assessments allow evaluators to score the oral-motor pattern, however, they remain ultimately subjective. Thus, clinicians are in need of objective measures to identify the specific area of deficit in the sucking pattern of each infant to tailor therapies to their specific needs. Therapeutic approaches involve pacifiers, cheek/chin support, tactile, oral kinesthetic, auditory, vestibular, and/or visual sensorimotor inputs. These therapies are performed to train the infant to suck appropriately using these subjective assessments along with the experience of the therapist (usually a speech therapist), but newer, more objective measures are coming along. Recent studies have correlated pathological sucking patterns with neuroimaging data to get a map of the affected brain regions to better inform therapies. The purpose of this review is to provide a broad scope synopsis of the research field of infant nutritive and non-nutritive feeding, their underlying neurophysiology, and relationship of abnormal activity with brain injury in preterm and term infants.
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Affiliation(s)
- Sabrina Shandley
- Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, United States
| | - Gilson Capilouto
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington, KY, United States
- NFANT Labs, LLC, Marietta, GA, United States
| | - Eleonora Tamilia
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - David M. Riley
- Neonatal Intensive Care Unit, Cook Children's Health Care System, Fort Worth, TX, United States
- School of Medicine, Texas Christian University and University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Yvette R. Johnson
- Neonatal Intensive Care Unit, Cook Children's Health Care System, Fort Worth, TX, United States
- School of Medicine, Texas Christian University and University of North Texas Health Science Center, Fort Worth, TX, United States
- Neonatal Intensive Care Unit Early Support and Transition (NEST), Developmental Follow-Up Center, Neonatology Department, Cook Children's Health Care System, Fort Worth, TX, United States
| | - Christos Papadelis
- Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, United States
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
- School of Medicine, Texas Christian University and University of North Texas Health Science Center, Fort Worth, TX, United States
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States
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Simmen P, Kreuzer S, Thomet M, Suter L, Jesacher B, Tran PA, Haeberlin A, Schulzke S, Jost K, Niederhauser T. Multichannel Esophageal Heart Rate Monitoring of Preterm Infants. IEEE Trans Biomed Eng 2020; 68:1903-1912. [PMID: 33044926 DOI: 10.1109/tbme.2020.3030162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Autonomic dysregulation in preterm infants requires continuous monitoring of vital signs such as heart rate over days to months. Unfortunately, common surface electrodes are prone to electrocardiography (ECG) signal artifacts and cause serious skin irritations during long-term use. In contrast, esophageal ECG is known to be very sensitive due to the proximity of electrodes and heart and insensitive to external influences. This study addresses if multichannel esophageal ECG qualifies for heart rate monitoring in preterm infants. METHODS We recorded esophageal leads with a multi-electrode gastric feeding tube in a clinical study with 13 neonates and compared the heartbeat detection performance with standard surface leads. A computationally simple and versatile ECG wave detection algorithm was used. RESULTS Multichannel esophageal ECG manifested heartbeat sensitivity and positive predictive value greater than 98.5% and significant less false negative (FN) ECG waves as compared to surface ECG due to site-typical electrode motion artifacts. False positive bradycardia as indicated with more than 13 consecutive FN ECG waves was equally expectable in esophageal and surface channels. No adverse events were reported for the multi-electrode gastric feeding tube. CONCLUSION Heart rate monitoring of preterm infants with multiple esophageal electrodes is considered as feasible and reliable. Less signal artifacts will improve the detection of bradycardia, which is crucial for immediate interventions, and reduce alarm fatigue. SIGNIFICANCE Due to the possibility to integrate the multichannel ECG into a gastric feeding tube and meanwhile omit harmful skin electrodes, the presented system has great potential to facilitate future intensive care of preterm infants.
