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Steer KE, Johnson ML, Edmonds CE, Adjerid K, Bond LE, German RZ, Mayerl CJ. The Impact of Varying Nipple Properties on Infant Feeding Physiology and Performance Throughout Ontogeny in a Validated Animal Model. Dysphagia 2024; 39:460-467. [PMID: 37947879 PMCID: PMC11181904 DOI: 10.1007/s00455-023-10630-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023]
Abstract
Infant feeding requires successful interactions between infant physiology and the maternal (or bottle) nipple. Within artificial nipples, there is variation in both nipple stiffness and flow rates, as well as variation in infant physiology as they grow and mature. However, we have little understanding into how infants interact with variable nipple properties to generate suction and successfully feed. We designed nipples with two different stiffnesses and hole sizes and measured infant feeding performance through ontogeny using a pig model. We evaluated their response to nipple properties using high-speed X-Ray videofluoroscopy. Nipple properties substantially impacted sucking physiology and performance. Hole size had the most profound impact on the number of sucks infants took per swallow. Pressure generation generally increased with age, especially in nipples where milk acquisition was more difficult. However, most strikingly, in nipples with lower flow rates the relationship between suction generation and milk acquisition was disrupted. In order to design effective interventions for infants with feeding difficulties, we must consider how variation in nipple properties impacts infant physiology in a targeted manner. While reducing flow rate may reduce the frequency an infant aspirates, it may impair systems involved in sensorimotor integration.
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Affiliation(s)
- K E Steer
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 St Route 44, Rootstown, OH, 44272, USA
- Department of Biological Sciences, Northern Arizona University, Flagstaff, USA
| | - M L Johnson
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 St Route 44, Rootstown, OH, 44272, USA
| | - C E Edmonds
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 St Route 44, Rootstown, OH, 44272, USA
- School of Biomedical Sciences, Kent State University, Kent, USA
| | - K Adjerid
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 St Route 44, Rootstown, OH, 44272, USA
- Department of Biomedical Engineering, Tulane University, New Orleans, USA
| | - L E Bond
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 St Route 44, Rootstown, OH, 44272, USA
| | - R Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 St Route 44, Rootstown, OH, 44272, USA
| | - C J Mayerl
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 St Route 44, Rootstown, OH, 44272, USA.
- Department of Biological Sciences, Northern Arizona University, Flagstaff, USA.
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Fisher A, Ermarth A, Ling CY, Brinker K, DuPont TL. Method of home tube feeding and 2-3-year neurodevelopmental outcome. J Perinatol 2024:10.1038/s41372-024-02013-2. [PMID: 38811755 DOI: 10.1038/s41372-024-02013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To describe the Bayley Scales of Infant Development 3rd Edition (Bayley-III) of infants discharged home receiving tube feeds. STUDY DESIGN Retrospective review of infants discharged with nasogastric or gastrostomy tube feeds and completed a Bayley-III assessment at 2-3-years of age through a neonatal follow-up program. Results were reported using descriptive statistics. RESULTS Of infants discharged with nasogastric feeds, median Bayley-III scores were in the low-average to average range, and full oral feeds were achieved in 75%. Of infants discharged with gastrostomy tube feeds, median Bayley-III scores were in the extremely low range, and full oral feeds were achieved in 36%. Our data set did not demonstrate a distinct patient demographic that correlated to the type of feeding tube at discharge. CONCLUSION Neurodevelopmental outcome at 2-3 years does not appear to be negatively impacted by the decision to discharge an infant from the NICU with home NG feedings.
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Affiliation(s)
- Allison Fisher
- Department of Pediatrics, Division of Neonatology, University of Utah, Salt Lake City, UT, USA
| | - Anna Ermarth
- Department of Pediatrics, Division of Gastroenterology, University of Utah, Salt Lake City, UT, USA
| | - Con Yee Ling
- Department of Pediatrics, Division of Neonatology, University of Utah, Salt Lake City, UT, USA
| | | | - Tara L DuPont
- Department of Pediatrics, Division of Neonatology, University of Utah, Salt Lake City, UT, USA.
