Oral Motor Intervention Improved the Oral Feeding in Preterm Infants: Evidence Based on a Meta-Analysis With Trial Sequential Analysis

Effectiveness of Oral-Motor Stimulation on Oral Feeding in Premature Infants: A Protocol for Systematic Review and Meta-Analysis of Controlled Randomized Trials

Objectives

Premature infants (born before 37 weeks of gestational age) frequently experience feeding difficulties due to underdeveloped oral motor skills and poor chewing, swallowing, and breathing coordination. In order to improve oral feeding efficiency in these infants, Oral-Motor Stimulation (OMS) has been used in various studies. This systematic review study will aim to assess the effectiveness of OMS for oral feeding in preterm infants.

Materials & Methods

The authors will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. They will conduct a search in electronic databases, including PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials in The Cochrane Library (CENTRAL), Medline via PubMed, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for nursing and related healthcare texts without language restrictions from the first month of 1991 to the fifth month of 2024 to achieve the study objectives. All Randomized Controlled Clinical Trials (RCT) examining the effect of OMS on oral feeding in preterm infants will be included in this study.

Results

The primary outcome of this systematic review will be oral feeding, and the secondary outcomes will include duration of hospitalization, weight gain, and feeding efficiency. Two independent reviewers will select and extract data for the study. The Cochrane Risk of Bias Tool (RoB2) will be used to evaluate potential biases in the study. Publication bias will be evaluated using funnel plots, Begg's, and Egger's tests. The degree of heterogeneity among the studies will be assessed using the I2 statistic and the χ2 test. Analyses of subgroups will also be carried out. All meta-analyses will be conducted using Stata V.14.

Conclusion

This systematic review protocol for preterm infants will aim to promote evidence-based decision-making and support the development of clinical practice guidelines in preterm feeding.

Comparing the effects of 5-minute premature infant oral motor intervention with 15-minute Fucile treatment in term infants with feeding difficulties: A multi-arm randomised clinical trial

PURPOSE

The aim of the present study was to investigate whether term infants with feeding difficulties who received either a 5-minute premature infant oral motor intervention (PIOMI) or a 15-minute Fucile treatment had different outcomes, compared to term infants in a nontreatment group.

METHOD

Stable term infants (N = 51) born between 37-41 weeks of gestational age with feeding difficulties were randomly assigned into one of two intervention groups and a control group. One intervention group received PIOMI and the other group received Fucile treatment once a day for seven consecutive days; the control group received usual care only. The volume of milk intake, the amount of weight gain, and the length of hospital stay were compared across all groups.

RESULT

Findings indicated that the volume of milk intake and weight gain showed significant improvement in all three groups. However, pairwise comparison revealed that infants in the Fucile group had significantly higher volume of milk intake and weight gain compared to infants in both the control and PIOMI groups. Length of hospital stay was not significantly different amongst all groups.

CONCLUSION

The effects of Fucile treatment were more considerable than for usual care or PIOMI. This finding raises the possibility that prolonged exercise may facilitate improvement in feeding skills for term infants with feeding difficulties.

Effect of Premature Infant Oral Motor Intervention on Oral Feeding and Weight Gain: A Systematic Review and Meta-Analysis

Background

Sucking and swallowing coordination did not achieve until 32-34 weeks of gestation in premature infants. Oral motor stimulations improve oral motor musculature and neurobehavioral synergism which improves the rate of oral feeding readiness and weight gain and ultimately reduces the duration of hospitalization. Premature Infant Oral Motor Interventions (PIOMI) is a specific oral motor therapy effective in improving the clinical outcomes among premature infants. Earlier no review had been conducted specifically to assess the effectiveness of PIOMI on oral feeding progression, weight gain, and Length of hospital Stay (LOS) among premature infants. So, the present review had been planned.

Materials and Methods

Review was conducted by searching databases like PubMed/Medline, Embase, Ovid, Clinical Key and Academia, Google and Google Scholar (from PIOMI inception to October 2020). Published articles on RCTs and clinical trials were included.

Results

Six studies, with a total of 301 premature infants, were included in Meta Analysis (MA). PIOMI was found effective in early attainment of feeding progression (Mean Difference (MD) = -4.63 days at 95% Confidence Interval (CI) = -4.97 to - 4.29, p < 0.001) and shifting from gavage to independent oral feeding (MD = -2.54 days at 95% CI = -3.13 to - 1.95, p < 0.001), shows weight gain at discharge (MD = 51.61 grams at 95% CI = 19.84 to 83.38, p = 0.001), and reduces LOS (MD = -2.81 days at 95% CI = -3.51 to - 2.10, p < 0.001).

Conclusions

Review shows shows the effectiveness of PIOMI in improving oral feeding progression and early attainment of gavage to independent oral feedings, and it also showed weight gain at discharge and reduced LOS.

Effect of the Premature Infant Oral Motor Intervention on Sucking Capacity in Preterm Infants in Turkey: A Randomized Controlled Trial

BACKGROUND

Preterm infants have oral feeding difficulty that often delays discharge, indicating a need for evidence-based interventions for oral-motor development.

