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Kim C, Zimmerman E, Huerta-Montañez G, Rosario-Pabón ZY, Vélez-Vega CM, Alshawabkeh AN, Cordero JF, Meeker JD, Watkins DJ. Associations between biomarkers of prenatal metals exposure and non-nutritive suck among infants from the PROTECT birth cohort in Puerto Rico. FRONTIERS IN EPIDEMIOLOGY 2022; 2:1057515. [PMID: 38455310 PMCID: PMC10911005 DOI: 10.3389/fepid.2022.1057515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/15/2022] [Indexed: 03/09/2024]
Abstract
Background/Aim Infant non-nutritive suck (NNS) has been used as an early marker of neonatal brain function. Although there is an established relationship between prenatal exposure to certain metals and brain development, the association between metal exposure and NNS has not been explored. Therefore, in this study we assessed associations between maternal urinary metal(loid) concentrations and NNS measurements among infants from the Puerto Rico PROTECT birth cohort. We hypothesized that maternal urinary metal(loid) concentrations are significantly associated with infant NNS measures in a sex-dependent manner. Methods We measured urinary concentrations of 14 metal(loid)s in pregnant women at up to three time points in pregnancy. The geometric mean of each metal(loid) for each pregnant woman was calculated and used as an exposure measurement across gestation. NNS measurements (duration, frequency, amplitude, bursts/min, cycles/burst, cycles/min) were collected from infants between 4 and 6 (±2 weeks) weeks of age using our custom research pacifier. Linear regression was used to estimate associations between urinary metal(loid) concentrations across pregnancy and continuous NNS variables. Sex-specific effects were estimated using interaction terms between NNS variables and infant sex. Results We observed significant positive associations between mercury, manganese, and tin with NNS duration (mercury: %Δ = 1.08, 95% CI: 0.42, 1.74; manganese: %Δ = 0.67, 95% CI: 0.15, 1.20; tin: %Δ = 0.83, 95% CI: 0.17, 1.49) and NNS cycles/burst (mercury: %Δ = 1.85, 95% CI: 0.58, 3.11; manganese: (%Δ = 1.37, 95% CI: 0.40, 2.34; tin: %Δ = 1.68, 95% CI: 0.46, 2.91). Furthermore, the association between NNS cycles/min with cadmium (%Δ = 8.06, 95% CI: 3.33, 12.78), manganese (%Δ = 4.44, 95% CI: 1.40, 7.47), and tin (%Δ = 4.50, 95% CI: 0.81, 8.18) were in the opposite direction from its association with zinc (%Δ = -9.30, 95% CI: -14.71, -3.89), as well as with copper (%Δ = -6.58, 95% CI: -12.06, -1.10). For the sex-stratified analysis, the negative associations between metal(loid)s and NNS duration were predominantly driven by male infants; however, the negative associations between metal(loid)s and NNS bursts/min were mainly driven by female infants. Conclusion We observed significant associations between prenatal metal(loid) exposure and NNS measurements among infants from the ongoing Puerto Rico PROTECT cohort. Similar to previous studies that have demonstrated associations between NNS and subsequent neurodevelopment, this study highlights the potential of NNS as a quantitative index to measure altered neurodevelopment from prenatal metal(loid) exposures. We believe this study will inform future efforts aimed at reducing health risks related to early life metal exposures, such as developing early identification of metal-induced adverse outcomes in child neurodevelopment.