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Fucile S, Hennessey G, Meghji S, Dow K. Exploration of the Association Between Sucking Measures and Ability to Attain Independent Oral Feeds Among Infants Who Are Born Preterm. Am J Occup Ther 2024; 78:7803205120. [PMID: 38709676 DOI: 10.5014/ajot.2024.050581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
IMPORTANCE Infants who are born preterm often experience difficulty transitioning from full tube to independent oral feeds, which often prolongs their hospital stay. No clinical measures associated with attainment of independent oral feeds are currently available. OBJECTIVE To identify specific nutritive sucking measures associated with time to attainment of independent oral feeds among infants who are born preterm. DESIGN An observational cohort pilot study was undertaken. SETTING A Level 2 to Level 3 neonatal intensive care unit. PARTICIPANTS Fourteen infants (7 male, 7 female) born at or less than 34 wk gestation were enrolled. OUTCOMES AND MEASURES The monitored suck measures included average suck strength (millimeters of mercury), average sucking burst duration (seconds), average suck count (number of sucks), and average pause duration (seconds). Time to independent oral feeds (days) and baseline characteristics were also monitored. The nutritive sucking measures were recorded once, during the first 5 min of an oral feed, when infants were taking an average of three to four oral feeds per day using a nipple monitoring device. RESULTS An inverse relation was found among average suck burst duration (p = .04), gestational age (p = .03), and days to attainment of independent oral feeds. CONCLUSIONS AND RELEVANCE Study results suggest that average sucking burst duration, during the first 5 min of an oral feed, is associated with time to attain independent oral feeds. Plain-Language Summary: Sucking burst duration is a simple measure that may be used clinically to identify early on infants who may have trouble transitioning from full tube to independent oral feedings. The results of this study suggest that a suck burst duration in the first 5 min of an oral feeding is inversely associated with the length of time to achieve independent oral feeding. The results highlight the importance of considering an infant's nutritive sucking ability when evaluating their potential to achieve independent oral feedings.
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Affiliation(s)
- Sandra Fucile
- Sandra Fucile, PhD, OT Reg. (Ont), is Assistant Professor, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada;
| | - Grace Hennessey
- Grace Hennessey, MscOT, is Occupational Therapy Student, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Suraya Meghji
- Suraya Meghji, MscOT, is Occupational Therapy Student, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Kimberly Dow
- Kimberly Dow, MD, is Professor, Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
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Hübl N, Riebold B, Schramm D, Seidl RO. Differences in the swallowing process of newborns and healthy preterm infants: first results with a non-invasive bioimpedance and electromyography measurement system. Eur Arch Otorhinolaryngol 2024; 281:843-854. [PMID: 37996534 PMCID: PMC10796423 DOI: 10.1007/s00405-023-08344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE Preterm infants (PI) have difficulty coordinating sucking, swallowing and breathing, and there is a risk of aspiration. The causes of this are not yet sufficiently understood. The aim of this study was to test a novel measurement device to measure breathing and pharyngeal processes involved in swallowing externally in everyday life to identify possible differences in neonates (NB) and PI. METHODS Forty healthy NB were studied at 4-8 weeks of age (mean: 6.7 weeks) and 20 healthy PI (mean gestational age 30.5 weeks) at postmenstrual age (PMA) 34/35 weeks (mean PMA 35.1 weeks) during a single feeding. Surface electrodes were used to measure bioimpedance and electromyography reflecting swallow-related changes in the pharynx and muscle activation of the tongue and submental muscles. A respiratory belt was combined with recording of the depth of chest movements and the occurrence of pauses in breathing. RESULTS Velocity and extent of pharyngeal closure did not differ significantly across the feeding period (velocity: p=0.09, closure: p=0.17), but during the first two suck-swallow bursts PI had greater velocity (p<0.001*) and extent of pharyngeal closure (p=0.004*) than NB. The duration of swallowing phases was significantly longer in PIs (p<0.001*), their muscle activation decreased faster (p<0.001*), and they had more pauses in breathing than NBs. CONCLUSIONS The novel measurement device allowed, for the first time in everyday life, the measurement of factors influencing swallowing and breath-swallow coordination in NBs and PIs. PIs showed differences from NBs most likely due to differences in muscle strength and condition.