PURPOSE

To test the Premature Infant Oral Motor Intervention (PIOMI) on the development of oral-motor function, feeding, and anthropometric outcomes using sucking manometry.

METHODS

A single-blind randomized experimental design was conducted with a sample of 60 preterm infants from 2 neonatal intensive care units between May 2019 and March 2020. The experimental group received PIOMI for 5 min/d for 14 consecutive days. Sucking capacity, anthropometrics (weight and head circumference), bottle feeding, breast/chest feeding initiation, and length of hospital stay were measured. The Yakut Sucking Manometer (PCT/TR2019/050678) was developed specifically for this study and tested for the first time.

RESULTS

The experimental group had a statistically significant percent increase over controls in sucking power (69%), continuous sucking before releasing the bottle (16%), sucking time (13%), and sucking amount (12%) with partial η 2 values of interaction between the groups of 0.692, 0.164, 0.136, and 0.121, respectively. The experimental group had a higher increase in weight (89%) and head circumference (81%) over controls ( F = 485.130, P < .001; F = 254.754, P < .001, respectively). The experimental group transitioned to oral feeding 9.9 days earlier than controls ( t = -2.822; P = .007), started breast/chest feeding 10.8 days earlier ( t = 3.016; P = .004), and were discharged 3.0 days earlier.

IMPLICATIONS FOR RESEARCH/PRACTICE

The PIOMI had a significant positive effect on anthropometrics, sucking capacity, readiness to initiate bottle and breast/chest feeding, and a 3-day reduction in length of hospital stay.

Effectiveness of multistimulation approach on feeding habits of low-birth-weight babies-A randomized control trial

Introduction

Low- birth- weight neonates face oral feeding difficulties due to hemodynamic instability, immaturity of central nervous systems, and incomplete development of oral functions. Use of several interventions might help in improvement of the feeding ability of neonates. The objective of the study was to evaluate the effect of the multistimulation approach in low-birth-weight babies on the oral feeding performance, oral intake volume, weight gain and transition time from tube to total oral intake.

Methods

A Randomized, parallel-group, multiple arm trial study was conducted, and a total of 44 low birth weight babies were randomized into three parallel groups with a 2:1:1 ratio. Babies who are Hemodynamically stable were included in the trial. In two Intervention groups, one received an oral stimulation program, another intervention group received tactile stimulation, and the control group received routine newborn procedures for the same duration of time. Oral feeding performance was determined by Oral Feeding Skills (OFS) on a daily basis for five days after providing ten days of intervention. Neonates were monitored until hospital discharge.

Results

Infants in the stimulation groups had significantly better oral feeding performance than infants in the control group in terms of mean proficiency, transfer rate and overall transfer of feeding volume. There was a substantial increase in mean feeding score, daily weight, oral intake volume, and early transition time in both intervention groups compared to control. There was no significant difference in feeding behaviours between the oromotor and multistimulation groups, but the multistimulation group gained more weight compared to the oromotor group.

Conclusions

Infants exposed to the stimulation programme had better feeding skills and a shorter transition period from tube feeding to oral feeding; however, the babies who received multistimulation gained greater weight than babies who received only oromotor stimulation. The study recommends multi stimulation in the form of oromotor, and tactile stimulation can be used as an effective NICU procedure for maintaining an infant's ability to take feeds orally before being discharged from the hospital.

•

This study observed that Oromotor or with combination of tactile stimulation, was quite effective in improving feeding habits of low birth weight babies when compared to routine newborn care.

•

Providing low birth weight babies with multistimulation help in improving infants’ growth and motor development due to the additive or synergistic effect on oral feeding performance and weight gain.

•

In clinical practice, multistimulation can be implemented as a routine intervention in the NICU for enhancing early transition to independent feeding among premature and low birth weight babies.

Effects of oral stimulation with breast milk in preterm infants oral feeding: a randomized clinical trial

OBJECTIVES

This study was performed to evaluate the effect of oral stimulation with breast milk for preterm infants.

METHODS

A total of 68 subjects form neonatal intensive care unit were randomly assigned into control group (n=20), premature infant oral motor intervention (PIOMI) group (n=25) and premature infant oral motor intervention with breast milk (BM-PIOMI) group (n=23).

RESULTS

BM-PIOMI group had significant shorter initiation of oral feeding (IOF) time compared to PIOMI group (2.95 days, 95% CI [0.42-5.48]) or control group (9.79 days, 95% CI [7.07-12.51]). BM-PIOMI group had significant sooner transition time from IOF to full oral feeding (FOF) compared to control group (6.68 days, 95% CI [2.2-11.16]), but not to PIOMI group (2.09 days, 95% CI [-2.07 to 6.25]). Length of hospital stay (LOS) did not show statistical different between three groups (control 38.85 ± 14.40 vs. PIOMI 38.48 ± 11.76 vs. BM-PIOMI 38.04 ± 12.2). Growth mixture model identified improvement in non-nutritive sucking (NNS) score in BM-PIOMI group compared to control and PIOMI group (0.8293, p<0.0001, and 0.8296, p<0.0001, respectively).