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Siegel N, Lopez J, Shi AC, Neimanis S, Jodeh D, Khavanin N, Redett RJ, Sterni LM, Walsh JM, Dalesio NM, Rottgers SA, Morrison CS, Steinberg JP. Laryngoscopy Grade Improvement and Difficult Airway Resolution in Infants With Robin Sequence Undergoing Mandibular Distraction Osteogenesis: A Multi-Institutional Study. Cleft Palate Craniofac J 2020; 58:805-814. [PMID: 33030045 DOI: 10.1177/1055665620964052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Mandibular distraction osteogenesis (MDO) aims to relieve tongue-based airway obstruction in Robin Sequence (RS). We investigated direct laryngoscopy grade (DLG) improvement and difficult airway (DA) resolution following MDO. DESIGN Retrospective cohort analysis. SETTING Three tertiary care institutions. PATIENTS Sixty-four infants with RS who underwent a single MDO procedure in their first year of life were identified from January 2010 to January 2019. MAIN OUTCOME MEASURES The primary outcome was DLG pre- and post-MDO. Secondary outcomes included DA designation, pre- and post-MDO polysomnographic assessment for obstructive sleep apnea (OSA), length of stay, need for gastrostomy, and major/minor adverse events. RESULTS Median DLG improved from II pre-MDO to I at the time of distractor removal (n = 43, P < .001). No significant change was seen in patients with a third recorded time point (eg, palatoplasty; n = 78, P = .52). Twenty-six (47%) of 55 patients were designated as DA pre-MDO, and 10 (18%) of 55 patients retained the label post-MDO (P < .01). Five (50%) of these 10 patients appeared to be inappropriately retained. Median obstructive apnea-hypopnea index improved from 38.6 (range 31.2-62.8) pre-MDO to 2.9 (range 1-3.9) post-MDO (n = 12; P = .002). CONCLUSION Mandibular distraction osteogenesis allowed for DLG improvement that was stably maintained as well as functional improvement in OSA, with minimal morbidity. Difficult airway designation persisted in the electronic record of some infants despite clinical resolution.
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Affiliation(s)
- Nicholas Siegel
- Department of Plastic and Reconstructive Surgery, 1500The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joseph Lopez
- Department of Plastic and Reconstructive Surgery, 1500The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Aria C Shi
- Department of Plastic and Reconstructive Surgery, 1500The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sara Neimanis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 6923University of Rochester Medical Center, Rochester, NY, USA
| | - Diana Jodeh
- Department of Plastic and Reconstructive Surgery, 7582Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Nima Khavanin
- Department of Plastic and Reconstructive Surgery, 1500The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, 1500The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Laura M Sterni
- Division of Pulmonology, Department of Pediatrics, 1500The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jonathan M Walsh
- Department of Otolaryngology-Head and Neck Surgery, 1500The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nicholas M Dalesio
- Department of Anesthesiology, 1500The Johns Hopkins Hospital, Baltimore, MD, USA
| | - S Alex Rottgers
- Department of Plastic and Reconstructive Surgery, 7582Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Clinton S Morrison
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 6923University of Rochester Medical Center, Rochester, NY, USA
| | - Jordan P Steinberg
- Department of Plastic and Reconstructive Surgery, 1500The Johns Hopkins Hospital, Baltimore, MD, USA
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Braimah IZ, Enweronu-Laryea C, Sackey AH, Kenu E, Agyabeng K, Ofori-Adjei IODB, Beyuo V, Oku A, Essuman VA. Incidence and risk factors of retinopathy of prematurity in Korle-Bu Teaching Hospital: a baseline prospective study. BMJ Open 2020; 10:e035341. [PMID: 32759242 PMCID: PMC7409996 DOI: 10.1136/bmjopen-2019-035341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the incidence of retinopathy of prematurity (ROP) and any associated risk factors among preterm infants at the Neonatal Intensive Care Unit (NICU) of Korle-Bu Teaching Hospital (KBTH). DESIGN Prospective study. SETTING Level 3 NICU of KBTH from June 2018 to February 2019. PARTICIPANTS Eligible infants with birth weight (BW) less than 2 kg or gestational age (GA) less than 37 weeks were examined at scheduled intervals until full maturity of their retina. OUTCOME MEASURES The primary outcome measure was cumulative incidence of ROP and secondary outcome measure was risk factors associated with ROP. RESULTS Of the 401 infants, 222 were females (55.4%), mean±SD GA was 32.3±2.4 weeks (median 32, IQR 31 to 34) and mean BW 1.6±0.4 kg (median 1.5, IQR 1.3 to 1.9). The cumulative incidence of ROP was 13.7% (95% CI: 10.5 to 17.5%), with 1.8% (seven infants) having type 1 ROP. Increased risk of ROP was observed in babies with supplemental oxygen exposure (p<0.001), BW less than 1.5 kg (p=0.019), confirmed neonatal sepsis (p=0.001), nasogastric tube feeding (p=0.03) and poor pupillary dilation (0.032). A reduced risk of ROP was observed in boys (p=0.004) and after delivery by caesarean section (p=0.019). CONCLUSION The rates of ROP at KBTH are comparable to other NICUs in sub-Saharan Africa. Birth weight less than 1.5 kg, confirmed neonatal sepsis, nasogastric tube feeding and poor pupil dilation were independently associated with increased incidence of ROP. ROP screening should be a part of the routine service for premature infants in Ghana.
