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Bhakta M, Satapathy DM, Padhy M, Dalai S, Panda JN, Marandi P, Svn S, Pattnaik A. Assessing the Prevalence and Risk Factors of Postpartum Depression: A Cross-Sectional Study Conducted in the Urban Areas of Ankuli in Southern Odisha. Cureus 2024; 16:e61503. [PMID: 38952605 PMCID: PMC11216125 DOI: 10.7759/cureus.61503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2024] [Indexed: 07/03/2024] Open
Abstract
Background Postpartum depression (PPD) is a complex mix of physical, emotional, and behavioral changes that happen in some women after giving birth. Objectives The aim of the study is to determine the prevalence of PPD using the Edinburgh Postnatal Depression Scale (EPDS) and evaluate the predisposing factors for PPD. Methodology The present observational study was conducted in the Department of Community Medicine, Maharaja Krushna Chandra Gajapati (MKCG) Medical College and Hospital, Brahmapur, Odisha, India from May 2022 to November 2022. Using the EPDS, participants were assessed for postnatal depression. Every subject additionally filled out a risk factor questionnaire covering important sociodemographic and obstetric parameters. The prevalence of an EPDS score of 12 or above is the primary outcome measure. Results The study encompassed 121 mothers, with 8.26% scoring above the depression cutoff of 12 and 6.61% falling within the borderline range. Notably, all mothers surpassing the cutoff were from joint families, contrasting with those from nuclear families. A predominant portion of the depressive group was in their 20s, while the borderline group primarily consisted of mothers in their 30s. Urban residency and government hospital care were universal among the samples. Mode of delivery showed significance, with a higher prevalence of PPD observed among those who underwent a lower segment cesarean section. Additionally, maternal age, anemia, mode of delivery, educational status, adverse life events, and lack of partner support significantly correlated with depression scores. Notably, maternal age emerged as the most influential factor, followed by anemia and mode of delivery. Spearman correlation analysis revealed moderate negative associations between various aspects of maternal depression and the ages of their babies, indicating that younger infants were associated with greater maternal distress. However, the correlation between feeling sad or miserable and the baby's age was negligible. These findings emphasize the multifaceted nature of PPD, highlighting the interplay between sociodemographic factors, maternal well-being, and infant age.
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Affiliation(s)
- Madhumita Bhakta
- Community Medicine, Maharaja Krushna Chandra Gajapati (MKCG) Medical College and Hospital, Brahmapur, IND
| | - Durga M Satapathy
- Community Medicine, Maharaja Krushna Chandra Gajapati (MKCG) Medical College and Hospital, Brahmapur, IND
| | - Manisha Padhy
- Community Medicine, Maharaja Krushna Chandra Gajapati (MKCG) Medical College and Hospital, Brahmapur, IND
| | - Sithal Dalai
- Community Medicine, Maharaja Krushna Chandra Gajapati (MKCG) Medical College and Hospital, Brahmapur, IND
| | - Jasmin N Panda
- Community Medicine, Maharaja Krushna Chandra Gajapati (MKCG) Medical College and Hospital, Brahmapur, IND
| | - Pramila Marandi
- Community Medicine, Maharaja Krushna Chandra Gajapati (MKCG) Medical College and Hospital, Brahmapur, IND
| | - Swamy Svn
- Community Medicine, Maharaja Krushna Chandra Gajapati (MKCG) Medical College and Hospital, Brahmapur, IND
| | - Amita Pattnaik
- Community Medicine, Maharaja Krushna Chandra Gajapati (MKCG) Medical College and Hospital, Brahmapur, IND
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Bamehrez M. Hypoglycemia and associated comorbidities among newborns of mothers with diabetes in an academic tertiary care center. Front Pediatr 2023; 11:1267248. [PMID: 37900684 PMCID: PMC10611491 DOI: 10.3389/fped.2023.1267248] [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: 07/26/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
Background Hypoglycemia is considered the common metabolic problem in newborns with serious long-term sequelae. This study evaluates the incidence of hypoglycemia in the newborns of mothers with diabetes mellitus and assesses the comorbidities that affect the newborns of mothers with gestational diabetes compared with the newborns of mothers with pregestational diabetes mellitus. Methods This retrospective cohort study was conducted between January-2018 and December-2020. All admissions to the hospital nursery of the newborns of diabetic mothers with diabetes mellitus were included. Results The study comprised 1,036 mothers with diabetes, of the newborns of mothers with pregestational diabetes, 22% had hypoglycemia, and of mothers with gestational diabetes, 12%. Mothers with pregestational diabetes had a significantly higher risk of needing an emergency cesarean section (OR: 2.1, 95% CI: 1.3-3.4); and of having a baby who is large for its gestational age (OR: 9.5, 95% CI: 2.6-35.5), must be admitted to the NICU (OR: 2.9, 95% CI: 1.5-5.6), has respiratory distress syndrome (OR: 3.3, 95% CI: 1.5-7.4), and needs gavage feeding (OR: 3.5, 95% CI: 1.4-8.9). Conclusion About 13% of the newborns of mothers with diabetes had hypoglycemia. Significantly more of these newborns were of mothers with pregestational diabetes than of mothers with gestational diabetes. Newborn of mothers with pregestational diabetes mellitus have the risk of large weight and neurological problems, such as sucking difficulties, length of hospital stay, NICU admission, and respiratory distress syndrome.