CONCLUSIONS

Oral stimulation with breast milk can better promotes the oral feeding process of premature infants than the simple oral stimulation, by shorten IOF time and improve early NNS score, but does not shorten transition time from IOF to FOF and LOS.

Cardio-Respiratory Events and Food Autonomy Responses to Early Uni-Modal Orofacial Stimulation in Very Premature Babies: A Randomized, Controlled Study

Uni-modal orofacial stimulation (OFS) for preventing very preterm infants’ oral disorders is highly controversial. Our study sought to demonstrate that OFS reduced cardio-respiratory events and improved food autonomy in a population of very preterm infants. Our study was randomized, controlled, prospective, and unicentric. The preterm included were born between 26–29 weeks gestational age (GA) with a corrected postnatal age <33 weeks GA. They were randomized into two groups: the experimental group underwent OFS, according to a protocol established, over 10 consecutive days, and the control group underwent no OFS. The primary outcome was the number of cardiorespiratory events: apnea–bradycardia (with or without desaturations) or number of isolated desaturations, which were evaluated at four separate times. Measurements occurred during the first, fourth and eighth independent feedings. Seventeen patients were included in the experimental group and 18 in the control group. The number of cardiorespiratory events for all independent feeding times was significantly reduced in the OFS group (p = 0.003) with univariate analysis, but not with multivariable analysis. The quantity of milk ingested during the first autonomous feeding was higher in the experimental group. The acquisition of food autonomy and the duration of hospitalization were similar in the two groups. While our study does not affirm that an early unimodal OFS improves premature infants’ cardiorespiratory evolution and/or the acquisition of food autonomy, it does indicate an improved food efficiency during their first autonomous feedings.

Effectiveness of Oral Sensory-Motor Stimulation in Premature Infants in the Neonatal Intensive Care Unit (NICU) Systematic Review

The aim of this study was to identify and to assess the best evidence currently available on the effectiveness of oral sensory-motor stimulation in preterm infants in the neonatal intensive care unit. We performed a systematic review following the Preferred Reporting Items for Systematic Reviews (PRISMA) statements. The search was conducted using the Pubmed, Web of Science (WOS), PEDro and Scopus databases. Clinical trials were reviewed and PEDro rating scale was used to assess the methodological quality of these studies. Results: 1267 studies were found and 11 were relevant and included in this review. Improvements were obtained in achieving independent feeding, maturation of the sucking pattern, transition to full feeding, motor function and length of hospital stay in most studies. Conclusions: there is evidence to support the benefits of the use of oral sensorimotor stimulation to achieve independent oral feeding in preterm infants, thereby reducing their stay in the Neonatal Intensive Care Unit.

Effect of Oral Motor Intervention on Oral Feeding in Preterm Infants: A Systematic Review and Meta-Analysis

Objective This review article aimed to explore the effect of oral motor intervention on oral feeding in preterm infants through a meta-analysis. Method Eligible studies were retrieved from four databases (PubMed, Embase, Cochrane Library, and Web of Science) up to July 2020 and screened based on established selection criteria. Thereafter, relevant data were extracted and heterogeneity tests were conducted to select appropriate effect models according to the chi-square test and I ² statistics. Assessment of risk of bias was performed among the included studies. Finally, a meta-analysis was carried out to evaluate the effect of oral motor intervention in preterm infants according to four clinical indicators: transition time for oral feeding, length of hospital stay, feeding efficiency, and weight gain. Results Eighteen randomized controlled trials with 848 participants were selected to evaluate the effect of oral motor intervention on preterm infants. The meta-analysis results revealed that oral motor intervention could effectively reduce the transition time to full oral feeds and the length of hospital stay as well as increase feeding efficiency and weight gain. Conclusions Oral motor intervention was an effective way to improve oral feeding in preterm infants. It is worthy to be used widely in hospitals to improve the clinical outcomes of preterm infants and reduce the economic burdens of families and society. Future studies should seek to identify detailed intervention processes and intervention durations for clinical application.

Parent-Administered Oral Stimulation in Preterm Infants: A Randomized, Controlled, Open-Label Pilot Study

OBJECTIVE

 The study aimed to assess whether there was any difference in the transition time to full oral feedings between parent-administered and professional-administered premature infant oral motor intervention (PIOMI). The study also evaluated parental satisfaction with performing the intervention through an open-ended questionnaire.

STUDY DESIGN

 A single-center, randomized, controlled, open-label pilot study was carried on between March 2017 and May 2019. A total of 39 infants born ≤32 weeks' gestation were randomly assigned to either parent-performed or professionally performed oral stimulation. The oral stimulation was performed once a day for seven consecutive days between 31 and 32 weeks' postmenstrual age.

RESULTS

 There was no statistically significant difference in transition time, weight gain, or length of hospital stay between the two groups. No adverse events were observed. Parents' satisfaction was high, and their active involvement enhanced their perception of adequacy to care for their infant.