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Affiliation(s)
- Nicole Hübl
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Benjamin Riebold
- TU Berlin, Control Systems Group, Einsteinufer 17, 10587, Berlin, Germany
| | - Dirk Schramm
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Rainer O Seidl
- Ear-Nose and Throat, Unfallkrankenhaus Berlin, UKB, Warener Str.7, 12683, Berlin, Germany
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Dietrich LJ, Gong A, Gelfond J, Blanco CL. Oral feeding trajectories and neurodevelopmental outcomes at 12 and 24 month follow-up for preterm infants. J Neonatal Perinatal Med 2024; 17:21-30. [PMID: 38393924 DOI: 10.3233/npm-230088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND Few studies characterize feeding performance in the NICU when predicting neurodevelopmental outcomes. Our objective was to investigate the relationship between time to full oral feeds (FULL-PO) and neurodevelopmental and feeding outcomes in the first 2 years in preterm infants admitted to the NICU. METHODS This retrospective study included infants born between 01/01/2014-07/31/2017, gestational age < 32 weeks and/or birth weight < 1500 g. We examined feeding difficulties, cerebral palsy, and Bayley scores for those reaching FULL-PO at a post menstrual age (PMA)≤38.0 weeks (EARLY) vs.>38.0 weeks (LATE). Additionally, the oral feeding achieved at various timepoints between 36- and 42-weeks postmenstrual age (PMA) was measured to construct a timeline of oral feeding acquisition. RESULTS Of 192 infants, 147(77%) achieved FULL-PO EARLY and 45(23%) LATE. Comorbidities and length of stay were higher and unadjusted Bayley scores were lower at 12 months corrected age (CA) and 24 months chronological age (CH) in the LATE group. Feeding difficulties were higher in the LATE group at 24 months CH. Infants born < 27-28 weeks GA were more likely to achieve oral feeding at a later PMA. Infants with bronchopulmonary dysplasia (BPD) had significant feeding and developmental delays. CONCLUSIONS Establishing full oral feeds by 38.0 weeks PMA may be used as a predictor for feeding difficulties at 24 months CH. Infants born < 27-28 weeks GA and those with BPD are more likely to take extended amounts of time to achieve full oral feeding and need additional feeding support. Infants with BPD are high risk for neurodevelopmental delays.
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Affiliation(s)
- L J Dietrich
- Pediatrics, Division of Neonatology, University of Texas Health San Antonio, San Antonio, TX, USA
- University Health System, San Antonio, TX, USA
| | - A Gong
- Pediatrics, Division of Neonatology, University of Texas Health San Antonio, San Antonio, TX, USA
- University Health System, San Antonio, TX, USA
| | - J Gelfond
- Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, TX, USA
| | - C L Blanco
- Pediatrics, Division of Neonatology, University of Texas Health San Antonio, San Antonio, TX, USA
- University Health System, San Antonio, TX, USA
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Jenkins DD, Moss HG, Adams LE, Hunt S, Dancy M, Huffman SM, Cook D, Jensen JH, Summers P, Thompson S, George MS, Badran BW. Higher Dose Noninvasive Transcutaneous Auricular Vagus Nerve Stimulation Increases Feeding Volumes and White Matter Microstructural Complexity in Open-Label Study of Infants Slated for Gastrostomy Tube. J Pediatr 2023; 262:113563. [PMID: 37329979 PMCID: PMC11000235 DOI: 10.1016/j.jpeds.2023.113563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To determine whether transcutaneous auricular vagus nerve stimulation (taVNS) paired with twice daily bottle feeding increases the volume of oral feeds and white matter neuroplasticity in term-age-equivalent infants failing oral feeds and determined to need a gastrostomy tube. STUDY DESIGN In this prospective, open-label study, 21 infants received taVNS paired with 2 bottle feeds for 2 - 3 weeks (2x). We compared 1) increase oral feeding volumes with 2x taVNS and previously reported once daily taVNS (1x) to determine a dose response, 2) number of infants who attained full oral feeding volumes, and 3) diffusional kurtosis imaging and magnetic resonance spectroscopy before and after treatment by paired t tests. RESULTS All 2x taVNS treated infants significantly increased their feeding volumes compared with 10 days before treatment. Over 50% of 2x taVNS infants achieved full oral feeds but in a shorter time than 1x cohort (median 7 days [2x], 12.5 days [1x], P < .05). Infants attaining full oral feeds showed greater increase in radial kurtosis in the right corticospinal tract at the cerebellar peduncle and external capsule. Notably, 75% of infants of diabetic mothers failed full oral feeds, and their glutathione concentrations in the basal ganglia, a measure of central nervous system oxidative stress, were significantly associated with feeding outcome. CONCLUSIONS In infants with feeding difficulty, increasing the number of daily taVNS-paired feeding sessions to twice-daily significantly accelerates response time but not the overall response rate of treatment. taVNS was associated with white matter motor tract plasticity in infants able to attain full oral feeds. TRIAL REGISTRATION Clinicaltrials.gov (NCT04643808).