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Affiliation(s)
- Maha Bamehrez
- Pediatric Department, King Abdul Aziz University Hospital, Jeddah, Saudi Arabia
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Greene Z, O'Donnell CP, Walshe M. Oral stimulation for promoting oral feeding in preterm infants. Cochrane Database Syst Rev 2023; 6:CD009720. [PMID: 37338236 PMCID: PMC10281084 DOI: 10.1002/14651858.cd009720.pub3] [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: 06/21/2023]
Abstract
BACKGROUND Preterm infants (< 37 weeks' post-menstrual age (PMA)) are often delayed in attaining oral feeding. Normal oral feeding is suggested as an important outcome for the timing of discharge from the hospital and can be an early indicator of neuromotor integrity and developmental outcomes. A range of oral stimulation interventions may help infants to develop sucking and oromotor co-ordination, promoting earlier oral feeding and earlier hospital discharge. This is an update of our 2016 review. OBJECTIVES To determine the effectiveness of oral stimulation interventions for attainment of oral feeding in preterm infants born before 37 weeks' PMA. SEARCH METHODS Searches were run in March 2022 of the following databases: CENTRAL via CRS Web; MEDLINE and Embase via Ovid. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. Searches were limited by date 2016 (the date of the search for the original review) forward. Note: Due to circumstances beyond our control (COVID and staffing shortages at the editorial base of Cochrane Neonatal), publication of this review, planned for mid 2021, was delayed. Thus, although searches were conducted in 2022 and results screened, potentially relevant studies found after September 2020 have been placed in the section, Awaiting Classification, and not incorporated into our analysis. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing a defined oral stimulation intervention with no intervention, standard care, sham treatment or non-oral intervention (e.g. body stroking protocols or gavage adjustment protocols) in preterm infants and reporting at least one of the specified outcomes. DATA COLLECTION AND ANALYSIS Following the updated search, two review authors screened the titles and abstracts of studies and full-text copies when needed to identify trials for inclusion in the review. The primary outcomes of interest were time (days) to exclusive oral feeding, time (days) spent in NICU, total hospital stay (days), and duration (days) of parenteral nutrition. All review and support authors contributed to independent extraction of data and analysed assigned studies for risk of bias across the five domains of bias using the Cochrane Risk of Bias assessment tool. The GRADE system was used to rate the certainty of the evidence. Studies were divided into two groups for comparison: intervention versus standard care and intervention versus other non-oral or sham intervention. We performed meta-analysis using a fixed-effect model. MAIN RESULTS We included 28 RCTs (1831 participants). Most trials had methodological weaknesses, particularly in relation to allocation concealment and masking of study personnel. Oral stimulation compared with standard care Following meta-analysis, it is uncertain whether oral stimulation reduces the time to transition to oral feeding compared with standard care (mean difference (MD) -4.07 days, 95% confidence interval (CI) -4.81 to -3.32 days, 6 studies, 292 infants; I2 =85%, very low-certainty evidence due to serious risk of bias and inconsistency). Time (days) spent in the neonatal intensive care unit (NICU) was not reported. It is uncertain whether oral stimulation reduces the duration of hospitalisation (MD -4.33, 95% CI -5.97 to -2.68 days, 5 studies, 249 infants; i2 =68%, very low-certainty evidence due to serious risk of bias and inconsistency). Duration (days) of parenteral nutrition was not reported. Oral stimulation compared with non-oral intervention Following meta-analysis, it is uncertain whether oral stimulation reduces the time to transition to exclusive oral feeding compared with a non-oral intervention (MD -7.17, 95% CI -8.04 to -6.29 days, 10 studies, 574 infants; I2 =80%, very low-certainty evidence due to serious risk of bias, inconsistency and precision). Time (days) spent in the NICU was not reported. Oral stimulation may reduce the duration of hospitalisation (MD -6.15, 95% CI -8.63 to -3.66 days, 10 studies, 591 infants; I2 =0%, low-certainty evidence due to serious risk of bias). Oral stimulation may have little or no effect on the duration (days) of parenteral nutrition exposure (MD -2.85, 95% CI -6.13 to 0.42, 3 studies, 268 infants; very low-certainty evidence due to serious risk of bias, inconsistency and imprecision). AUTHORS' CONCLUSIONS There remains uncertainty about the effects of oral stimulation (versus either standard care or a non-oral intervention) on transition times to oral feeding, duration of intensive care stay, hospital stay, or exposure to parenteral nutrition for preterm infants. Although we identified 28 eligible trials in this review, only 18 provided data for meta-analyses. Methodological weaknesses, particularly in relation to allocation concealment and masking of study personnel and caregivers, inconsistency between trials in effect size estimates (heterogeneity), and imprecision of pooled estimates were the main reasons for assessing the evidence as low or very low certainty. More well-designed trials of oral stimulation interventions for preterm infants are warranted. Such trials should attempt to mask caregivers to treatment when possible, paying particular attention to blinding of outcome assessors. There are currently 32 ongoing trials. Outcome measures that reflect improvements in oral motor skill development as well as longer term outcome measures beyond six months of age need to be defined and used by researchers to capture the full impact of these interventions.