CONCLUSION

 Following adequate training, a parent-administered PIOMI may be considered in preterm infants to reduce the transition time to full oral feeding and enhance the direct involvement of parents in neonatal care.

KEY POINTS

· No difference in transition time between parent-performed and professional-performed PIOMI.. · PIOMI may be delivered by parents following appropriate training.. · Active involvement of parents may improve the parent-infant bonding..

Effectiveness of the Premature Infant Oral Motor Intervention on Feeding Performance, Duration of Hospital Stay, and Weight of Preterm Neonates in Neonatal Intensive Care Unit: Results From a Randomized Controlled Trial

BACKGROUND

Most preterm neonates are unable to achieve independent oral feeding and are fed using tubes. Premature infant oral motor intervention (PIOMI) is effective in initiating early oral feeding and reducing hospital stays.

OBJECTIVE

This study aimed to evaluate the effectiveness of PIOMI on feeding performance, duration of hospital stay, and weight of preterm neonates in the neonatal intensive care unit (NICU).

METHODS

This was a parallel randomized controlled trial conducted in Egypt. Sixty preterm neonates born between 30 and 34 weeks of gestation were randomly selected (30 in the study group and 30 in the control group). The study was conducted at the NICU in Sohag, Egypt, over 3 months from October to December 2019. Two tools were used: demographic data of preterm neonates according to gestational age, sex, weight, and diagnosis, and PIOMI.

RESULTS

Among the preterm neonates in the study group, full oral feeding was achieved significantly earlier (P = .03), milk leakage decreased significantly (P = .001), weight was significantly higher (P = .018), and the duration of hospital stay was significantly lower (P = .014) than that in the control group.

CONCLUSION

Premature infant oral motor intervention was effective in improving preterm neonates' feeding performance, reducing the duration of hospital stay, and increasing their weight. This study recommended that a training program for nurses in the NICU about PIOMI for preterm neonates be conducted, along with training of the parents to use PIOMI and the implementation of policies in the NICU to conduct PIOMI as a part of daily routine preterm neonatal care.

Nonnutritive Sucking Before Oral Feeding of Preterm Infants in Turkey: A Randomized Controlled Study

BACKGROUND

The use of a pacifier is recommended to support sucking reflex during transition from gavage feeding to oral feeding and ensure readiness for feeding.

PURPOSE

A randomized controlled experimental design was used to determine the effect of a pacifier given before feeding on physiological characteristics and feeding performance in preterm infants initially fed orally.

DESIGN AND METHODS

The data were obtained from preterm infants (N = 72) born before 31st gestational week, who were admitted to Newborn Intensive Care Unit of a training and research hospital affiliated with Ministry of Health between January 2017-July 2018 and met the case selection criteria. Heart rates, oxygen saturation levels and feeding performances of preterm infants in both groups before, during, and after feeding were compared.

RESULTS

Heart rates of preterm infants in the experimental group were statistically significantly lower (Experimental: 139.64 ± 10.16; Control: 149.31 ± 8.40; p < 0.01) and their oxygen saturation levels were higher (Experimental: 97.22 ± 2.22; Control: 96.33 ± 1.93; p < 0.05). Feeding efficiency rates (Experimental: 1.94 ± 1.19; Control: 0.69 ± 0.34; p < 0.01) and the percentage of food intake (Experimental: 89.5 ± 23.93; Control: 70.86 ± 27.41; p < 0.01) of newborns in the experimental group were statistically significantly higher and their feeding duration was shorter (Experimental: 10.58 ± 8.29; Control: 16.14 ± 8.31; p < 0.01).

CONCLUSIONS

It was determined that a pacifier given before feeding is effective on regulating physiological parameters and supporting feeding performance in preterm infants.

PRACTICE IMPLICATIONS

The use of a pacifier in the first transition to oral feeding in preterm infants supports their sucking reflex, calms them down, and ensures the readiness for feeding.

Abnormal Nutritive Sucking as an Indicator of Neonatal Brain Injury

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.

The effect of non-nutritive sucking combined with oral motor stimulation and oral support on feeding performance in premature infants: A single-blind randomized-clinical trial

PURPOSE

Feeding problems are common in premature infants (PIs) and may lead to negative consequences such as malnutrition, dehydration, excessive weight loss, as well as developmental and psychological deficits. Moreover, they are associated with increased length of hospital stay/cost. There is not enough evidence on how feeding problems should be treated in PIs. The goal of this study was to investigate the effects of non-nutritive sucking combined with oral motor stimulation and oral support on feeding performance in PIs.

METHODS

A single-blind randomized clinical trial was performed on 44 PIs with feeding problems. Patients were randomly categorized into two groups: (1) combined intervention (CI) and (2) non-nutritive sucking (NNS). The CI group received NNS, oral motor stimulation and oral support simultaneously. Infants in both groups received 14 treatment sessions for 14 consecutive days. The Preterm Oral Feeding Readiness Assessment Scale (POFRAS) was used as the primary outcome measure. Weight, volume of milk intake, time to achieve full oral feeding, and length of hospital stay were secondary outcome measures. All measures were assessed before treatment, after the 7th session, after the 14th session, and after 7 days after the end of treatment.