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Affiliation(s)
- Imoro Zeba Braimah
- Surgery (Eye), University of Ghana Medical School, College of Health Sciences, Accra, Ghana
- Lions International Eye Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Christabel Enweronu-Laryea
- Child Health, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
- Child Health, Korle Bu Teaching Hospital, Accra, Ghana
| | - Adziri Harold Sackey
- Child Health, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
- Child Health, Korle Bu Teaching Hospital, Accra, Ghana
| | - Ernest Kenu
- Epidemiology, School of Public health, University of Ghana College of Health Sciences, Accra, Ghana
| | - Kofi Agyabeng
- Bio-statistics, School of Public Health, University of Ghana College of Health Sciences, Accra, Ghana
| | | | - Vera Beyuo
- Lions International Eye Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Aaron Oku
- Lions International Eye Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Vera Adobea Essuman
- Surgery (Eye), University of Ghana Medical School, College of Health Sciences, Accra, Ghana
- Lions International Eye Centre, Korle Bu Teaching Hospital, Accra, Ghana
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Bartolome R, Kaneko-Tarui T, Maron J, Zimmerman E. The Utility of Speech-Language Biomarkers to Predict Oral Feeding Outcomes in the Premature Newborn. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1022-1029. [PMID: 32650666 PMCID: PMC7844339 DOI: 10.1044/2019_ajslp-csw18-19-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/23/2019] [Accepted: 07/31/2019] [Indexed: 06/11/2023]
Abstract
Purpose Successful oral feeding and speech emergence are dependent upon the coordination of shared oral muscles and facial nerves. We aimed to determine if the speech-associated genes, forkhead box P2 (FOXP2), contactin-associated protein-like 2 (CNTNAP2), glutamate receptor, ionotropic, N-methyl D-aspartate 2A (GRIN2A), and neurexin 1, were detectable in neonatal saliva and could predict feeding outcomes in premature newborns. Method In this prospective, observational, preliminary study, saliva collected from 51 premature infants (gestational ages: 30-34 6/7 weeks) at different stages of oral feeding development underwent gene expression analysis. Binary (+/-) expression profiles were explored and examined in relation to days to achieve full oral feeds. Results GRIN2A and neurexin 1 rarely amplified in neonatal saliva and were not informative. Infants who amplified FOXP2 but not CNTNAP2 at the start of oral feeds achieved oral feeding success 3.20 (95% CI [-2.5, 8.9]) days sooner than other gene combinations. Conclusions FOXP2 and CNTNAP2 may be informative in predicting oral feeding outcomes in newborns. Salivary analysis at the start of oral feeding trials may inform feeding outcomes in this population and warrants further investigation.
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Affiliation(s)
- Ruby Bartolome
- Floating Hospital for Children, Tufts Medical Center, Boston, MA
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA
| | | | - Jill Maron
- Floating Hospital for Children, Tufts Medical Center, Boston, MA
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA
| | - Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
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Abstract
In the United States, preterm birth rates have steadily increased since 2014. Despite the recent advances in neonatal-perinatal care, more than 40% of very low-birth-weight infants develop chronic lung disease (CLD) and almost 25% have feeding difficulties resulting in delayed achievement of full oral feeds and longer hospital stay. Establishment of full oral feeds, a major challenge for preterm infants, becomes magnified among those on respiratory support and/or with CLD. The strategies to minimize aerodigestive disorders include supporting nonnutritive sucking, developing infant-directed feeding protocols, sensory oromotor stimulation, and early introduction of oral feeds.