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Affiliation(s)
- Christine Kim
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, United States
| | - Gredia Huerta-Montañez
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, United States
| | - Zaira Y. Rosario-Pabón
- UPR Medical Sciences Campus, University of Puerto Rico Graduate School of Public Health, San Juan, Puerto Rico
| | - Carmen M. Vélez-Vega
- UPR Medical Sciences Campus, University of Puerto Rico Graduate School of Public Health, San Juan, Puerto Rico
| | | | - José F. Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, United States
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Deborah J. Watkins
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
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Martens A, Hines M, Zimmerman E. Changes in non-nutritive suck between 3 and 12 months. Early Hum Dev 2020; 149:105141. [PMID: 32784100 PMCID: PMC8943411 DOI: 10.1016/j.earlhumdev.2020.105141] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/07/2020] [Accepted: 07/21/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Non-nutritive suck (NNS) is one piece of the complex oral feeding process, yet there is paucity on how it develops throughout the first year of life. AIMS To determine changes in infant NNS between 3 and 12 months of age. STUDY DESIGN Twenty-six full-term infants (65% male) completed this study. All infants were offered our custom research pacifier to attain a quantitative analysis of their suck pattern. Based on quantitative analyses of NNS cycle count, the best 2 min of infants' suck were selected and analyzed. OUTCOME MEASURES NNS duration, amplitude, cycles/burst, frequency, cycles, and bursts. RESULTS NNS duration, bursts, cycles/burst and cycles significantly decreased from 3 to 12 months, yet amplitude significantly increased over the same time period. Additionally, no significant differences were evident for NNS frequency. Three-month-old infants produced a median of 4.50 suck bursts per minute that contained 9.60 cycles/burst, resulting in a burst duration of 4.74 s. The median NNS frequency was 2.09 Hz, with an average amplitude of 14.05 cmH20. Twelve-month-old infants produced a median of 2.50 suck bursts that contained 3.75 cycles/burst, resulting in a burst duration of 1.67 s. The median NNS frequency was 2.11 Hz with an amplitude of 19.75 cmH20. CONCLUSION Full-term infants significantly change their NNS duration, amplitude, burst number, cycles/burst and cycle number with no significant changes present in NNS frequency between 3 and 12 months. Knowledge of NNS emergence and maturation during the first year of life is imperative for proper NNS assessment so that healthcare professionals can identify delays.
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Affiliation(s)
- Alaina Martens
- Department of Communication Sciences & Disorders, Northeastern University, 360 Huntington Ave., Boston, MA 02115, USA.
| | - Morgan Hines
- Department of Communication Sciences & Disorders, Northeastern University, 360 Huntington Ave., Boston, MA 02115, USA.
| | - Emily Zimmerman
- Department of Communication Sciences & Disorders, Northeastern University, 360 Huntington Ave., Boston, MA 02115, USA.
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Chen CT, Wang LY, Wang YL, Lin BS. Quantitative Real-Time Assessment for Feeding Skill of Preterm Infants. J Med Syst 2017; 41:95. [DOI: 10.1007/s10916-017-0744-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/27/2017] [Indexed: 10/19/2022]
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Pernicious Effects of Toe Sucking Habit in Children. Case Rep Dent 2016; 2016:2475784. [PMID: 28025625 PMCID: PMC5153467 DOI: 10.1155/2016/2475784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/22/2016] [Accepted: 11/15/2016] [Indexed: 11/17/2022] Open
Abstract
Digit sucking is common nonnutritive sucking habit in childhood. However it is unusual to find toe sucking habit in children. We report a case of a seven-year-old child sucking great toe of the left foot. The child was referred by her paediatrician for dental evaluation due to her complaint of recurrent episodes of pyrexia. A dental evaluation was warranted as no particular system contributed to such recurrent episodes of fever in this child. Although dental examination did not reveal any cause for recurrent episodes of pyrexia, as a part of routine history taking we discovered that this child indulges frequently in sucking the great toe of her left foot since infancy. Any nonnutritive sucking habit is considered deleterious; this habit also caused significant effect on the child's dentofacial structures, sucked toe, and her general health. Hence the treatment plan was formulated for immediate cessation of habit. Appropriate interception of habit and timely orthodontic intervention led to not only early interception of cross-bite but also decrease in pyrexial episodes. This case report describes the pernicious effects of toe sucking habit and its relevance to recurrent pyrexia in children.
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Bromiker R, Medoff-Cooper B, Flor-Hirsch H, Kaplan M. Influence of hyperbilirubinemia on neonatal sucking. Early Hum Dev 2016; 99:53-6. [PMID: 27391573 DOI: 10.1016/j.earlhumdev.2016.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 04/12/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mothers of hyperbilirubinemic newborns frequently report to us that their infant is feeding poorly. As poor feeding in an extremely hyperbilirubinemic newborn may be an early sign of bilirubin encephalopathy, we hypothesized that neonatal hyperbilirubinemia would suppress the volume of feed ingested and diminish sucking parameters in comparison with minimally jaundiced neonates. OBJECTIVE To determine whether hyperbilirubinemia does diminish feeding and sucking in neonates. STUDY DESIGN Neonates in a well-baby nursery with serum total bilirubin (STB) ≥15.0mg/dL were compared with those with transcutaneous bilirubin ≤10mg/dL. Neonur, a modification of Krohn's Nutritive Sucking Apparatus, was used to quantify sucking parameters. Measurements during a 5min feeding period included volume ingested (measured manually), number of sucks, average maximum sucking pressure, number of bursts, average burst duration, pause between bursts duration, number of sucks per burst, and average intersuck interval. Outcome measures were volume ingested and, presuming decreased volume, sucking parameter analysis would determine the component affected by hyperbilirubinemia. RESULTS 17 hyperbilirubinemic newborns (STB 17.8±1.6mg/dL) were compared with 24 controls, all with transcutaneous bilirubin <10.0mg/dL. The volume of feed ingested was similar between the hyperbilirubinemic newborns and controls (30.00 [20.00-42.50] ml vs. 25.00 [15.00-30.00] ml, p=0.2) (median [95% confidence interval]). No significant differences were noted in any of the other sucking parameters measured. CONCLUSIONS At concentrations of STB in the range of 15-20mg/dL, hyperbilirubinemia did not diminish feed volume or sucking parameters in term newborns. Poor feeding in moderately hyperbilirubinemic newborns cannot be attributed to the level of bilirubin per se.