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Affiliation(s)
- Dorothea D Jenkins
- Department of Pediatrics at the Medical University of South Carolina, Charleston, SC; Department of Neuroscience, Medical University of South Carolina, Charleston, SC.
| | - Hunter G Moss
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC; Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC
| | - Lauren E Adams
- College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Sally Hunt
- College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Morgan Dancy
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC
| | - Sarah M Huffman
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC
| | - Daniel Cook
- College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Jens H Jensen
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC; Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC; Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Philipp Summers
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC
| | - Sean Thompson
- Department of Neurology, Emory University School of Medicine, Atlanta, GA
| | - Mark S George
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC; Ralph H. Johnson VA Medical Center, Charleston, SC
| | - Bashar W Badran
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC; Neuro-X Lab, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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Sheikh-Mohamed SO, Wilson H, Fucile S. Interventions to Enhance Achievement to Independent Oral Feeds in Premature Infants: A Scoping Review. Phys Occup Ther Pediatr 2023; 44:295-315. [PMID: 37867325 DOI: 10.1080/01942638.2023.2271064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
AIM To assess the effectiveness of interventions aimed at facilitating the transition from full tube to independent oral feeds in premature infants. METHODS Scoping review methodology using the Preferred Reporting items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA_ScR). A search of six databases (EMBASE, MEDLINE, CINAHL, Web of Science, COCHRANE, and OT Seeker), using keywords related to oral feeding and premature infants retrieved 11,870 articles. Full-text screening was completed for 36 articles, and 21 articles were included in this review. RESULTS Review of the 21 articles revealed five intervention types: oral stimulation (n = 14), swallow/gustatory stimulation (n = 3), olfactory stimulation (n = 2), tactile/kinesthetic stimulation (n = 1), and auditory stimulation (n = 1). Oral stimulation had the most studies with consistent evidence supporting its beneficial effect to facilitate achievement to independent oral feeds, swallow/gustatory stimulation appeared to have some benefit, but evidence for olfactory, tactile/kinesthetic, and auditory stimulation was sparse. CONCLUSION Oral stimulation has the most studies with consistent evidence, and thus is suggested as a suitable early intervention strategy that can be used by health providers to facilitate the achievement to independent oral feeds in premature infants. The alternate forms of stimulation have limited evidence and necessitate further studies to confirm their benefits.
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Affiliation(s)
| | - Hillary Wilson
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Sandra Fucile
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
- Department of Pediatrics, Queen's University, Kingston, Canada
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Controzzi T, Chesi F, Scaramuzzo RT, Giampietri M, Morganti R, Fiori S, Moretti E, Gargani L, Filippi L. Lung ultrasound supports clinical evaluation of feeding competence development in preterm neonates. Front Pediatr 2023; 11:1222473. [PMID: 37800012 PMCID: PMC10548820 DOI: 10.3389/fped.2023.1222473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/25/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction The achievement of alimentary competencies is a milestone in the development of preterm neonates. Ten percent of neonates <37 weeks of gestational age and 25% of those VLBW experience swallowing disorders, with an increased risk of problems in the early phase of life (failure to thrive, growth retardation, inhalation, and consequent risk of pulmonary infection) and later in life due to delayed development of oromotor skills.The main diagnostic tools for swallowing disorders are endoscopic (fiber-optic endoscopic examination of swallowing, FEES) or radiographic (videofluoroscopic swallowing study, VFSS) exams. Given the invasiveness of these methods and the bias due to rheologic differences between bolus and contrast medium, FEES and VFSS are poorly reproducible. Moreover, neither of the technique is capable of detecting post-meal inhalations, especially microinhalations or those consequent to a whole meal rather than to a single swallowing.Lung ultrasound (LUS) is a widespread, repeatable, safe, fast point-of-care tool and we reported previous encouraging results in detecting silent and overt inhalation related to the meal in children with dysphagia/gastroesophageal reflux disease (GERD) risk factors. Methods We report a pilot study, that investigated LUS approach (performing imaging before and after meals) to assess feeding competence development in a cohort of n. 19 newborns <32 weeks of age. Results Meal monitoring by LUS did not show any significant difference in scoring before/after eating. The achievement of full enteral feeding correlates with GA at birth (p < 0.001) but not with LUS scoring. The introduction of the first meal by bottle correlates both with gestational age (p < 0.001) and ultrasound scores (p = 0.004). LUS score at 7 days of life resulted predictive for length of invasive/non-invasive respiratory support (p = 0.002) and length of oxygen supply (p = 0.001), while LUS score at 48 h of life did not (p n.s.). Discussion Our study suggests that the development of oral feeding skills is not strictly dependent on gestational age. Moreover, our research suggests the predominant role of LUS in predicting the time of readiness to oral feeding, as the LUS score can be a marker of respiratory and lung wellness, and consequently a predictor of neonate stability during deglutitory apnea.