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Affiliation(s)
- Zelda Greene
- Neonatology, National Maternity Hospital, Dublin, Ireland
- Adjunct Assistant Professor in Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Colm Pf O'Donnell
- Department of Neonatology, National Maternity Hospital, Dublin 2, Ireland
- University College Dublin, Dublin, Ireland
| | - Margaret Walshe
- Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Non-nutritive suck and voice onset time: Examining infant oromotor coordination. PLoS One 2021; 16:e0250529. [PMID: 33905427 PMCID: PMC8078818 DOI: 10.1371/journal.pone.0250529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/08/2021] [Indexed: 11/19/2022] Open
Abstract
The variability of a child’s voice onset time (VOT) decreases during development as they learn to coordinate upper vocal tract and laryngeal articulatory gestures. Yet, little is known about the relationship between VOT and other early motor tasks. The aims of this study were to evaluate the relationship between infant vocalization and another early oromotor task, non-nutritive suck (NNS). Twenty-five full-term infants (11 male, 14 female) completed this study. NNS was measured with a customized pacifier at 3 months to evaluate this early reflex. Measures of mean VOT and variability of VOT (measured via coefficient of variation) were collected from 12-month-old infants using a Language Environmental Analysis device. Variability of VOTs at 12 months was significantly related to NNS measures at 3-months. Increased VOT variability was primarily driven by increased NNS intraburst frequency and increased NNS burst duration. There were no relationships between average VOT or range of VOT and NNS measures. Findings from this pilot study indicate a relationship between NNS measures of intraburst frequency and burst duration and VOT variability. Infants with increased NNS intraburst frequency and NNS burst duration had increased VOT variability, suggesting a relationship between the development of VOT and NNS in the first year of life. Future work is needed to continue to examine the relationship between these early oromotor actions and to evaluate how this may impact later speech development.
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Early behavioral markers for neurodevelopmental disorders in the first 3 years of life: An overview of systematic reviews. Neurosci Biobehav Rev 2020; 116:183-201. [DOI: 10.1016/j.neubiorev.2020.06.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023]
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Filippa M, Menin D, Panebianco R, Monaci MG, Dondi M, Grandjean D. Live Maternal Speech and Singing Increase Self-Touch and Eye-Opening in Preterm Newborns: A Preliminary Study. JOURNAL OF NONVERBAL BEHAVIOR 2020. [DOI: 10.1007/s10919-020-00336-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Ding W, Zhao L, Sheng N, Ma J, Zhang Y. Impact of Neonatal Intensive Care Unit oral feeding on neuropsychomotor outcomes at 9 months of corrected age in Chinese low-birthweight preterm infants: A retrospective study. J Clin Nurs 2018; 28:420-429. [PMID: 29777555 DOI: 10.1111/jocn.14537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 04/12/2018] [Accepted: 05/07/2018] [Indexed: 12/17/2022]
Abstract
AIMS AND OBJECTIVES To examine the changes in neuropsychomotor development and investigate the effect of feeding progression in Neonatal Intensive Care Unit (NICU) on neuropsychomotor outcomes in low-birthweight preterm infants within 9 months of corrected age. BACKGROUND Low-birthweight (LBW) preterm infants (<37 weeks of gestation and birthweight <2,500 g) are at a high risk for neuropsychomotor development delay. Therefore, exploring NICU practices related to neuropsychomotor development is important. DESIGN This is a retrospective hospital-based cohort study. METHODS This study included 196 LBW preterm infants who were admitted to the NICU between January 2014-March 2016 and attended the follow-up growth evaluation in the clinic after discharge. The neuropsychomotor development of preterm infants was assessed every 3 months to a corrected age of 9 months using the paediatric neuropsychomotor diagnostic scale (PNDS). Generalised linear mixed models (GLMM) were performed. RESULTS The total PNDS scores had a downward trend, but the difference on pairwise comparison was not statistically significant. In total, 18.1%, 15.2% and 9.7% of preterm infants were examined for neuropsychomotor disorders at 3, 6 and 9 months of corrected age, respectively. The result of GLMM showed that the early initiation of oral feeding with breast milk was associated with optimal neuropsychomotor development. The first 3 months of corrected age is the critical period for neurodevelopmental disorders. CONCLUSIONS This study showed the importance of the early initiation of oral feeding with breast milk as early as possible within the NICU setting and highlighted the importance of close developmental follow-up. RELEVANCE TO CLINICAL PRACTICE The early initiation of oral feeding with breast milk may be recommended to promote neuropsychomotor development of LBW preterm infants within the NICU setting. Early identification of neuropsychomotor developmental delays within the first 3 months may guide early interventions.
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Affiliation(s)
- Wenwen Ding
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Lijin Zhao
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Nan Sheng
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jiali Ma
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Zhang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
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Reid J, Reilly S, Kilpatrick N. Sucking Performance of Babies with Cleft Conditions. Cleft Palate Craniofac J 2017; 44:312-20. [PMID: 17477747 DOI: 10.1597/05-173] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To describe the sucking performance of bottle-fed babies with cleft conditions. Participants: Forty 2-week-old-babies with cleft lip (CL; n = 8), cleft palate (CP; n = 22), and cleft lip and palate (CLP; n = 10) were examined. Methods: Suction, compression, and other sucking parameters were measured during bottle-feeding and compared to determine if they varied with cleft condition or feeding ability. Results: All babies with CL and one with CLP demonstrated suction. Thirteen of 22 babies with CP demonstrated suction but only three maintained regular pressure changes over time. Between-group differences in the amplitude of suction and compression were associated with cleft condition. Cleft lip participants demonstrated the greatest amplitude of suction followed by those with CP and CLP. Cleft lip and CP participants generated similar amplitudes of compression. This was greater than their counterparts with CLP. Good feeders (n = 15) generated high levels of suction, while satisfactory (n = 15) and poor feeders (n = 10) did not generate any during bottle-feeding. Conclusion: Between-group differences in intra-oral pressures were confirmed when babies were examined by cleft condition. Babies with smaller clefts (i.e., CL or minor soft palate clefts) were more likely to generate normal levels of suction and compression compared to their counterparts with larger clefts. Since good feeders were more likely to have smaller clefts it was not surprising that they demonstrated higher suction pressures than babies with satisfactory or poor feeding ability. Compression values were not significantly different across the feeding ability groups. These data may inform feeding management strategies.