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Affiliation(s)
- Ruben Bromiker
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel; The Faculty of Medicine of the Hebrew University, Jerusalem, Israel
| | - Barbara Medoff-Cooper
- University of Pennsylvania School of Nursing and The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Michael Kaplan
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel; The Faculty of Medicine of the Hebrew University, Jerusalem, Israel.
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Wang YL, Kuo HC, Wang LY, Ko MJ, Lin BS. Design of wireless multi-parameter monitoring system for oral feeding of premature infants. Med Biol Eng Comput 2015; 54:1061-9. [PMID: 26429347 DOI: 10.1007/s11517-015-1400-x] [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] [Received: 06/25/2014] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
Premature infants often cannot successfully and coordinately complete their oral feeding. Mature sucking, swallowing, and respiration activities are crucial indicators for the survival of newborn infants. Due to the vulnerability and unobvious muscle activities of premature infants, current clinical care givers mainly depend on the subjective behavioral observation of infants during oral feeding. There is still lack of an integrated oral feeding monitoring system to objectively and quantifiably monitor the related physiological parameters of premature infants. In this study, a wireless multi-parameter monitoring system for oral feeding of premature infants was proposed to monitor the sucking-swallowing-respiratory activities and the heart rate variability to provide quantitative indices of oral feeding. Here, a novel sucking pressure sensing module was also developed to monitor the premature infant's sucking pressure under oral feeding to avoid the immersion influence of milk. The experimental results showed that the proposed system detected the related physiological parameters of premature infants during oral feeding effectively and may provide an objective clinical evaluation tool for oral feeding ability and safety of premature infants in the future.
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Affiliation(s)
- Yu-Lin Wang
- Department of Rehabilitation, Chi Mei Medical Center, Tainan, Taiwan.,Department of Sports Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Hsing-Chien Kuo
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan, 711, Taiwan
| | - Lin-Yu Wang
- Department of Rehabilitation, Chi Mei Medical Center, Tainan, Taiwan.,Department of Childhood Education and Nursery, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Mei-Ju Ko
- Department of Rehabilitation, Chi Mei Medical Center, Tainan, Taiwan
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan, 711, Taiwan.
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Chen CT, Wang YL, Wang CA, Ko MJ, Fang WC, Lin BS. Wireless Monitoring System for Oral-Feeding Evaluation of Preterm Infants. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2015; 9:678-685. [PMID: 26173220 DOI: 10.1109/tbcas.2015.2438031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The oral feeding disorder is one of the important indicators for the high risk group of neurodevelopment delay. The procedure of oral feeding requires the coordination of sucking, swallowing, and breathing activities, and it is the most complex sensorimotor process for newborn infants. Premature infants often uneasily complete the procedure of oral feeding. However, the evaluation of the oral feeding disorders and severity are usually dependent on the subjective clinical experience of the physician. Monitoring the sucking-swallowing-breathing activities directly is difficult for preterm infants. In this study, a wireless monitoring system for oral-feeding evaluation of full term and preterm infants was proposed to objectively and quantitatively evaluate the coordination of suck-swallow-respiration function during oral feeding. Moreover, the ratios of the swallowing and breathing event numbers to the sucking event number were defined to evaluate the coordination of suck-swallow-respiration function during oral feeding. Finally, the system performance was validated and the coordination of suck-swallow-respiration function for full term and preterm infants during oral feeding was also investigated.