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Affiliation(s)
- Tiziana Controzzi
- U.O. Neonatologia, Dipartimento Materno-Infantile, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Francesca Chesi
- U.O. Neonatologia, Dipartimento Materno-Infantile, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Rosa Teresa Scaramuzzo
- U.O. Neonatologia, Dipartimento Materno-Infantile, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Matteo Giampietri
- U.O. Neonatologia, Dipartimento Materno-Infantile, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Riccardo Morganti
- Sezione di Statistica, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Simona Fiori
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
- IRCCS Fondazione Stella Maris, Calambrone, Italy
| | | | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Luca Filippi
- U.O. Neonatologia, Dipartimento Materno-Infantile, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
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Comuk Balci N, Takci S, Seren HC. Improving feeding skills and transition to breastfeeding in early preterm infants: a randomized controlled trial of oromotor intervention. Front Pediatr 2023; 11:1252254. [PMID: 37790695 PMCID: PMC10543751 DOI: 10.3389/fped.2023.1252254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Oromotor therapy exercises used for preterm infants in the NICU might promote oral-motor skills and shorten discharge day. This study investigates the impact of an oral-motor therapy program on the successful transition to breastfeeding (BF) and the enhancement of feeding skills in preterm infants below 30 weeks of gestational age who experience feeding intolerance. Methods The intervention group received oral-motor therapy programme for one month, while the control group did not. The feeding skills were evaluated by Early Feeding Skills Assessment Tool (EFS) and Preterm Oral Feeding Readiness Scales (POFRAS). Results There was a significant difference in EFS and POFRAS scores, transition to bottle feeding at discharge and transition to BF after discharge between babies given oral-motor therapy programme and controls (p < 0.05). While the transition time to full enteral feeds did not vary significantly between the groups, noteworthy outcomes were observed in the intervention group, including differences in feeding type at discharge, the nature of feeds at discharge, and the success of transitioning to breastfeeding after discharge. Discussion We conclude that the oromotor therapy exercises in NICU improves the quality of sucking, contributes to better oromotor skills and promotes transition to enteral feeding and BF in preterm babies. Clinical Trial Registration ClinicalTrials.gov, identifier (NCT05845684).