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Azuma D, Maron JL. Individualizing Oral Feeding Assessment and Therapies in the Newborn . RESEARCH AND REPORTS IN NEONATOLOGY 2020. [DOI: 10.2147/rrn.s223472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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The effects of oral feeding while on nasal continuous positive airway pressure (NCPAP) in preterm infants. J Perinatol 2020; 40:909-915. [PMID: 32086439 PMCID: PMC7224016 DOI: 10.1038/s41372-020-0632-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/30/2020] [Accepted: 02/11/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine whether delaying oral feeding until coming off NCPAP will alter feeding and respiratory-related morbidities in preterm infants. DESIGN In this retrospective pre-post analysis, outcomes were compared in two preterm infant groups (≤32 weeks gestation). Infants in Group 1 were orally fed while on NCPAP, while infants in Group 2 were only allowed oral feedings after ceasing NCPAP. RESULTS Although infants in Group 2 started feeds at a later postmenstrual age (PMA), they reached full oral feeding at a similar PMA compared with Group 1. Interestingly, there was a positive correlation between the duration of oral feeding while on NCPAP and the time spent on respiratory support in Group 1. CONCLUSIONS Delayed oral feeding until ceasing NCPAP did not contribute to feeding-related morbidities. We recommend caution when initiating oral feedings in preterm infants on NCPAP without evaluating the safety of the infants and their readiness for oral feedings.
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Impact of High Flow Nasal Cannula Therapy on Oral Feeding in Very Low Birth Weight Infants with Chronic Lung Disease. J UOEH 2019; 41:131-138. [PMID: 31292356 DOI: 10.7888/juoeh.41.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Previous studies on high-flow nasal cannula (HFNC) in very-low-birth-weight infants (VLBWIs) focused on comparing HFNC with nasal continuous positive airway pressure (nCPAP) to determine the usefulness of HFNC as a backup in the case of extubation failure and nasal trauma; however, the studies did not consider oral feeding. This retrospective case-control study aimed at elucidating whether HFNC could prevent the delay in feeding and achievement of full oral feeding in VLBWIs with chronic lung disease (CLD). Forty five VLBWIs were enrolled in this study: an HFNC group (n = 11) that was supported by HFNC at oral feeding initiation, and a non-HFNC group (n = 34) that could start oral feeding without HFNC. The gestational age and birth weight of the HFNC group were lower than those in the non-HFNC group. The median duration of exposure to oxygen and neonatal intensive care unit stay were comparable in both groups. The timings of oral feeding initiation and full oral feeding achievement in both groups were not significantly different: 35.3 (33.0 - 38.1) vs. 35.5 (33.7 - 42.4) weeks (P = 0.91) for the HFNC and 38.6 (34.4 - 42.3) vs. 36.7 (34.6 - 44.4) weeks postmenstrual age (P = 0.29) for the non-HFNC. Clinically significant aspiration pneumonia during the period of oral feeding was not observed in the HFNC group. Respiratory support by HFNC in VLBWIs with CLD might prevent oral feeding delay. Initiation of oral feeding of VLBWIs on HFNC might be safe and might accelerate the achievement of oral feeding milestones.