RESULTS

Both groups improved in all outcome measures across time (P < 0.001). The improvements in the POFRAS, volume of milk intake, and time to achieve full oral feeding were significantly greater in the CI group than the NNS group (P < 0.001). The improvements attained in weight and length of hospital stay were not significantly different between the CI and NNS groups (P > 0.05). Large effect sizes were found for POFRAS score in both CI (d = 3.98) and NNS (d = 2.19) groups.

CONCLUSION

The current study showed that the combined intervention including NNS, oral motor stimulation, and oral support significantly improved the feeding performance in PIs.

Effect of Pacifier Design on Nonnutritive Suck Maturation and Weight Gain in Preterm Infants: A Pilot Study

Background

Pacifiers are effective in promoting oral feeding by increasing the maturation of nonnutritive sucking to nutritive suck in preterm neonates. It is unclear whether pacifier design can influence suck dynamics and weight loss during the first week of life.

Objectives

This pilot study examined the feasibility of studying the effect of pacifier design on suck maturation and weight loss in preterm neonates.

Methods

Twenty-five preterm neonates (mean [SD] birth weight 1791 [344.9] grams, mean [SD] gestational age 33.1 [1.2] weeks) were studied in a single newborn intensive care unit. Neonates were assigned to either an orthodontic pacifier (n = 13) or a bulb-shaped pacifier (n = 12) immediately after birth. Suck dynamics (cycles per minute, total compressions per minute, cycle bursts, and amplitude) were assessed with an NTrainer (Innara Health, Olathe, Kansas). Weight was recorded during the first week of life on day 1.2 (±2.5 days) and day 6.0 (±2.1 days). Descriptive statistics were applied to analyze data.

Results

No significant differences were seen between groups with respect to birth weight and gestational age. Reproducible nonnutritive sucking measurements could be obtained with the NTrainer, with both types of pacifiers. No differences were detected in nonnutritive sucking dynamics or weight loss over time within each group or between groups.

Conclusions

Data indicate that it is feasible to measure nonnutritive sucking dynamics and associated weight loss in relation to pacifier design in preterm neonates. Larger trials over longer time periods are needed to determine whether pacifier design influences suck dynamics and maturation, oromotor function, feeding/weight loss, and dental formation in preterm neonates. (Curr Ther Res Clin Exp. 2020; 81:XXX–XXX)

Factors associated with postmenstrual age at full oral feeding in very preterm infants

Aim

We aimed to identify variables associated with gestational age at full oral feeding in a cohort of very preterm infants.

Methods

In this retrospective study, all infants born below 32 weeks of gestation and admitted to a level III neonatal unit in 2015 were included. We dichotomized our population of 122 infants through the median age at full oral feeding, and explored which variables were statistically different between the two groups. We then used linear regression analysis to study the association between variables known from the literature and variables we had identified and age at full oral feeding.

Results

The median postnatal age at full oral feeding was 36 6/7weeks post menstrual age (Q1-Q3 35 6/7-392/7), and was associated with the duration of hospital of stay. In the univariable linear regression, the variables significantly associated with full oral feeding were gestational age, socioeconomic status, sepsis, patent ductus arteriosus, duration of supplementary oxygen, of non-invasive and invasive ventilation, and bronchopulmonary dysplasia. In the multivariable regression analysis, duration of non-invasive ventilation and oxygen therapy, bronchopulmonary dysplasia, and patent ductus arteriosus were associated with an older age at full oral feeding, with bronchopulmonary dysplasia the single most potent predictor.

Discussion

Lung disease severity is a major determinant of age at full oral feeding and thus length of stay in this population. Other factors associated with FOF include socioeconomic status and patent ductus arteriosus, There is a need for research addressing evidence-based bundles of care for these infants at risk of long-lasting feeding and neurodevelopmental impairments.

To Individualize the Management Care of High-Risk Infants With Oral Feeding Challenges: What Do We Know? What Can We Do?

The increase in preterm infants' survival over the last 30 years has shed light over their inability to feed by mouth safely and efficiently. With adverse events such as increased risks for oxygen desaturation, bradycardia, penetration/aspiration, infants' hospitalization in neonatal intensive care units (NICUs) are understandably prolonged. Unfortunately, this leads to delayed mother-infant reunion, maternal stress, breastfeeding obstacles, and increased medical costs. Such impediments have stimulated clinicians and researchers to better understand the underlying causes and develop evidence-based solutions to assist these infants. However, it is notable that the research-to-practice translation of this knowledge has been limited as there are still no validated guidelines or protocols as how to best diagnose and care for these infants. This report revisits the immature physiologic functions at the root of these infants' oral feeding difficulties, the current practices, and the recent availability of evidence-based efficacious tools and interventions. Taking advantage of the latter, it presents a renewed perspective of how management strategies can be tailored to the specific needs of individual patients.