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White-Traut R, Rankin KM, Pham T, Li Z, Liu L. Preterm infants' orally directed behaviors and behavioral state responses to the integrated H-HOPE intervention. Infant Behav Dev 2014; 37:583-96. [PMID: 25189523 DOI: 10.1016/j.infbeh.2014.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 08/11/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
Abstract
Preterm infants are challenged by immature infant behavioral organization which may negatively influence their ability to oral feed. The purpose of this study was to determine whether the integrated H-HOPE (Hospital to Home: Optimizing the Infant's Environment) intervention would improve infant behavioral organization by increasing the frequency of orally directed behaviors and the proportion of time spent in an alert behavioral state when offered prior to oral feeding. Mother-infant dyads (n=198) were randomly assigned to the H-HOPE intervention or the Attention Control groups. Infants were born at 29-34 weeks gestation and were clinically stable. Mothers had at least two social environmental risk factors such as minority status or less than high school education. H-HOPE is an integrated intervention that included (1) twice-daily infant directed stimulation using the ATVV intervention (auditory, tactile, visual, and vestibular stimuli) and (2) maternal participatory guidance sessions by a nurse-community advocate team. Orally directed behaviors and behavioral states were assessed weekly prior to feeding during hospitalization when infants were able to feed orally. There were no differences between the groups at baseline (Day 0, prior to the initiation of the integrated H-HOPE intervention). We observed a pattern of increased frequency of orally directed behaviors in the H-HOPE intervention group when compared to the Attention Control group, however, the proportion of time spent in an alert behavioral state remained stable in both groups over the course of the study. On Day 7, the H-HOPE intervention group exhibited a significantly higher mean frequency of orally directed behaviors than the Attention Control group (12.6 vs. 7.1 pre-intervention, 51.8 vs. 33.2 during intervention, 4.3 vs. 3.2 immediately after intervention, and 8.9 vs. 5.3 immediately prior to feeding). On Day 7, the H-HOPE intervention group exhibited a significantly higher proportion of time spent in an alert behavioral state only during intervention (0.26 vs. 0.11) and immediately after intervention (0.28 vs. 0.06). These findings are suggestive that the integrated H-HOPE intervention facilitated infant behavioral organization for clinically stable infants born between 29 and 34 weeks gestation. The orally directed behaviors appear to be an important indicator of the infant's preparation for feeding, and when used in conjunction with assessment of behavioral states, are especially valuable to the clinician. Use of this combined assessment approach in practice would strengthen clinician assessment for initiation of (beginning the first oral feeding) and daily preparation for oral feeding in preterm infants.
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Affiliation(s)
- Rosemary White-Traut
- Children's Hospital of Wisconsin, Milwaukee, WI, United States; Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States.
| | - Kristin M Rankin
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | - Thao Pham
- Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
| | - Zhuoying Li
- Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
| | - Li Liu
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
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Cantrill RM, Creedy DK, Cooke M, Dykes F. Effective suckling in relation to naked maternal-infant body contact in the first hour of life: an observation study. BMC Pregnancy Childbirth 2014; 14:20. [PMID: 24423381 PMCID: PMC3898526 DOI: 10.1186/1471-2393-14-20] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 01/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Best practice guidelines to promote breastfeeding suggest that (i) mothers hold their babies in naked body contact immediately after birth, (ii) babies remain undisturbed for at least one hour and (iii) breastfeeding assistance be offered during this period. Few studies have closely observed the implementation of these guidelines in practice. We sought to evaluate these practices on suckling achievement within the first hour after birth. METHODS Observations of seventy-eight mother-baby dyads recorded newborn feeding behaviours, the help received by mothers and birthing room practices each minute, for sixty minutes. RESULTS Duration of naked body contact between mothers and their newborn babies varied widely from 1 to 60 minutes, as did commencement of suckling (range = 10 to 60 minutes). Naked maternal-infant body contact immediately after birth, uninterrupted for at least thirty minutes did not predict effective suckling within the first hour of birth. Newborns were four times more likely to sustain deep rhythmical suckling when their chin made contact with their mother's breast as they approached the nipple (OR 3.8; CI 1.03 - 14) and if their mothers had given birth previously (OR 6.7; CI 1.35 - 33). Infants who had any naso-oropharyngeal suctioning administered at birth were six times less likely to suckle effectively (OR .176; CI .04 - .9). CONCLUSION Effective suckling within the first hour of life was associated with a collection of practices including infants positioned so their chin can instinctively nudge the underside of their mother's breast as they approach to grasp the nipple and attach to suckle. The best type of assistance provided in the birthing room that enables newborns to sustain an effective latch was paying attention to newborn feeding behaviours and not administering naso-oropharyngeal suction routinely.