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Affiliation(s)
- Julie Reid
- Speech Pathology Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
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Wolthuis-Stigter MI, Da Costa SP, Bos AF, Krijnen WP, Van Der Schans CP, Luinge MR. Sucking behaviour in infants born preterm and developmental outcomes at primary school age. Dev Med Child Neurol 2017; 59:871-877. [PMID: 28432690 DOI: 10.1111/dmcn.13438] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 11/29/2022]
Abstract
AIM To determine the association between sucking in infants born preterm and developmental outcomes at 5 years. METHOD Thirty-four infants were included (mean gestational age 30wks 4d, mean birthweight 1407g). The Neonatal Oral-Motor Assessment Scale was used longitudinally from 37 to 50 weeks postmenstrual age. At 5 years, we assessed motor skills, intelligence, language, verbal memory, and behavioural problems. Linear regression analyses were performed to test whether aspects of sucking behaviour predicted these developmental outcomes. Where linear regression was not appropriate, Spearman's correlation coefficients were calculated between sucking and developmental outcomes. RESULTS Sucking was associated with total motor skills (B [unstandardized correlation coefficient for normally distributed data]=22.66, 95% confidence interval [CI] 6.61 to 38.71), balance (Spearman's ρ=0.64, p<0.001), total intelligence (B=-1.16, 95% CI -1.89 to -0.44, B=10.48, 95% CI 0.39 to 20.71, B=-2.22, 95% CI -3.42 to -1.02), verbal intelligence (B=-0.95; 95% CI -1.83 to -0.07, B=-2.02; 95% CI -3.55 to -0.49), performance intelligence (B=-1.34, 95% CI -2.13 to -0.54, B=12.36, 95% CI 1.13 to 23.60, B=-2.37, 95% CI -3.75 to -0.96), and language (B=-1.78, 95% CI -3.36 to -0.19). All associations were in the same direction: the better the sucking, the higher the test scores. Verbal memory and behavioural problems were not associated with sucking. INTERPRETATION Abnormal sucking between 42 weeks and 50 weeks postmenstrual age may reflect abnormal neurological functioning in children born preterm.
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Affiliation(s)
- Mechteld I Wolthuis-Stigter
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Saakje P Da Costa
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Arend F Bos
- Department of Pediatrics, Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Wim P Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Cees P Van Der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands.,Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Margreet R Luinge
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
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Do orally-directed behaviors mediate the relationship between behavioral state and nutritive sucking in preterm infants? Early Hum Dev 2017; 109:26-31. [PMID: 28431255 PMCID: PMC5479324 DOI: 10.1016/j.earlhumdev.2017.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 11/22/2022]
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Greene Z, O'Donnell CPF, Walshe M. Oral stimulation for promoting oral feeding in preterm infants. Cochrane Database Syst Rev 2016; 9:CD009720. [PMID: 27644167 PMCID: PMC6457605 DOI: 10.1002/14651858.cd009720.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Preterm infants (< 37 weeks' postmenstrual age) are often delayed in attaining oral feeding. Normal oral feeding is suggested as an important outcome for the timing of discharge from the hospital and can be an early indicator of neuromotor integrity and developmental outcomes. A range of oral stimulation interventions may help infants to develop sucking and oromotor co-ordination, promoting earlier oral feeding and earlier hospital discharge. OBJECTIVES To determine the effectiveness of oral stimulation interventions for attainment of oral feeding in preterm infants born before 37 weeks' postmenstrual age (PMA).To conduct subgroup analyses for the following prespecified subgroups.• Extremely preterm infants born at < 28 weeks' PMA.• Very preterm infants born from 28 to < 32 weeks' PMA.• Infants breast-fed exclusively.• Infants bottle-fed exclusively.• Infants who were both breast-fed and bottle-fed. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed (1966 to 25 February 2016), Embase (1980 to 25 February 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 25 February 2016). We searched clinical trials databases, conference proceedings and the reference lists of retrieved articles. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing a defined oral stimulation intervention with no intervention, standard care, sham treatment or non-oral intervention in preterm infants and reporting at least one of the specified outcomes. DATA COLLECTION AND ANALYSIS One review author searched the databases and identified studies for screening. Two review authors screened the abstracts of these studies and full-text copies when needed to identify trials for inclusion in the review. All review authors independently extracted the data and analysed each study for risk of bias across the five domains of bias. All review authors discussed and analysed the data and used the GRADE system to rate the quality of the evidence. Review authors divided studies into two groups for comparison: intervention versus standard care and intervention versus other non-oral or sham intervention. We performed meta-analysis using a fixed-effect model. MAIN RESULTS This review included 19 randomised trials with a total of 823 participants. Almost all included trials had several methodological weaknesses. Meta-analysis showed that oral stimulation reduced the time to transition to oral feeding compared with standard care (mean difference (MD) -4.81, 95% confidence interval (CI) -5.56 to -4.06 days) and compared with another non-oral intervention (MD -9.01, 95% CI -10.30 to -7.71 days), as well as the duration of initial hospitalisation compared with standard care (MD -5.26, 95% CI -7.34 to -3.19 days) and compared with another non-oral intervention (MD -9.01, 95% CI -10.30 to -7.71 days).Investigators reported shorter duration of parenteral nutrition for infants compared with standard care (MD -5.30, 95% CI -9.73 to -0.87 days) and compared with another non-oral intervention (MD -8.70, 95% CI -15.46 to -1.94 days). They could identify no effect on breast-feeding outcomes nor on weight gain. AUTHORS' CONCLUSIONS Although the included studies suggest that oral stimulation shortens hospital stay, days to exclusive oral feeding and duration of parenteral nutrition, one must interpret results of these studies with caution, as risk of bias and poor methodological quality are high overall. Well-designed trials of oral stimulation interventions for preterm infants are warranted. Such trials should use reliable methods of randomisation while concealing treatment allocation, blinding caregivers to treatment when possible and paying particular attention to blinding of outcome assessors.