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Affiliation(s)
- Nilay Comuk Balci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Türkiye
| | - Sahin Takci
- Department of Neonatology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Türkiye
| | - H. Canan Seren
- Department of Neonatology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Türkiye
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Greene Z, O'Donnell CP, Walshe M. Oral stimulation for promoting oral feeding in preterm infants. Cochrane Database Syst Rev 2023; 6:CD009720. [PMID: 37338236 PMCID: PMC10281084 DOI: 10.1002/14651858.cd009720.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Preterm infants (< 37 weeks' post-menstrual age (PMA)) are often delayed in attaining oral feeding. Normal oral feeding is suggested as an important outcome for the timing of discharge from the hospital and can be an early indicator of neuromotor integrity and developmental outcomes. A range of oral stimulation interventions may help infants to develop sucking and oromotor co-ordination, promoting earlier oral feeding and earlier hospital discharge. This is an update of our 2016 review. OBJECTIVES To determine the effectiveness of oral stimulation interventions for attainment of oral feeding in preterm infants born before 37 weeks' PMA. SEARCH METHODS Searches were run in March 2022 of the following databases: CENTRAL via CRS Web; MEDLINE and Embase via Ovid. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. Searches were limited by date 2016 (the date of the search for the original review) forward. Note: Due to circumstances beyond our control (COVID and staffing shortages at the editorial base of Cochrane Neonatal), publication of this review, planned for mid 2021, was delayed. Thus, although searches were conducted in 2022 and results screened, potentially relevant studies found after September 2020 have been placed in the section, Awaiting Classification, and not incorporated into our analysis. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing a defined oral stimulation intervention with no intervention, standard care, sham treatment or non-oral intervention (e.g. body stroking protocols or gavage adjustment protocols) in preterm infants and reporting at least one of the specified outcomes. DATA COLLECTION AND ANALYSIS Following the updated search, two review authors screened the titles and abstracts of studies and full-text copies when needed to identify trials for inclusion in the review. The primary outcomes of interest were time (days) to exclusive oral feeding, time (days) spent in NICU, total hospital stay (days), and duration (days) of parenteral nutrition. All review and support authors contributed to independent extraction of data and analysed assigned studies for risk of bias across the five domains of bias using the Cochrane Risk of Bias assessment tool. The GRADE system was used to rate the certainty of the evidence. Studies were divided into two groups for comparison: intervention versus standard care and intervention versus other non-oral or sham intervention. We performed meta-analysis using a fixed-effect model. MAIN RESULTS We included 28 RCTs (1831 participants). Most trials had methodological weaknesses, particularly in relation to allocation concealment and masking of study personnel. Oral stimulation compared with standard care Following meta-analysis, it is uncertain whether oral stimulation reduces the time to transition to oral feeding compared with standard care (mean difference (MD) -4.07 days, 95% confidence interval (CI) -4.81 to -3.32 days, 6 studies, 292 infants; I2 =85%, very low-certainty evidence due to serious risk of bias and inconsistency). Time (days) spent in the neonatal intensive care unit (NICU) was not reported. It is uncertain whether oral stimulation reduces the duration of hospitalisation (MD -4.33, 95% CI -5.97 to -2.68 days, 5 studies, 249 infants; i2 =68%, very low-certainty evidence due to serious risk of bias and inconsistency). Duration (days) of parenteral nutrition was not reported. Oral stimulation compared with non-oral intervention Following meta-analysis, it is uncertain whether oral stimulation reduces the time to transition to exclusive oral feeding compared with a non-oral intervention (MD -7.17, 95% CI -8.04 to -6.29 days, 10 studies, 574 infants; I2 =80%, very low-certainty evidence due to serious risk of bias, inconsistency and precision). Time (days) spent in the NICU was not reported. Oral stimulation may reduce the duration of hospitalisation (MD -6.15, 95% CI -8.63 to -3.66 days, 10 studies, 591 infants; I2 =0%, low-certainty evidence due to serious risk of bias). Oral stimulation may have little or no effect on the duration (days) of parenteral nutrition exposure (MD -2.85, 95% CI -6.13 to 0.42, 3 studies, 268 infants; very low-certainty evidence due to serious risk of bias, inconsistency and imprecision). AUTHORS' CONCLUSIONS There remains uncertainty about the effects of oral stimulation (versus either standard care or a non-oral intervention) on transition times to oral feeding, duration of intensive care stay, hospital stay, or exposure to parenteral nutrition for preterm infants. Although we identified 28 eligible trials in this review, only 18 provided data for meta-analyses. Methodological weaknesses, particularly in relation to allocation concealment and masking of study personnel and caregivers, inconsistency between trials in effect size estimates (heterogeneity), and imprecision of pooled estimates were the main reasons for assessing the evidence as low or very low certainty. More well-designed trials of oral stimulation interventions for preterm infants are warranted. Such trials should attempt to mask caregivers to treatment when possible, paying particular attention to blinding of outcome assessors. There are currently 32 ongoing trials. Outcome measures that reflect improvements in oral motor skill development as well as longer term outcome measures beyond six months of age need to be defined and used by researchers to capture the full impact of these interventions.