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Affiliation(s)
- Ruth M Cantrill
- Metro South Hospital and Health Service, Queensland Health, PO Box 7254, Redland Bay, Queensland 4165, Australia
| | - Debra K Creedy
- Griffith Health Institute Griffith University, Nathan, Queensland 4111, Australia
| | - Marie Cooke
- Griffith Health Institute Griffith University, Nathan, Queensland 4111, Australia
| | - Fiona Dykes
- Maternal and Infant Nutrition and Nurture Unit (MIANN), University of Central Lancashire, Lancashire, UK
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Abstract
OBJECTIVE To synthesize the published research pertaining to breastfeeding establishment and outcomes among late preterm infants and to describe the state of the science on breastfeeding within this population. DATA SOURCES Online databases Ovid MEDLINE, CINAHL, PubMed, and reference lists of reviewed articles. STUDY SELECTION Nine data-based research articles examining breastfeeding patterns and outcomes among infants born between 34 0/7 and 36 6/7 weeks gestation or overlapping with this time period by at least 2 weeks. DATA EXTRACTION Effect sizes and descriptive statistics pertaining to breastfeeding initiation, duration, exclusivity, and health outcomes among late preterm breastfed infants. DATA SYNTHESIS Among late preterm mother/infant dyads, breastfeeding initiation appears to be approximately 59% to 70% (U.S.), whereas the odds of breastfeeding beyond 4 weeks or to the recommended 6 months (exclusive breastfeeding) appears to be significantly less than for term infants, and possibly less than infants ≤34 to 35 weeks gestation. Breastfeeding exclusivity is not routinely reported. Rehospitalization, often related to "jaundice" and "poor feeding," is nearly twice as common among late preterm breastfed infants as breastfed term or nonbreastfed late preterm infants. Barriers to optimal breastfeeding in this population are often inferred from research on younger preterm infants, and evidence-based breastfeeding guidelines are lacking. CONCLUSIONS Late preterm infants are at greater risk for breastfeeding-associated rehospitalization and poor breastfeeding establishment compared to their term (and possibly early preterm) counterparts. Contributing factors have yet to be investigated systematically.
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Affiliation(s)
- Jill V Radtke
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA 15261, USA.
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12
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Boiron M, Da Nobrega L, Roux S, Saliba E. Pharyngeal swallowing rhythm in response to oral sensorimotor programs in preterm infants. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.jnn.2009.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Poore M, Barlow SM, Wang J, Estep M, Lee J. Respiratory treatment history predicts suck pattern stability in preterm infants. JOURNAL OF NEONATAL NURSING : JNN 2008; 14:185-192. [PMID: 19956344 PMCID: PMC2614286 DOI: 10.1016/j.jnn.2008.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sensory deprivation and motor restriction associated with extensive oxygen therapy may lead to poor oromotor control in preterm infants. Non-nutritive suck is one of the first complex oromotor behaviors infants perform. This study determined the spatiotemporal variability of non-nutritive suck (NNS) pressure trajectories in three preterm groups with differing oxygen histories-one control group with minimal or no O(2) therapy, and two Respiratory Distress Syndrome (RDS) groups with either a mild/moderate (RDS1) or moderate/severe (RDS2) O(2) history. The Non-nutritive Suck Spatiotemporal Index (NNS STI) quantifies spatial and temporal variability across kinematic trajectories, and was calculated from digital representations of infants' suck pressure signals. An ANCOVA revealed a significant effect for group (p < .001) on the NNS STI measure, with RDS2 infants showing highly variable NNS patterning, and thus relatively underdeveloped suck. Extensive oxygen therapy, which alters the oral sensory environment and reduces motor experiences, disrupts the development of coordinated NNS in preterm infants.
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Affiliation(s)
- Meredith Poore
- Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, USA
| | - Steven M. Barlow
- Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, USA
- Programs in Neuroscience, Human Biology and Bioengineering, University of Kansas, USA
- Communication Neuroscience Laboratories Bioengineering, University of Kansas, USA
| | - Jingyan Wang
- Communication Neuroscience Laboratories Bioengineering, University of Kansas, USA
| | - Meredith Estep
- Programs in Neuroscience, Human Biology and Bioengineering, University of Kansas, USA
| | - Jaehoon Lee
- Center for Biobehavioral Neurosciences in Communication Disorders Statistics Core, University of Kansas, USA
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Abstract
AIM To validate a non-nutritive sucking (NNS) scoring system for oral feeding in preterm newborns (PTNB). METHODS A cohort study was carried out in two phases. In phase one of the study, 22 mastered speech-language pathologists received the protocol and procedure for a NNS scoring system to evaluate the content and presentation of the form and to define the grading scale. In phase two, six speech-language pathologists evaluated 51 PTNBs weekly, using the defined scoring system. SETTING This study was carried out in the Nursery Annex to the Maternity at the Intensive and Neonatal Pediatrics Service, Instituto da Criança, Hospital das Clinicas, School of Medicine, University of São Paulo (FMUSP) during the period from May 2004 to May 2006. PARTICIPANTS A total of 28 speech-language pathologist experts and 51 PTNBs. RESULTS In the first phase of the study, 22 speech-language pathologists selected the criteria, utilized in the NNS evaluation with 80% agreement. In the second phase of the study, the NNS evaluation was carried out on 51 PTNB, and a scoring system of 50 points was proposed, which corresponds to the smallest number of false positive and negative results regarding oral feeding ability. CONCLUSION An NNS evaluation system was validated that was able to indicate when oral feeding could safely begin in PTNBs with a high level of agreement among the speech-language pathologists who have participated.