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Affiliation(s)
- Zelda Greene
- Our Lady's Children's HospitalSpeech and Language Therapy DepartmentCrumlinDublinIreland
| | - Colm PF O'Donnell
- National Maternity HospitalDepartment of NeonatologyHolles StreetDublin 2Ireland
| | - Margaret Walshe
- Trinity College DublinClinical Speech and Language Studies7‐9 South Leinster StreetDublinIreland2
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Ziadi M, Héon M, Aita M. A Critical Review of Interventions Supporting Transition from Gavage to Direct Breastfeeding in Hospitalized Preterm Infants. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.nainr.2016.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bakalar D, Tamaiev J, Zeigler HP, Feinstein P. Abolition of lemniscal barrellette patterning in Prrxl1 knockout mice: Effects upon ingestive behavior. Somatosens Mot Res 2015; 32:236-48. [PMID: 26402339 DOI: 10.3109/08990220.2015.1086327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Ingestive behaviors in mice are dependent on orosensory cues transmitted via the trigeminal nerve, as confirmed by transection studies. However, these studies cannot differentiate between deficits caused by the loss of the lemniscal pathway vs. the parallel paralemniscal pathway. The paired-like homeodomain protein Prrxl1 is expressed widely in the brain and spinal cord, including the trigeminal system. A knockout of Prrxl1 abolishes somatotopic barrellette patterning in the lemniscal brainstem nucleus, but not in the parallel paralemniscal nucleus. Null animals are significantly smaller than littermates by postnatal day 5, but reach developmental landmarks at appropriate times, and survive to adulthood on liquid diet. A careful analysis of infant and adult ingestive behavior reveals subtle impairments in suckling, increases in time spent feeding and the duration of feeding bouts, feeding during inappropriate times of the day, and difficulties in the mechanics of feeding. During liquid diet feeding, null mice display abnormal behaviors including extensive use of the paws to move food into the mouth, submerging the snout in the diet, changes in licking, and also have difficulty consuming solid chow pellets. We suggest that our Prrxl1(-/-) animal is a valuable model system for examining the genetic assembly and functional role of trigeminal lemniscal circuits in the normal control of eating in mammals and for understanding feeding abnormalities in humans resulting from the abnormal development of these circuits.
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Affiliation(s)
- Dana Bakalar
- a Department of Psychology , Hunter College, City University of New York , New York , USA and
| | - Jonathan Tamaiev
- a Department of Psychology , Hunter College, City University of New York , New York , USA and
| | - H Philip Zeigler
- a Department of Psychology , Hunter College, City University of New York , New York , USA and
| | - Paul Feinstein
- b Department of Biological Sciences and The Graduate Center Biochemistry , Biology and Biopsychology and Behavioral Neuroscience Programs, Hunter College, City University of New York , New York , USA
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Multilevel analysis of air pollution and early childhood neurobehavioral development. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:6827-41. [PMID: 24992486 PMCID: PMC4113847 DOI: 10.3390/ijerph110706827] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 06/19/2014] [Accepted: 06/23/2014] [Indexed: 11/16/2022]
Abstract
To investigate the association between the ambient air pollution levels during the prenatal and postnatal stages and early childhood neurobehavioral development, our study recruited 533 mother-infant pairs from 11 towns in Taiwan. All study subjects were asked to complete childhood neurobehavioral development scales and questionnaires at 6 and 18 months. Air pollution, including particulate matter ≤10 μm (PM10), carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and hydrocarbons, was measured at air quality monitoring stations in the towns where the subjects lived. Multilevel analyses were applied to assess the association between air pollution and childhood neurobehavioral development during pregnancy and when the children were 0 to 6 months, 7 to 12 months, and 13 to 18 months old. At 18 months, poor subclinical neurodevelopment in early childhood is associated with the average SO2 exposure of prenatal, during all trimesters of pregnancy and at postnatal ages up to 12 months (first trimester β = -0.083, se = 0.030; second and third trimester β = -0.114, se = 0.045; from birth to 12 months of age β = -0.091, se = 0.034). Furthermore, adverse gross motor below average scores at six months of age were associated with increased average non-methane hydrocarbon, (NMHC) levels during the second and third trimesters (β = -8.742, se = 3.512). Low-level SO2 exposure prenatally and up to twelve months postnatal could cause adverse neurobehavioral effects at 18 months of age. Maternal NMHC exposure during the 2nd and 3rd trimesters of pregnancy would be also associated with poor gross motor development in their children at 6 months of age.
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Pickler RH, Reyna BA, Griffin JB, Lewis M, Thompson AM. Changes in Oral Feeding in Preterm Infants Two Weeks After Hospital Discharge. ACTA ACUST UNITED AC 2012. [PMID: 23185127 DOI: 10.1053/j.nainr.2012.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this analysis was to measure changes in preterm infant feeding skill between discharge and two weeks post-discharge. Data were from two samples - 22 preterm infants who participated in a non-experimental study of feeding readiness and 63 preterm infants who participated in a study of four oral feeding approaches. Both studies were approved by the institutional review board; parents gave informed consent. The Early Feeding Skills Assessment (EFSA) was used to measure feeding skills. Data were analyzed descriptively and by ANOVA and regression. Analysis revealed that feeding skills changed selectively from discharge to post-discharge and that discharge skills were predictive of post-discharge skill. Changes that occur in feeding skills during the immediate post-discharge period have received little attention from researchers. The findings suggest that enhanced pre-discharge assessment and parent teaching maybe necessary to reduce reported parental stress associated with feeding the newly discharged infant and to promote a positive feeding experience.