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van der Heijden ME, Zoghbi HY. Development of the brainstem respiratory circuit. WILEY INTERDISCIPLINARY REVIEWS-DEVELOPMENTAL BIOLOGY 2019; 9:e366. [PMID: 31816185 DOI: 10.1002/wdev.366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 02/01/2023]
Abstract
The respiratory circuit is comprised of over a dozen functionally and anatomically segregated brainstem nuclei that work together to control respiratory rhythms. These respiratory rhythms emerge prenatally but only acquire vital importance at birth, which is the first time the respiratory circuit faces the sole responsibility for O2 /CO2 homeostasis. Hence, the respiratory circuit has little room for trial-and-error-dependent fine tuning and relies on a detailed genetic blueprint for development. This blueprint is provided by transcription factors that have specific spatiotemporal expression patterns along the rostral-caudal or dorsal-ventral axis of the developing brainstem, in proliferating precursor cells and postmitotic neurons. Studying these transcription factors in mice has provided key insights into the functional segregation of respiratory control and the vital importance of specific respiratory nuclei. Many studies converge on just two respiratory nuclei that each have rhythmogenic properties during the prenatal period: the preBötzinger complex (preBötC) and retrotrapezoid nucleus/parafacial nucleus (RTN/pF). Here, we discuss the transcriptional regulation that guides the development of these nuclei. We also summarize evidence showing that normal preBötC development is necessary for neonatal survival, and that neither the preBötC nor the RTN/pF alone is sufficient to sustain normal postnatal respiratory rhythms. Last, we highlight several studies that use intersectional genetics to assess the necessity of transcription factors only in subregions of their expression domain. These studies independently demonstrate that lack of RTN/pF neurons weakens the respiratory circuit, yet these neurons are not necessary for neonatal survival because developmentally related populations can compensate for abnormal RTN/pF function at birth. This article is categorized under: Nervous System Development > Vertebrates: Regional Development.
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Affiliation(s)
- Meike E van der Heijden
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas.,Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, Texas
| | - Huda Y Zoghbi
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas.,Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, Texas.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Howard Hughes Medical Institute, Baylor College of Medicine, Houston, Texas
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Lagarde MLJ, van Alfen N, de Groot SAF, Geurts ACH, van den Engel-Hoek L. Adaptive capacity of 2- to 5-month-old infants to the flow, shape, and flexibility of different teats during bottle feeding: a cross-sectional study. BMC Pediatr 2019; 19:477. [PMID: 31805974 PMCID: PMC6894202 DOI: 10.1186/s12887-019-1859-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 11/28/2019] [Indexed: 02/02/2023] Open
Abstract
Background Nutritive sucking is a complex activity, the biomechanical components of which may vary in relation to respiratory phase, swallow-rate per minute, suck-swallow ratio, and swallow non-inspiratory flow (SNIF). Quantitative measurement of these components during nutritive sucking in healthy infants could help us to understand the complex development of sucking, swallowing, and breathing. This is important because the coordination between these components is often disturbed in infants with feeding difficulties. The aims of this study were to describe the biomechanical components of sucking and swallowing in healthy 2- to 5-month-old infants during bottle feeding, to assess whether infants adapt to the characteristics of two different teats, and to determine which independent variables influence the occurrence of SNIF. Methods Submental muscle activity, nasal airflow, and cervical auscultation were evaluated during bottle-feeding with two different teats. Results Sixteen term-born infants (6 boys) aged 2–5 months were included. All infants showed variable inhalation and exhalation after swallowing. The swallow rate per minute was significantly higher when infants fed with a higher flow teat (Philips Avent Natural 2.0™). Infants had suck:swallow ratios ranging from 1:1 to 4:1. A suck:swallow ratio of 1:1 occurred significantly more often when infants fed with a higher flow teat, whereas a suck:swallow ratio of 2:1 occurred significantly more often when infants fed with a low-flow teat (Philips Avent Classic+™). A suck:swallow ratio of 1:1 was negatively correlated with SNIF, whereas a suck:swallow ratio of 2:1 was positively correlated with SNIF. Conclusion Healthy infants aged 2–5 months can adapt to the flow, shape, and flexibility of different teats, showing a wide range of biomechanical and motor adaptations.