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Affiliation(s)
- F C B Neiva
- School of Medicine, University of São Paulo, Brazil.
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Poore M, Zimmerman E, Barlow SM, Wang J, Gu F. Patterned orocutaneous therapy improves sucking and oral feeding in preterm infants. Acta Paediatr 2008; 97:920-7. [PMID: 18462468 DOI: 10.1111/j.1651-2227.2008.00825.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM To determine whether NTrainer patterned orocutaneous therapy affects preterm infants' non-nutritive suck and/or oral feeding success. SUBJECTS Thirty-one preterm infants (mean gestational age 29.3 weeks) who demonstrated minimal non-nutritive suck output and delayed transition to oral feeds at 34 weeks post-menstrual age. INTERVENTION NTrainer treatment was provided to 21 infants. The NTrainer promotes non-nutritive suck output by providing patterned orocutaneous stimulation through a silicone pacifier that mimics the temporal organization of suck. METHOD Infants' non-nutritive suck pressure signals were digitized in the NICU before and after NTrainer therapy and compared to matched controls. Non-nutritive suck motor pattern stability was calculated based on infants' time- and amplitude-normalized digital suck pressure signals, producing a single value termed the Non-Nutritive Suck Spatiotemporal Index. Percent oral feeding was the other outcome of interest, and revealed the NTrainer's ability to advance the infant from gavage to oral feeding. RESULTS Multilevel regression analyses revealed that treated infants manifest a disproportionate increase in suck pattern stability and percent oral feeding, beyond that attributed to maturational effects alone. CONCLUSION The NTrainer patterned orocutaneous therapy effectively accelerates non-nutritive suck development and oral feeding success in preterm infants who are at risk for oromotor dysfunction.
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Affiliation(s)
- M Poore
- Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, Lawrence, KS 66045-7555, USA
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Bell AF, Lucas R, White-Traut RC. Concept clarification of neonatal neurobehavioural organization. J Adv Nurs 2008; 61:570-81. [PMID: 18261065 DOI: 10.1111/j.1365-2648.2007.04561.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM This paper is a report of a concept analysis of neonatal neurobehavioural organization for healthy full-term infants. BACKGROUND The neonatal period is an opportune time for researchers and clinicians to assess and intervene for optimal neurobehavioural organization. Yet there is inconsistency and lack of clarity in a scientifically grounded definition of neonatal neurobehavioural organization. Clarification of the concept will strengthen research findings that influence practice for optimal infant development. METHOD A concept analysis of the literature between 1939 and 2007 (n = 57) was conducted using Penrod and Hupcey's principle-based concept analysis and Morse's concept clarification. FINDINGS The concept analysis within and across multiple disciplines revealed: (1) a view of the concept as a holistic phenomenon with multiple dimensions; (2) no agreement on the ideal instrument to operationally define the concept; and (3) consistency in implied meaning, but great variability in terminology. Neonatal neurobehavioural organization was defined as the ability of the neonate to use goal-directed states of consciousness, in reciprocal interaction with the caregiving environment, to facilitate the emergence of differentiating, hierarchical, and coordinated neurobehavioural systems, with ever-increasing resiliency and capacity to learn from complex stimuli. CONCLUSION A clear conceptual definition will help the international community to communicate effectively within and between disciplines and to apply evidence-based research findings. It will encourage the development of valid and reliable instruments to capture the concept's multiple dimensions and direct attention to the infant's experience, which sculpts early neurobehavioural organization.
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Affiliation(s)
- Aleeca F Bell
- College of Nursing, University of Illinois at Chicago, Illinois, USA.