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Affiliation(s)
- Rita H Pickler
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 11016, Cincinnati, OH 45229,
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16
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Slattery J, Morgan A, Douglas J. Early sucking and swallowing problems as predictors of neurodevelopmental outcome in children with neonatal brain injury: a systematic review. Dev Med Child Neurol 2012; 54:796-806. [PMID: 22607330 DOI: 10.1111/j.1469-8749.2012.04318.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM Early sucking and swallowing problems may be potential markers of neonatal brain injury and assist in identifying those infants at increased risk of adverse outcomes, but the relation between early sucking and swallowing problems and neonatal brain injury has not been established. The aim of the review was, therefore, to investigate the relation between early measures of sucking and swallowing and neurodevelopmental outcomes in infants diagnosed with neonatal brain injury and in infants born very preterm (<32wks) with very low birthweight (<1500g), at risk of neonatal brain injury. METHOD We conducted a systematic review of English-language articles using CINAHL, EMBASE, and MEDLINE OVID (from 1980 to May 2011). Additional studies were identified through manual searches of key journals and the works of expert authors. Extraction of data informed an assessment of the level of evidence and risk of bias for each study using a predefined set of quality indicators. RESULTS A total of 394 abstracts were generated by the search but only nine studies met the inclusion criterion. Early sucking and swallowing problems were present in a consistent proportion of infants and were predictive of neurodevelopmental outcome in infancy in five of the six studies reviewed. LIMITATIONS The methodological quality of studies was variable in terms of research design, level of evidence (National Health and Medical Research Council levels II, III, and IV), populations studied, assessments used and the nature and timing of neurodevelopmental follow-up. CONCLUSIONS Based upon the results of this review, there is currently insufficient evidence to clearly determine the relation between early sucking and swallowing problems and neonatal brain injury. Although early sucking and swallowing problems may be related to later neurodevelopmental outcomes, further research is required to delineate their value in predicting later motor outcomes and to establish reliable measures of early sucking and swallowing function.
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Affiliation(s)
- Justine Slattery
- School of Human Communication Sciences, La Trobe University, Melbourne, Victoria, Australia.
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Greene Z, Walshe M, O'Donnell CPF. Effects of oral stimulation for oral feeding in preterm infants. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009720] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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18
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Poore MA, Barlow SM. Suck Predicts Neuromotor Integrity and Developmental Outcomes. ACTA ACUST UNITED AC 2009. [DOI: 10.1044/ssod19.1.44] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Neonatal motor behavior predicts both current neurological status and future neurodevelopmental outcomes. For speech pathologists, the earliest observable patterned oromotor behavior is suck. Suck production requires effective coordination of an infant's oral sensorimotor system and is subject to a variety of neuromodulatory inputs. Demonstration and practice of coordinated suck serves as a biomarker for oral feeding skills neural integrity and is being assessed for its relation to neurodevelopmental outcomes (speech, cognition, and learning) by research teams in the United States, Europe, Japan, and Brazil. Suck may also serve as an intervention point to prevent feeding disorders and mitigate speech-language delays and disorders.
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Affiliation(s)
- Meredith A. Poore
- Communication Neuroscience Laboratories and Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas Lawrence, KS
| | - Steven M. Barlow
- Communication Neuroscience Laboratories, Department of Speech-Language-Hearing: Sciences and Disorders, and Programs in Neuroscience, Human Biology, and Bioengineering, University of Kansas Lawrence, KS
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Abstract
AIM To report changes in ingestive behaviour from 35 to 40 weeks post-conceptual age and examine the association between birth weight and feeding maturation in preterm infants. METHODS One hundred and four preterm infants born 24 to 34 weeks gestational age were studied. Feeding maturation was assessed as the change from 35 to 40 weeks post-conceptual age in the number of sucks over 5 min, sucking bursts, sucks per burst, time between bursts and maximum pressure during a suck (Pmax). The association between birth weight and each sucking behaviour was examined after adjusting for potential confounders. RESULTS Significant changes in feeding maturation occurred between 35 and 40 weeks. Birth weight was positively associated with change in Pmax and change in number of sucks per burst for extremely premature infants born 24 to <29 weeks gestational age but not for very premature infants born >/=29 to 34 weeks. The association between birth weight and change in Pmax for extremely premature infants remained significant after adjustment (adjusted beta = 0.128 mmHg increase in change in maximum sucking pressure per every 1 g of birth weight, 95% CI = 0.017, 0.239, p = 0.03). CONCLUSION Birth weight is positively associated with maturation in maximum sucking pressure among infants born extremely premature.
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Affiliation(s)
- Brian H Wrotniak
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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20
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Abstract
PURPOSE To validate a 2-step infant developmental screening protocol administered by nonphysician health professionals. METHODS The Parent Concerns Survey and the Meade Movement Checklist (MMCL) were administered during 5 community clinics. Infant scores at 4 months were compared with the Bayley Scales of Infant Development II and Movement Assessment of Infants at 6 months and to the Ages and Stages Questionnaires at 8 months. RESULTS Parents identified significantly more concerns on the Parent Concerns Survey (x2 = 6.43, p = 0.011) than parents not attending clinics. The correlation between infant MMCL scores at 4 months and Movement Assessment of Infants was r = 0.58 (p = 0.01) and r = -0.48 (p = 0.01) with Bayley Scales of Infant Development II scores at 6 months. The MMCL demonstrated 87.5% sensitivity, 91.4% specificity, and 70% positive predictive value. CONCLUSION Combining parent concerns and observational screening effectively identified infants for further evaluation. This 2-step screening by nonphysician health professionals provides a valid, new perspective for screening young infants.