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Affiliation(s)
- M L J Lagarde
- Radboud University Medical Center, Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands.
| | - N van Alfen
- Radboud University Medical Center, Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - S A F de Groot
- Radboud University Medical Center, Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands
| | - A C H Geurts
- Radboud University Medical Center, Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands
| | - L van den Engel-Hoek
- Radboud University Medical Center, Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands
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Yi YG, Oh BM, Shin SH, Shin JY, Kim EK, Shin HI. Association of uncoordinated sucking pattern with developmental outcome in premature infants: a retrospective analysis. BMC Pediatr 2019; 19:440. [PMID: 31722705 PMCID: PMC6854670 DOI: 10.1186/s12887-019-1811-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/29/2019] [Indexed: 01/24/2023] Open
Abstract
Background Stress signals during sucking activity such as nasal flaring, head turning, and extraneous movements of the body have been attributed to incoordination of sucking, swallowing, and respiration (SSR) in premature infants. However, the association of uncoordinated sucking pattern with developmental outcomes has not yet been investigated. The aim of this study was to investigate whether uncoordinated sucking pattern during bottle-feeding in premature infants is associated with the developmental outcomes at 8–12 and 18–24 months of age (corrected for prematurity). Methods We retrospectively reviewed the medical records and video recordings for the Neonatal Oral-Motor Assessment Scale (NOMAS) of premature infants and divided them into two groups based on the presence or absence of incoordination. The Bayley-III cognition composite scores of the incoordination-positive and incoordination-negative group were compared at 8–12 and 18–24 months of age. Results Seventy premature infants exhibited a disorganized sucking pattern according to the NOMAS. The average Bayley-III cognition composite scores at 8–12 months of age were 92.5 ± 15.6 and 103.0 ± 11.3 for the incoordination-positive (n = 22) and incoordination-negative groups (n = 48), respectively (p = 0.002). The average Bayley-III cognition composite scores at 18–24 months were 90.0 ± 17.9 and 100.7 ± 11.5 for the incoordination-positive (n = 21) and incoordination-negative groups (n = 46), respectively (p = 0.005). A multiple linear regression analysis indicated that the presence of uncoordinated sucking pattern, grade 3 or 4 germinal matrix hemorrhage–intraventricular hemorrhage, and moderate to severe bronchopulmonary dysplasia were independently associated with cognitive development at 18–24 months of age. Conclusions Uncoordinated sucking pattern in premature infants was independently associated with a higher risk of abnormal developmental outcome in the cognitive domain of the Bayley-III at both 8–12 and 18–24 months. There may be a need for periodic follow-up and early intervention for developmental delay when incoordination of SSR that results in stress signals on the NOMAS is observed before 40 weeks postmenstrual age.
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Affiliation(s)
- You Gyoung Yi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seung Han Shin
- Division of Neonatology, Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jin Yong Shin
- Division of Occupational Therapy, Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Ee-Kyung Kim
- Division of Neonatology, Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Warren MG, Do B, Das A, Smith PB, Adams-Chapman I, Jadcherla S, Jensen EA, Goldstein RF, Goldberg RN, Cotten CM, Bell EF, Malcolm WF. Gastrostomy Tube Feeding in Extremely Low Birthweight Infants: Frequency, Associated Comorbidities, and Long-term Outcomes. J Pediatr 2019; 214:41-46.e5. [PMID: 31427096 PMCID: PMC6815700 DOI: 10.1016/j.jpeds.2019.06.066] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/07/2019] [Accepted: 06/25/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the frequency of gastrostomy tube (GT) placement in extremely low birth weight (ELBW) infants, associated comorbidities, and long-term outcomes. STUDY DESIGN Analysis of ELBW infants from 25 centers enrolled in the National Institute of Child Health and Human Development Neonatal Research Network's Generic Database and Follow-up Registry from 2006 to 2012. Frequency of GT placement before 18-22 months, demographic and medical factors associated with GT placement, and associated long-term outcomes at 18-22 months of corrected age were described. Associations between GT placement and neonatal morbidities and long-term outcomes were assessed with logistic regression after adjustment for center and common co-variables. RESULTS Of the 4549 ELBW infants included in these analyses, 333 (7.3%) underwent GT placement; 76% had the GT placed postdischarge. Of infants with GTs, 11% had birth weights small for gestational age, 77% had bronchopulmonary dysplasia, and 29% severe intraventricular hemorrhage or periventricular leukomalacia. At follow-up, 56% of infants with a GT had weight <10th percentile, 61% had neurodevelopmental impairment (NDI), and 55% had chronic breathing problems. After adjustment, small for gestational age, bronchopulmonary dysplasia, intraventricular hemorrhage/periventricular leukomalacia, poor growth, and NDI were associated with GT placement. Thirty-two percent of infants with GTs placed were taking full oral feeds at follow-up. CONCLUSIONS GT placement is common in ELBW infants, particularly among those with severe neonatal morbidities. GT placement in this population was associated with poor growth, NDI, and chronic respiratory and feeding problems at follow-up. The frequency of GT placement postneonatal discharge indicates the need for close nutritional follow-up of ELBW infants. TRIAL REGISTRATION ClinicalTrials.gov: NCT00063063.
