Development of a Wireless Oral-Feeding Monitoring System for Preterm Infants

SmartLact8: A Bio-Inspired Robotic Breast Pump for Customized and Comfort Milk Expression

According to the 2018 National Immunization Survey conducted by the Center for Disease Control and Prevention (CDC), 83.9% of the breastfeeding mothers in the United States have used a breast pump at least once. However, the majority of existing products use a vacuum-only mechanism to extract milk. This causes common breast injuries such as nipple soreness, breast-tissue damage, and lactation complications after pumping. The objective of this work was to develop a bio-inspired breast pump prototype, named as SmartLac8, that can mimic infant suckling patterns. The input vacuum pressure pattern and compression forces are inspired from term infants' natural oral suckling dynamics captured in prior clinical experiments. Open-loop input-output data are used to perform system identification for two different pumping stages that facilitates controller design for closed-loop stability and control. A physical breast pump prototype with soft pneumatic actuators and custom piezoelectric sensors was successfully developed, calibrated, and tested in dry lab experiments. Compression and vacuum pressure dynamics were successfully coordinated to mimic the infant's feeding mechanism. Experimental data on sucking frequency and pressure on the breast phantom were consistent with clinical findings.

A Review of Quantitative Instruments for Understanding Breastfeeding Dynamics

Breastfeeding, as a unique behavior of the postpartum period and an ideal source of nourishment, is profoundly impacted by the physiology and behavior of both mothers and infants. For more than three-quarters of a century, there has been an ongoing advancement of instruments that permit insight into the complex process of latching during breastfeeding, which includes coordinating sucking, swallowing, and breathing. Despite the available methodologies for understanding latching dynamics, there continues to be a large void in the understanding of infant latching and feeding. The causes for many breastfeeding difficulties remain unclear, and until a clearer understanding of the mechanics involved is achieved, the struggle will continue in the attempts to aid infants and mothers who struggle to breastfeed. In this review, the history of development for the most prominent tools employed to analyze breastfeeding dynamics is presented. Additionally, the importance of the most advanced instruments and systems used to understand latching dynamics is highlighted and how medical practitioners utilize them is reported. Finally, a controversial argument amongst pediatric otolaryngolo gists concerning breastfeeding difficulties is reviewed and the urgent need for quantification of latching dynamics in conjunction with milk removal rate through prospective controlled studies is discussed.

Oral Feeding Success: A Concept Analysis

BACKGROUND

The term "oral feeding success" (OFS) is frequently used in clinical practice and research. However, OFS is inconsistently defined, which impacts the ability to adequately evaluate OFS, identify risk factors, and implement interventions in clinical practice and research.

PURPOSE

To develop the defining attributes, antecedents, and consequences for the concept of OFS in preterm infants during their initial hospitalization.

METHODS

PubMed, CINAHL, and PsycINFO databases were searched for English articles containing the key words "oral feeding success" and "preterm infants." The Walker and Avant method for concept analysis was employed.

RESULTS

Sixteen articles revealed the defining attributes, antecedents, and consequences. Defining attributes included (1) physiologic stability; (2) full oral feeding; and (3) combined criteria of feeding proficiency (≥30% of the prescribed volume during the first 5 minutes), feeding efficiency (≥1.5 mL/min over the entire feeding), and intake quantity (≥80% of the prescribed volume).

IMPLICATIONS FOR PRACTICE

The 3 defining attributes may be used in clinical practice to consistently evaluate OFS. The antecedents of OFS provide clinicians with a frame of reference to assess oral feeding readiness, identify risk factors, and implement effective interventions. The consequences of OFS allow clinicians to anticipate challenges when OFS is not achieved and create a care plan to support the infants.

IMPLICATIONS FOR RESEARCH

The empirical referents of OFS provide consistent and clear operational definitions of OFS for use in research. The antecedents and consequences may guide researchers to select specific measures or covariates to evaluate valid measures of OFS.

A Novel System to Measure Infants' Nutritive Sucking During Breastfeeding: the Breastfeeding Diagnostic Device (BDD)

Breastfeeding is optimal for infant health, but more than 66% of mothers cease exclusive breastfeeding within three months after giving birth. Evaluating infants’ sucking effort provides valuable diagnosis to mothers encountering barriers with breastfeeding. Sucking microstructure is defined as an array of metrics that comprehensively capture infants’ ability to create a sealed latch onto mother’s nipple and regulate feeding, including number of sucks, sucks per burst, number of bursts, intra suck interval, and maximal sucking pressure. In this paper, we proposed a breastfeeding diagnostic device (BDD) which allows convenient and objective measurement of infants’ sucking microstructure in both home and clinical settings. BDD utilizes an air-based pressure transducer to measure infants’ sucking behavior. We conducted pilot clinical studies on six dyads of mother and infant to test the feasibility of the BDD system. To facilitate comparison, both breastfeeding and bottle-feeding were conducted on the six dyads using the BDD in home settings, and the outcomes are comparable with prior recordings in research or clinical settings. By offering a convenient and objective measurement of the sucking microstructure, the BDD will provide clinically meaningful guidance and diagnosis to mothers struggling with breastfeeding. BDD will also serve as an objective metric useful in research areas relevant to infant behaviors, assessment of neurodevelopment, and potentially a screening tool for developmental disabilities.