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Dodrill P, McMahon S, Donovan T, Cleghorn G. Current management of transitional feeding issues in preterm neonates born in Queensland, Australia. Early Hum Dev 2008; 84:637-43. [PMID: 18515021 DOI: 10.1016/j.earlhumdev.2008.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 08/17/2007] [Accepted: 04/19/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Many preterm neonates display difficulty establishing suck-feeding competence in the weeks following birth. Ineffective management of transitional feeding issues may cause patient complications, and can contribute to increased length of stay. AIMS Given that many neonatal nurseries appear to vary in their neonatal feeding management practices, the aim of this study was to investigate and document the routine level of support and intervention currently provided for preterm neonates with transitional feeding issues across the various level II (special care) nurseries (SCNs) in Queensland, Australia. METHODS A questionnaire was mailed to all Queensland SCNs in 2005 (n=36). The questionnaire contained a series of closed-choice and short-answer questions designed to obtain information from each SCN regarding their current practices for managing transitional feeding issues in preterm neonates. Results were confirmed during a follow-up phone call. RESULTS Responses were obtained from 29 SCNs (80.6%). None of these nurseries reported having any formal, written policies regarding the management of transitional feeding issues in preterm neonates. Wide variations were reported in relation to the suck-feeding assessments and interventions used by staff within the various SCNs. Of the 29 nurseries, 4 (13.8%) reported using checklists or assessments to judge readiness for suck-feeds, and 5 (17.2%) reported using pulse oximetry to judge tolerance of suck-feeding attempts. Eighteen SCNs (62.1%) reported offering some form of active intervention to assist neonates with transitional feeding issues, with the most common intervention techniques reported being non-nutritive sucking during tube feeds, pre-feeding oral stimulation, and actively pacing suck-feeds. Twenty-two SCNs (75.4%) reported having access to a lactation consultant to assist mothers with breastfeeding issues. CONCLUSIONS Differences were reported in the routine management of transitional feeding issues in preterm neonates across the various SCNs in Queensland. It is suggested that evidence based guidelines need to be developed, and that, in order to do this, further research studies are required to determine current best practice, as well as to answer remaining questions.
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Affiliation(s)
- Pamela Dodrill
- Discipline of Paediatrics & Child Health, School of Medicine, University of Queensland, Australia.
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22
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Thoyre SM. Feeding outcomes of extremely premature infants after neonatal care. J Obstet Gynecol Neonatal Nurs 2007; 36:366-75; quiz 376. [PMID: 17594415 DOI: 10.1111/j.1552-6909.2007.00158.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Feeding is a primary concern for families of extremely preterm (EP) infants following discharge from neonatal care. An increasing number of EP children are being referred for treatment of feeding problems, including eating only a few types of food or very small portions, difficulty transitioning to textured foods, and refusing food. These issues have the potential for significant consequences for the children's growth and development as well as their family's well-being. An understanding of the kinds of feeding problems faced by families of EP infants can help nurses guide families to be ready for and respond to these issues. In this article, the evidence for and the nature of feeding problems in EP children after discharge from neonatal care are examined.
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Affiliation(s)
- Suzanne M Thoyre
- School of Nursing, Carrington Hall, University of North Carolina at Chapel Hill, NC 27599-7460, USA.
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23
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Abstract
OBJECTIVE The purposes of this analysis were to determine how select characteristics of nutritive sucking (number of sucks, sucks/burst, and sucks/minute) change over time and to examine the effect of select factors (morbidity, maturity, prefeeding behavior state, and feeding experience) on those changes. STUDY DESIGN A longitudinal, non-experimental study was conducted in a Level 3 neonatal intensive care unit using a convenience sample of 88 preterm infants. Statistical analyses were performed using a repeated-measures mixed-model in SAS. RESULTS Sucking activity (number of sucks, sucks/burst, and sucks/minute) was predicted by morbidity, maturity, feeding experience and prefeeding behavior state. Experience at oral feeding had the greatest effect on changes in the number of sucks, suck/burst and sucks/minute. CONCLUSION Experience at feeding may result in more rapid maturation of sucking characteristics.
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Affiliation(s)
- R H Pickler
- School of Nursing, Virginia Commonwealth University, Richmond, VA 23219, USA.
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Bromiker R, Rachamim A, Hammerman C, Schimmel M, Kaplan M, Medoff-Cooper B. Immature sucking patterns in infants of mothers with diabetes. J Pediatr 2006; 149:640-3. [PMID: 17095335 DOI: 10.1016/j.jpeds.2006.07.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Revised: 05/05/2006] [Accepted: 07/13/2006] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate immaturity of sucking patterns of infants of mothers with diabetes. STUDY DESIGN Term infants born to mothers with gestational diabetes mellitus (16 mothers managed with insulin and 31 with diet alone) were compared with 55 matched healthy infants (control group). Sucking patterns were recorded and analyzed for number of sucks and bursts and averages maximum suck pressure, number of sucks per burst, suck width, and time between bursts. The measurements were made for feedings of 5 minutes duration with Kron's Nutritive Sucking Apparatus on the third day of life. RESULTS Relative to the control group, newborns of the insulin-treated mothers averaged 5.2 fewer bursts and 42 fewer sucks (P = .013 and P = .04, respectively). No differences were noted for other variables tested. There were no differences in sucking patterns between newborns of diet-managed mothers and control newborns. CONCLUSION Poorer sucking patterns were found among infants of insulin-managed mothers with diabetes. The present findings indicate some degree of neurologic immaturity during the early neonatal period.
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Affiliation(s)
- Ruben Bromiker
- Department of Neonatology, Shaare Zedek Medical Center, and the Faculty of Medicine of the Hebrew University, Jerusalem, Israel.