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Affiliation(s)
| | - Barbara Do
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD
| | - P Brian Smith
- Department of Pediatrics, Duke University, Durham, NC
| | - Ira Adams-Chapman
- Emory University School of Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA
| | | | - Erik A Jensen
- Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA
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Castenmiller J, de Henauw S, Hirsch-Ernst KI, Kearney J, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Naska A, Pelaez C, Pentieva K, Siani A, Thies F, Tsabouri S, Vinceti M, Bresson JL, Fewtrell M, Kersting M, Przyrembel H, Dumas C, Titz A, Turck D. Appropriate age range for introduction of complementary feeding into an infant's diet. EFSA J 2019; 17:e05780. [PMID: 32626427 PMCID: PMC7009265 DOI: 10.2903/j.efsa.2019.5780] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Following a request from the European Commission, the Panel on Nutrition, Novel Foods and Food Allergens (NDA) revised its 2009 Opinion on the appropriate age for introduction of complementary feeding of infants. This age has been evaluated considering the effects on health outcomes, nutritional aspects and infant development, and depends on the individual's characteristics and development. As long as foods have an age-appropriate texture, are nutritionally appropriate and prepared following good hygiene practices, there is no convincing evidence that at any age investigated in the included studies (< 1 to < 6 months), the introduction of complementary foods (CFs) is associated with adverse health effects or benefits (except for infants at risk of iron depletion). For nutritional reasons, the majority of infants need CFs from around 6 months of age. Infants at risk of iron depletion (exclusively breastfed infants born to mothers with low iron status, or with early umbilical cord clamping (< 1 min after birth), or born preterm, or born small-for-gestational age or with high growth velocity) may benefit from earlier introduction of CFs that are a source of iron. The earliest developmental skills relevant for consuming pureed CFs can be observed between 3 and 4 months of age. Skills for consuming finger foods can be observed in some infants at 4 months, but more commonly at 5-7 months. The fact that an infant may be ready from a neurodevelopmental perspective to progress to a more diversified diet before 6 months of age does not imply that there is a need to introduce CFs. There is no reason to postpone the introduction of potentially allergenic foods (egg, cereals, fish and peanut) to a later age than that of other CFs as far as the risk of developing atopic diseases is concerned. Regarding the risk of coeliac disease, gluten can be introduced with other CFs.
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Bell N, Harding C. An investigation of the flow rates of disposable bottle teats used to feed preterm and medically fragile infants in neonatal units across the UK in comparison with flow rates of commercially available bottle teats. SPEECH LANGUAGE AND HEARING 2019. [DOI: 10.1080/2050571x.2019.1646463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Nicoll Bell
- NHS Trust, Barking, Havering and Redbridge University Hospitals, Romford, UK
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - Celia Harding
- Division of LCS, City, University of London, London, UK
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Huff K, Rose RS, Engle WA. Late Preterm Infants: Morbidities, Mortality, and Management Recommendations. Pediatr Clin North Am 2019; 66:387-402. [PMID: 30819344 DOI: 10.1016/j.pcl.2018.12.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Infants born between 34 weeks 0 days and 36 weeks 6 days of gestation are termed late preterm. This group accounts for the majority of premature births in the United States, with rates increasing in each of the last 3 years. This increase is significant given their large number: nearly 280,000 in 2016 alone. Late preterm infants place a significant burden on the health care and education systems because of their increased risk of morbidities and mortality compared with more mature infants. This increased risk persists past the newborn period, leading to the need for continued health monitoring throughout life.