The Effectiveness of an Oral Sensorimotor Stimulation Protocol for the Early Achievement of Exclusive Oral Feeding in Premature Infants. A Randomized, Controlled Trial

Aims: This study is aimed to investigate the effectiveness of an oral stimulation protocol in preterm infants compared to usual care, to reduce the time for achieving safe full oral feeding.Methods: 47 preterm infants (25- 30 weeks of gestational age) were randomized into two groups. Babies of the EG (n = 24) received a 10-minute oral stimulation protocol while the CG (n = 23) received the standard care. The primary outcome were the days from the initiation of the intervention until the achievement of full oral feeding. Secondary outcomes were: days from the first day the intervention started until achieving a first oral intake of 30% in the first 5 minutes, days from the first day the intervention started until achieving a first oral intake of 100%, and days of hospitalization. A parametric survival model with Gaussian distribution was used.Results: The EG achieved full oral feeding 8.3 days before the CG (p = 0.013). EG also achieved the first oral intake of 30% in the first five minutes, 6.03 days before (p = 0.019) and of 100%, 5.88 days before (p = 0.040). EG also spent 6.9 days less hospitalized than CG (p = 0.028).Conclusion: Oral stimulation in preterm infants significantly shortens the time to achieve full oral feeding and reduces the length of hospitalization.

The effects of premature infant oral motor intervention (PIOMI) on oral feeding of preterm infants: A randomized clinical trial

OBJECTIVE

Given the increase in the birth and survival rate of the premature infants, a need for supportive health care services becomes more evident. The goal of the present study was to examine the effectiveness of the Premature Infant Oral Motor Intervention (PIOMI) in the feeding progression and early intervention. This study was a double-blind randomized clinical trial.

METHODS

This clinical trial included premature infants in the neonatal intensive care units (NICUs) of two hospitals in Tehran, who were randomly assigned into intervention and control group, each containing 15 infants. The PIOMI was administered to the intervention group in the course of 10 days. The infants in the control group received routine nursing services. Repeated measures ANOVA (RMA) were analyzed. The postmenstrual age and weight of the participants were examined at the time points of accomplishing one, four, and eight oral feedings a day and at the time of hospital discharge.

RESULTS

The intervention group reached the first oral feeding (with a mean of 7.2 days) and eight oral feeding (with a mean of 13.47 days) earlier than the control group. The length of hospital stay in intervention group was significantly shorter (P = 0.03). RMA wasn't statistically significant between groups for weight (F: 0.76, P: 0.39, ŋ: 0.03); but within-subjects test showed that change of the weight over time and for interaction of time and group was significant (F: 74.437, P < 0.001, ŋ: 0.727). The effect size of infants' age in the measurement times was 91%.

CONCLUSION

the results revealed that PIOMI is a fruitful method for premature infants. We suggest that PIOMI can be integrated in feeding rehabilitation programs of the premature infants born with gestational age of as young as 26-29 weeks, and applied at 29 weeks postmenstrual age (PMA).

THE CLINICAL TRIAL REGISTRATION NUMBER

IRCT20180410039260N1.

Early Intervention to Improve Sucking in Preterm Newborns: A Systematic Review of Quantitative Studies

BACKGROUND

Premature birth is associated with feeding difficulties due to inadequate coordination of sucking, swallowing, and breathing. Nonnutritive sucking (NNS) and oral stimulation interventions may be effective for oral feeding promotion, but the mechanisms of the intervention effects need further clarifications.

PURPOSE

We reviewed preterm infant intervention studies with quantitative outcomes of sucking performance to summarize the evidence of the effect of interventions on specific components of sucking.

METHODS

PubMed, CINAHL, MEDLINE, EMBASE, and PSYCOLIST databases were searched for English language publications through August 2017. Studies were selected if they involved preterm infants, tested experimental interventions to improve sucking or oral feeding skills, and included outcome as an objective measure of sucking performance. Specific Medical Subject Headings (MeSH) terms were utilized.

RESULTS

Nineteen studies were included in this review: 15 randomized, 1 quasi-randomized, and 3 crossover randomized controlled trials. Intervention types were grouped into 6 categories (i) NNS, (ii) NNS with auditory reinforcement, (iii) sensorimotor stimulation, (iv) oral support, (v) combined training, and (vi) nutritive sucking. Efficiency parameters were positively influenced by most types of interventions, though appear to be less affected by trainings based on NNS alone.

IMPLICATIONS FOR PRACTICE

These findings may be useful in the clinical care of infants requiring support to achieve efficient sucking skills through NNS and oral stimulation interventions.

IMPLICATIONS FOR RESEARCH

Further studies including quantitative measures of sucking performance outcome measures are needed in order to best understand the needs and provide more tailored interventions to preterm infants.