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Estep M, Barlow SM, Vantipalli R, Finan D, Lee J. Non-Nutritive Suck Parameter in Preterm Infants with RDS. JOURNAL OF NEONATAL NURSING : JNN 2008; 14:28-34. [PMID: 19190723 PMCID: PMC2443682 DOI: 10.1016/j.jnn.2007.12.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE: To characterize the integrity of non-nutritive suck (NNS) parameters among three groups of preterm infants ranging from normal to those with progressive degrees of respiratory distress syndrome (RDS). STUDY DESIGN: NNS compression waveforms were sampled from 55 infants in the neonatal intensive care unit using a silicone pacifier electronically instrumented for intraluminal pressure. Seven select NNS parameters were measured at two different sessions, and statistically analyzed using a General Linear Model Analysis of Covariance. RESULTS AND CONCLUSIONS: Preterm infants with a more extensive history of RDS and oxygen therapy manifest significantly (p≤0.001) degraded performance on six of the seven NNS measures. This trend was disproportionately amplified in preterm infants with moderate-to-severe RDS. Prolonged periods of RDS requiring oxygen therapy may cause maladaptive orosensory experiences, and restrict oral movements which may contribute to delayed NNS development.
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Affiliation(s)
- Meredith Estep
- Graduate Research Associate, Communication Neuroscience Laboratories, Program in Neuroscience, University of Kansas, Lawrence, Kansas USA
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Lappi H, Valkonen-Korhonen M, Georgiadis S, Tarvainen MP, Tarkka IM, Karjalainen PA, Lehtonen J. Effects of nutritive and non-nutritive sucking on infant heart rate variability during the first 6 months of life. Infant Behav Dev 2007; 30:546-56. [PMID: 17568681 DOI: 10.1016/j.infbeh.2007.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 02/10/2007] [Accepted: 04/28/2007] [Indexed: 10/23/2022]
Abstract
The effects of eating on heart rate variability (HRV) differ between adults and newborns. This may reflect the impact of suckling on the overall psychophysiological and autonomic nervous system maturation. The purpose of the present study was to explore whether the reactions of HRV during feeding change towards the adult pattern during the first 6 months of life. In addition, the effects of non-nutritive and nutritive sucking on heart rate (HR) and HRV were compared. The participants were 23 infants on whom recordings were performed as newborns and at 6, 12 and 24 weeks old. Nutritive sucking caused an increase in HR and a decline in HRV. The results were consistent with previous reports of a decrease in high frequency components of HRV during feeding in newborns, reflecting a decrease in parasympathetic activity. This response was apparent in all four ages studied, and remained similar throughout the 6-month period. However, age as an independent factor seemed to influence both HR and HRV. Pacifier sucking had no significant effects on HRV at any age. The results demonstrate the physical strain that sucking imposes on the baby, with a specific autonomic nervous system response involved. We consider this response an essential part of the overall psychophysiological maturation of infants.
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Affiliation(s)
- Hanne Lappi
- Department of Psychiatry, Kuopio University Hospital, Finland.
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Rocha AD, Moreira MEL, Pimenta HP, Ramos JRM, Lucena SL. A randomized study of the efficacy of sensory-motor-oral stimulation and non-nutritive sucking in very low birthweight infant. Early Hum Dev 2007; 83:385-8. [PMID: 16979854 DOI: 10.1016/j.earlhumdev.2006.08.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2006] [Revised: 07/28/2006] [Accepted: 08/06/2006] [Indexed: 11/27/2022]
Abstract
UNLABELLED To assess if sensory-motor-oral stimulation and non-nutritive sucking gavage feeding enhances the oral feeding performance of preterm infants born between 26 and 32 weeks of gestational age. STUDY DESIGN Very low birthweight infants (n=98) were randomized into a experimental and control group. Preterm infants in the experimental group received sensory-motor-oral stimulation and non-nutritive sucking and infants in the control group received a sham stimulation program. Both were administered from when they reached enteral diet (100 kcal/kg/day) until the beginning of oral diet. Primary outcome was length of hospital stay. RESULTS Independent oral feeding was attained significantly earlier in the experimental group than the control group, 38+/-16 days of life (mean+/-S.D.) versus 47+/-17 days of life, respectively (P<0.001) There was significant difference in length of hospital stay between the two groups (41.9+/-17 (mean+/-S.D.) versus 52.3+/-19 days (P<0.01)). CONCLUSION Sensory-motor-oral stimulation, together with early non-nutritive sucking (as soon as the newborn reaches full diet and is clinically stable) in very low birthweight preterm infants, as long as they are clinically stable, in this study, earlier initiation of oral feeding and earlier hospital discharge.