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Affiliation(s)
- Katie Huff
- Department of Neonatology, Indiana University School of Medicine, 699 Riley Hospital Drive, RR 208, Indianapolis, IN 46202, USA
| | - Rebecca S Rose
- Department of Neonatology, Indiana University School of Medicine, 699 Riley Hospital Drive, RR 208, Indianapolis, IN 46202, USA
| | - William A Engle
- Department of Neonatology, Indiana University School of Medicine, 699 Riley Hospital Drive, RR 208, Indianapolis, IN 46202, USA.
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Song D, Jegatheesan P, Nafday S, Ahmad KA, Nedrelow J, Wearden M, Nemerofsky S, Pooley S, Thompson D, Vail D, Cornejo T, Cohen Z, Govindaswami B. Patterned frequency-modulated oral stimulation in preterm infants: A multicenter randomized controlled trial. PLoS One 2019; 14:e0212675. [PMID: 30817764 PMCID: PMC6394921 DOI: 10.1371/journal.pone.0212675] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/30/2019] [Indexed: 12/15/2022] Open
Abstract
Objective To evaluate the effect of patterned, frequency-modulated oro-somatosensory stimulation on time to full oral feeds in preterm infants born 26–30 weeks gestation. Study design This is a multicenter randomized controlled trial. The experimental group (n = 109) received patterned, frequency-modulated oral stimulation via the NTrainer system through a pulsatile pacifier and the control group (n = 101) received a non-pulsatile pacifier. Intent-to-treat analysis (n = 210) was performed to compare the experimental and control groups and the outcomes were analyzed using generalized estimating equations. Time-to-event analyses for time to reach full oral feeds and length of hospital stay were conducted using Cox proportional hazards models. Results The experimental group had reduction in time to full oral feeds compared to the control group (-4.1 days, HR 1.37 (1.03, 1.82) p = 0.03). In the 29–30 weeks subgroup, infants in the experimental group had a significant reduction in time to discharge (-10 days, HR 1.87 (1.23, 2.84) p < 0.01). This difference was not observed in the 26–28 weeks subgroup. There was no difference in growth, mortality or morbidities between the two groups. Conclusions Patterned, frequency-modulated oro-somatosensory stimulation improves feeding development in premature infants and reduces their length of hospitalization. Trial registration ClinicalTrials.gov NCT01158391
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Affiliation(s)
- Dongli Song
- Pediatrics—Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States of America
- Stanford University School of Medicine, Palo Alto, CA, United States of America
- * E-mail:
| | - Priya Jegatheesan
- Pediatrics—Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States of America
- Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Suhas Nafday
- Pediatrics—Neonatology, Children's Hospital at Montefiore-Weiler Division, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Kaashif A. Ahmad
- Pediatrix Medical Group, North Central Baptist Hospital, San Antonio, TX, United States of America
- Pediatrics–Neonatology, Baylor College of Medicine, San Antonio, TX, United States of America
| | - Jonathan Nedrelow
- Pediatrics–Neonatology, Cook Children's Medical Center, Fort Worth, TX, United States of America
| | - Mary Wearden
- Pediatrix Medical Group, North Central Baptist Hospital, San Antonio, TX, United States of America
| | - Sheri Nemerofsky
- Pediatrics–Neonatology, Children's Hospital at Montefiore-Wakefield Division, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Sunshine Pooley
- Pediatrics—Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States of America
- Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Diane Thompson
- aVenture Consulting, LLC, Leawood, KS, United States of America
| | - Daniel Vail
- Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Tania Cornejo
- Neonatology, Montefiore Medical Center-Weiler, Bronx, New York, United States of America
| | - Zahava Cohen
- Neonatology, Montefiore Medical Center-Wakefield, Bronx, New York, United States of America
| | - Balaji Govindaswami
- Pediatrics—Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States of America
- Stanford University School of Medicine, Palo Alto, CA, United States of America
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