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Holditch-Davis D, Belyea M, Edwards LJ. Prediction of 3-year developmental outcomes from sleep development over the preterm period. Infant Behav Dev 2005. [DOI: 10.1016/j.infbeh.2004.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Finding ways to consistently prepare preterm infants and their families for more timely discharge must continue as a focus for everyone involved in the care of these infants in the neonatal intensive care unit. The gold standards for discharge from the neonatal intensive care unit are physiologic stability (especially respiratory stability), consistent weight gain, and successful oral feeding, usually from a bottle. Successful bottle-feeding is considered the most complex task of infancy. Fostering successful oral feeding in preterm infants requires consistently high levels of skilled nursing care, which must begin with accurate assessment of feeding readiness and thoughtful progression to full oral feeding. This comprehensive review of the literature provides an overview of the state of the science related to feeding readiness and progression in the preterm infant. The theoretical foundation for feeding readiness and factors that appear to affect bottle-feeding readiness, progression, and success are presented in this article.
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27
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McGrath JM, Medoff-Cooper B. Alertness and feeding competence in extremely early born preterm infants. ACTA ACUST UNITED AC 2002. [DOI: 10.1053/nbin.2002.35127] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Medoff-Cooper B, McGrath JM, Shults J. Feeding patterns of full-term and preterm infants at forty weeks postconceptional age. J Dev Behav Pediatr 2002; 23:231-6. [PMID: 12177569 DOI: 10.1097/00004703-200208000-00007] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Little research exists that addresses the differences in feeding skills between preterm (PT) infants at term and full-term (FT) infants. The purpose of this study was to quantify and examine the differences in sucking abilities of PT infants when measured at 40 weeks postconceptional age (PCA) and newly born FT infants. The sample consisted of 213 infants who were divided into three groups on the basis of their gestational age at birth (24-29 wk, 30-32 wk, and 38-42 wk). The Kron Nutritive Sucking Apparatus (KNSA) was used to examine the microstructure of sucking and feeding behaviors. There were significant differences among the three groups in several of the sucking variables: number of bursts (p = .005), intersuck interval (p = .0212), sucks per burst (p = .0003), suck width (p < .0001), intersuck width (p < .0001), mean maximum pressure (p < .0001), and intersuck width/interburst width (p = .02). The findings from this study demonstrate the importance of both maturation at birth and experience as factors influencing feeding behaviors.
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Abstract
Advances in congenital heart surgery have resulted in the increased survival of infants born with complex congenital heart disease. Questions remain, however, about how these patients will develop and whether they will have normal, productive lives. To date, studies have shown that although the vast majority of children with congenital heart disease have normal outcomes, as a group they generally have higher rates of neurodevelopmental problems. The developmental sequelae include mild problems in cognition, attention, and neuromotor functioning. The etiology of neurologic deficits in this population appears to be multifactorial with preoperative, operative, and postoperative factors all contributing to outcome. Continued research and attempts to minimize neurologic injury and associated sequelae are of primary importance. Recent data suggest that advances in care already may be improving outcome after congenital heart surgery. Ongoing documentation of the long-term outcome in this population needs to be mandated, as does the implementation of environmental enrichment programs to help ameliorate the long-term consequences of congenital heart disease.
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Affiliation(s)
- W T Mahle
- Sibley Heart Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322-1028, USA.
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Mahle WT, Wernovsky G. Long-term developmental outcome of children with complex congenital heart disease. Clin Perinatol 2001; 28:235-47. [PMID: 11265509 DOI: 10.1016/s0095-5108(05)70077-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
As the mortality of neonatal and infant surgery for CHD continues to decrease, attention is now focused on long-term sequelae, especially later cognitive and neurologic function, in survivors. Although children with repaired or palliated CHD have an increased risk for neurocognitive deficits, most survivors are performing within the normal range for most standardized measures. Even those children at highest risk, such as patients with HLHS, are comparable with survivors of other congenital lesions, such as diaphragmatic hernia, or low-birth weight children. Continued efforts are underway to reduce cerebral injury before, during, and after congenital heart surgery.
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Affiliation(s)
- W T Mahle
- Division of Cardiology, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, USA.
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Morris BH, Miller-Loncar CL, Landry SH, Smith KE, Swank PR, Denson SE. Feeding, medical factors, and developmental outcome in premature infants. Clin Pediatr (Phila) 1999; 38:451-7. [PMID: 10456239 DOI: 10.1177/000992289903800802] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This is a prospective, longitudinal study of premature infants investigating whether the length of time needed to reach full enteral feedings (FEF) or full nipple feedings (FNF) is related to medical complications and/or developmental outcome at 24 months corrected age. Premature infants (n = 161) from three institutions with birth weights less than 1,600 grams were followed up from birth to 24 months corrected age. The infants were stratified into groups by the severity of medical complications. Bayley Scales of Infant Development were performed at 24 months corrected age. Multiple linear regression was used to analyze the association between feeding milestones, medical complications, and developmental outcomes. Our results show that when controlling for birth weight and gestational age (GA), the severity of respiratory complications was significantly related to reaching FEF (p = 0.024) and FNF (p = 0.0014). Furthermore, when controlling for the severity of respiratory complications, GA, and socioeconomic status, an increased length of time to FEF was significantly associated with a poorer mental outcome (p = 0.0013). We conclude that there is an association between the length of time to reach FEF and mental developmental outcome at 24 months corrected age. Infants who reach full enteral feedings at an earlier age appear to have a better developmental outcome despite their GA and severity of respiratory complications.
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Affiliation(s)
- B H Morris
- Department of Pediatrics, University of Texas-Houston Medical School 77030, USA
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