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Mizuno K, Ueda A. Changes in sucking performance from nonnutritive sucking to nutritive sucking during breast- and bottle-feeding. Pediatr Res 2006; 59:728-31. [PMID: 16627890 DOI: 10.1203/01.pdr.0000214993.82214.1c] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Our aim was to obtain a better understanding of the differences between breast-feeding and bottle-feeding, particularly with regard to how sucking performance changes from nonnutritive sucking (NNS) to nutritive sucking (NS). Twenty-two normal term infants were studied while breast-feeding at 4 and 5 d postpartum. Five of the 22 infants were exclusively breast-fed, but we tested the other 17 infants while breast-feeding and while bottle-feeding. Before the milk ejection reflex (MER) occurs, little milk is available. As such, infants perform NNS before MER. For bottle-feeding, a one-way valve was affixed between the teat and the bottle so that the infants needed to perform NNS until milk flowed into the teat chamber. At the breast, the sucking pressure (-93.1 +/- 28.3 mm Hg) was higher during NNS compared with NS (-77.3 +/- 27.0 mm Hg). With a bottle, the sucking pressure was lower during NNS (-27.5 +/- 11.2 mm Hg) compared with NS (-87.5 +/- 28.5 mm Hg). Sucking frequency was higher and sucking duration was shorter during NNS compared with that during NS both at the breast and with a bottle. There were significant differences in the changes of sucking pressure and duration from NNS to NS between breast- and bottle-feeding. The change in sucking pressure and duration from NNS to NS differed between breast-feeding and bottle-feeding. Even with a modified bottle and teats, bottle-feeding differs from breast-feeding.
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Affiliation(s)
- Katsumi Mizuno
- Division of Neonatology, Chiba Children's Hospital, Chiba City, Chiba, Japan 266-0007.
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Abstract
Nutritive sucking and feeding behaviors have the potential to predict developmental outcomes. Research is beginning to connect nutritive sucking behaviors and neurodevelopmental outcomes, providing an important understanding of how infants develop during the first year of life. A program of research has evolved using sucking behaviors as the primary indices of both maturation and development in preterm infants. Clinical questions were the guiding force behind 5 funded grants from the National Institutes of Health and many small grants from foundations and professional organizations. Three of the National Institutes of Health studies were research based and 2 were for development of the feeding instrumentation. These cumulative grants have generated a significant volume of data; highlights and clinical implications of this work are presented in this article.
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Premji SS, McNeil DA, Scotland J. Regional neonatal oral feeding protocol: changing the ethos of feeding preterm infants. J Perinat Neonatal Nurs 2004; 18:371-84. [PMID: 15646307 DOI: 10.1097/00005237-200410000-00008] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Calgary Health Region Neonatal Oral Feeding Protocol is the culminating work of a broad range of healthcare professionals, including staff nurses, nurse practitioners, nurse educators, nurse managers, dietitians, lactation consultants, clinical nurse specialists, and occupational therapists. The protocol represents a synthesis of research evidence and expert opinion pertaining to the introduction and management of oral milk feedings for high-risk infants in the neonatal intensive care unit. This evidence-based neonatal oral feeding protocol is presented to share knowledge and skill required to create positive feeding experiences while assisting high-risk infants to achieve full oral feedings. Goals of this project include promoting consistent neonatal nursing feeding practices and changing the ethos in relation to feeding interactions between caregiver and infant in the neonatal intensive care unit. This culture change will assist nurses to identify what is unique about their professional practice, which is of particular importance given the skill mix resulting from hospital understaffing and a growing nursing workforce shortage.
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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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Abstract
BREAST MILK, THE MAINSTAY OF infant nutrition, provides the appropriate nutrients for optimal growth and development for most babies. Several conditions in women and infants preclude breastfeeding, however, and identifying these conditions early on is important. Women who are unable to breastfeed because their infants are ill and/or premature yet wish to establish lactation for their hospitalized newborns need instruction and support if they are to succeed. It is the responsibility of the discharging hospital to have personnel who are specifically trained to provide an individualized plan of care for each mother (Table 1). Written instructions for handling, storing, and preparing expressed breast milk are an essential part of such plans. The discharge plan for each mother should include specific recommendations related to the mother: medical/surgical history, expression techniques, and collection and storage procedures. Completion of the plan should incorporate the infant’s current medical condition and neurologic status, with particular emphasis placed on enhancing the quality of the maternalchild interaction.
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Affiliation(s)
- P K Lemons
- IU School of Medicine, Department of Developmental Pediatrics, Riley Hospital for Children, Indianapolis, Indiana 46202-5200, USA.
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