Patterned frequency-modulated oral stimulation in preterm infants: A multicenter randomized controlled trial

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

Effect of Unimodal and Multimodal Sensorimotor Interventions on Oral Feeding Outcomes in Preterm Infants: An Evidence-Based Systematic Review

BACKGROUND

Preterm infants often experience difficulty with the transition from tube to oral feeding. While many unimodal and multimodal sensorimotor interventions have been generated to optimize oral feeding skills, there has been little cohesion between interventions.

PURPOSE

The aims of this systematic review were to examine the effect of sensorimotor interventions on oral feeding outcomes and to determine whether multimodal interventions lead to better oral feeding performances than unimodal interventions.

SEARCH STRATEGY

A systematic search of CINAHL, Embase, MEDLINE, and PsycINFO databases was conducted. Studies were reviewed to assess the types of interventions used to improve transition to full oral feeding, volume intake, weight gain, and length of hospital stay.

RESULTS

The search identified 35 articles. Twenty-six studies examined a unimodal intervention, with the majority focusing on oral sensorimotor input and the others on tactile, auditory, and olfactory input. Nine studies assessed multimodal interventions, with the combination of tactile and kinesthetic stimulation being most common. Results varied across studies due to large differences in methodology, and caution is warranted when interpreting results across studies. The heterogeneity in the studies made it difficult to make any firm conclusions about the effects of sensorimotor interventions on feeding outcomes. Overall, evidence on whether multimodal approaches can lead to better oral feeding outcomes than a unimodal approach was insufficient.

IMPLICATIONS FOR PRACTICE

The use of sensorimotor interventions to optimize feeding outcomes in preterm infants varies based on methods used and modalities. These factors warrant caution by clinicians who use sensorimotor interventions in the neonatal intensive care unit.

IMPLICATIONS FOR RESEARCH

Large randomized clinical trials using a standardized approach for the administration of sensorimotor input are needed to further establish the effects on feeding outcomes in preterm infants.

Oral Sensorimotor Intervention Enhances Breastfeeding Establishment in Preterm Infants

OBJECTIVE

To assess the efficacy of an oral sensorimotor intervention on breastfeeding establishment and maintenance in preterm infants.

STUDY DESIGN

Thirty-one preterm infants born ≤34 weeks gestation were randomized into an experimental or control group. The experimental group received a 15-minute program consisting of stroking the peri-oral structures for the first 5 minutes, tongue exercises for the next 5 minutes, followed by non-nutritive sucking for the final 5 minutes. The control group received a sham intervention for the same duration. The interventions were administered once daily for 10 days. The outcomes included: time to attainment of full oral feeding, breastfeeding acquisition (i.e., ≥50% of direct breastfeeding at hospital discharge), breastfeeding skill assessment using the Preterm Infant Breastfeeding Behavior Scale (PIBBS), length of hospitalization, and breastfeeding maintenance at 3 and 6 months posthospitalization.

RESULTS

Full oral feeding was attained earlier in the experimental group compared with the control (10.7 ± 2.1 vs. 19.3 ± 3.6 days, p < 0.01). This was associated with a greater number of infants in the intervention group acquiring breastfeeding at hospital discharge compared with the controls (n = 11 vs. 5, p = 0.049). There was no statistical difference in PIBBS score, length of hospitalization, and breastfeeding rates at 3 and 6 months posthospitalization between the two groups (all tests, p > 0.32).

CONCLUSIONS

An oral sensorimotor intervention accelerated the achievement of full oral feeding and enhanced direct breastfeeding rates at hospital discharge only. Provision of an oral sensorimotor intervention is a safe and low-cost intervention that may increase breastfeeding rates in a highly vulnerable population.

Effect of oral stimulation on feeding performance and weight gain in preterm neonates: a randomised controlled trial

BACKGROUND

In preterm infants, oral stimulation enhances muscle tone and movement which facilitates normal oral motor developmental patterns improving oral feeding performance.

AIM

To study the effects on feeding performance, transition to independent oral feeding, weight gain and length of hospital stay of an oral stimulation programme in preterm neonates.

STUDY DESIGN

This randomised controlled trial was conducted in a tertiary care teaching hospital over a period of 10 months. Altogether, 102 preterm neonates (30-34 weeks gestation) were randomised into the intervention group (oro-motor stimulation for 5 min twice a day, n = 51) or the control group (routine care only, n = 51). The primary outcome measures were feeding performance, and transition period to reach independent oral feeding.

RESULTS

There was better feeding performance (overall intake and rate of milk transfer), shorter transition to independent oral feeding, better weight gain and shorter length of hospital stay in the intervention group (p < 0.001).

CONCLUSIONS

Oral stimulation improves feeding performance, weight gain rate and reduces hospital stay in preterm neonates born between 30 and 34 weeks of gestation. [Trial registration number: CTRI/2017/05/008630].

Meta-analysis comparing chewing gum versus standard postoperative care after colorectal resection

Background

Previous incomplete studies investigating the potential of chewing gum (CG) in patients undergoing colorectal resection did not obtain definitive conclusions. This updated meta-analysis was therefore conducted to evaluate the effect and safety of CG versus standard postoperative care protocols (SPCPs) after colorectal surgery.

Results

Total 26 RCTs enrolling 2214 patients were included in this study. The CG can be well-tolerated by all patients. Compared with SPCPs, CG was associated with shorter time to first flatus (weighted mean difference (WMD) −12.14 (95 per cent c.i. −15.71 to −8.56) hours; P < 0.001), bowl movement (WMD −17.32 (−23.41 to −11.22) hours; P < 0.001), bowel sounds (WMD −6.02 (−7.42 to −4.63) hours; P < 0.001), and length of hospital stay (WMD −0.95 (−1.55 to −0.35) days; P < 0.001), a lower risk of postoperative ileus (risk ratio (RR) 0.61 (0.44 to 0.83); P = 0.002), net beneficial and quality of life. There were no significant differences between the two groups in overall complications, nausea, vomiting, bloating, wound infection, bleeding, dehiscence, readmission, reoperation, mortality.

Materials and Methods

The potentially eligible randomized controlled trials (RCTs) that compared CG with SPCPs for colorectal resection were searched in PubMed, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), and Chinese Wanfang databases through May 2016. The trial sequential analysis was adopted to examine whether a firm conclusion for specific outcome can be drawn.

Conclusions

CG is benefit for enhancing return of gastrointestinal function after colorectal resection, and may be associated with lower risk of postoperative ileus.

Identification of Risk Factors for Poor Feeding in Infants with Congenital Heart Disease and a Novel Approach to Improve Oral Feeding

Many infants with complex congenital heart disease (CHD) do not develop the skills to feed orally and are discharged home on gastrostomy tube or nasogastric feeds. We aimed to identify risk factors for failure to achieve full oral feeding and evaluate the efficacy of oral motor intervention for increasing the rate of discharge on full oral feeds by performing a prospective study in the neonatal and cardiac intensive care units of a tertiary children's hospital. 23 neonates born at ≥37weeks gestation and diagnosed with single-ventricle physiology requiring a surgical shunt were prospectively enrolled and received oral motor intervention therapy. 40 historical controls were identified. Mean length of stay was 53.7days for the control group and 40.9days for the study group (p=0.668). 13/23 patients who received oral motor intervention therapy (56.5%) and 18/40 (45.0%) controls were on full oral feeds at discharge, a difference of 11.5% (95% CI -13.9% to 37.0%, p=0.378). Diagnosis of hypoplastic left heart syndrome, longer intubation and duration of withholding enteral feeds, and presence of gastroesophageal reflux disease were predictors of poor oral feeding on univariate analysis. Although we did not detect a statistically significant impact of oral motor intervention, we found clinically meaningful differences in hospital length of stay and feeding tube requirement. Further research should be undertaken to evaluate methods for improving oral feeding in these at-risk infants.

How Strong Is the Evidence for Sodium Bicarbonate to Prevent Contrast-Induced Acute Kidney Injury After Coronary Angiography and Percutaneous Coronary Intervention?

Hydration with sodium bicarbonate is one of the strategies to prevent contrast-induced acute kidney injury (CI-AKI). The purpose of this study was to determine how strong is the evidence for sodium bicarbonate to prevent CI-AKI after coronary angiography (CAG) and/or percutaneous coronary intervention (PCI).We conducted PubMed, EMBASE, and CENTRAL databases to search for randomized controlled trials (RCTs) comparing the efficacy of sodium bicarbonate with sodium chloride to prevent CI-AKI after CAG and/or PCI. Relative risk (RR), standardized mean difference (SMD), or weighted mean difference (WMD) with 95% confidence intervals (CIs) was calculated. Heterogeneity, publication bias, and study quality were evaluated, sensitivity analyses, cumulative analyses, and subgroup analyses were performed. The risk of random errors was assessed by trial sequential analysis (TSA).Sixteen RCTs (3537 patients) met the eligibility criteria. Hydration with sodium bicarbonate showed significant beneficial effects in preventing CI-AKI (RR 0.67; 95% CI: 0.47-0.96, P = 0.029), decreasing the change in serum creatinine (SCr) (SMD -0.31 95% CI: -0.55 to -0.07, P = 0.011) and estimated glomerular filtration rate (eGFR) (SMD -0.17 95% CI: -0.30 to -0.04, P = 0.013). But no significant differences were observed in the requirement for dialysis (RR 1.11; 95% CI: 0.60-2.07, P = 0.729), mortality (RR 0.71; 95% CI: 0.41-1.21, P = 0.204) and reducing the length of hospital stay (LHS) (WMD -1.47; 95% CI: -4.14 to 1.20, P = 0.279). The result of TSA on incidence of CI-AKI showed the required information size (RIS = 6614) was not reached and cumulative z curve did not cross TSA boundary. The result of TSA on the requirement for dialysis and mortality demonstrated the required information sizes (RIS = 170,510 and 19,516, respectively) were not reached, and the cumulative z-curve did not cross any boundaries.The evidence that sodium bicarbonate reduces the incidence of CI-AKI is encouraging but more well-designed randomized controlled trails are required to allow definitive firm conclusion to be drawn.