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Affiliation(s)
- Zelda Greene
- Neonatology, National Maternity Hospital, Dublin, Ireland
- Adjunct Assistant Professor in Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Colm Pf O'Donnell
- Department of Neonatology, National Maternity Hospital, Dublin 2, Ireland
- University College Dublin, Dublin, Ireland
| | - Margaret Walshe
- Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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11
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KOMATSU TAKESHI, FURUKAWA TATSUYA, KOBAYASHI DAISUKE, IWATANI SOTA, YOSHIMOTO SEIJI, YAMASHITA TOSHIHIKO, ENDO YUMI, KATSUNUMA SAYAKA, OTSU MASAHIDE, NIBU KENICHI. Influences of Orogastric and Nasogastric Tubes on Sucking Pressure during Bottle Feeding in Immature Infants. THE KOBE JOURNAL OF MEDICAL SCIENCES 2023; 69:E25-E32. [PMID: 37291069 PMCID: PMC10306263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/08/2023] [Indexed: 06/10/2023]
Abstract
Orogastric (OG) and nasogastric (NG) tubes have been reported to delay breastfeeding initiation and affect respiratory function. However, the effects of feeding tubes on sucking pressure have not been well studied. Fourteen preterm infants were enrolled in this study, and their sucking pressures during bottle feeding with an OG tube, NG tube, and without any tube were measured. Sucking pressure significantly increased after changing the OG tube to an NG tube (p = 0.044). However, sucking pressure showed no significant differences after changing the feeding method from an NG tube to oral intake. Thus, NG tubes are superior to OG tubes in terms of sucking pressure.
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Affiliation(s)
- TAKESHI KOMATSU
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - TATSUYA FURUKAWA
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - DAISUKE KOBAYASHI
- Department of Pediatric Rehabilitation and Orthopedics, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - SOTA IWATANI
- Department of Neonatology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - SEIJI YOSHIMOTO
- Department of Neonatology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - TOSHIHIKO YAMASHITA
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - YUMI ENDO
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - SAYAKA KATSUNUMA
- Department of Otolaryngology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - MASAHIDE OTSU
- Department of Otolaryngology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - KEN-ICHI NIBU
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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12
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Mayerl CJ, Gould FDH, Adjerid K, Edmonds C, German RZ. The Pathway from Anatomy and Physiology to Diagnosis: A Developmental Perspective on Swallowing and Dysphagia. Dysphagia 2023; 38:33-41. [PMID: 35441265 PMCID: PMC9579268 DOI: 10.1007/s00455-022-10449-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 04/04/2022] [Indexed: 01/29/2023]
Abstract
Dysphagia results from diverse and distinct etiologies. The pathway from anatomy and physiology to clinical diagnosis is complex and hierarchical. Our approach in this paper is to show the linkages from the underlying anatomy and physiology to the clinical presentation. In particular, the terms performance, function, behavior, and physiology are often used interchangeably, which we argue is an obstacle to clear discussion of mechanism of pathophysiology. We use examples from pediatric populations to highlight the importance of understanding anatomy and physiology to inform clinical practice. We first discuss the importance of understanding anatomy in the context of physiology and performance. We then use preterm infants and swallow-breathe coordination as examples to explicate the hierarchical nature of physiology and its impact on performance. We also highlight where the holes in our knowledge lie, with the ultimate endpoint of providing a framework that could enhance our ability to design interventions to help patients. Clarifying these terms, and the roles they play in the biology of dysphagia will help both the researchers studying the problems as well as the clinicians applying the results of those studies.
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Affiliation(s)
- C J Mayerl
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | - F D H Gould
- Department of Cell Biology and Neuroscience, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - K Adjerid
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | - C Edmonds
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | - R Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA.
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13
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Onesimo R, Giorgio V, Viscogliosi G, Sforza E, Kuczynska E, Margiotta G, Iademarco M, Proli F, Rigante D, Zampino G, Leoni C. Management of nutritional and gastrointestinal issues in RASopathies: A narrative review. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2022; 190:478-493. [PMID: 36515923 DOI: 10.1002/ajmg.c.32019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022]
Abstract
Noonan, Costello, and cardio-facio-cutaneous syndrome are neurodevelopmental disorders belonging to the RASopathies, a group of syndromes caused by alterations in the RAS/MAPK pathway. They are characterized by similar clinical features, among which feeding difficulties, growth delay, and gastro-intestinal disorders are frequent, causing pain and discomfort in patients. Hereby, we describe the main nutritional and gastrointestinal issues reported in individuals with RASopathies, specifically in Noonan syndrome, Noonan syndrome-related disorders, Costello, and cardio-facio-cutaneous syndromes. Fifty percent of children with Noonan syndrome may experience feeding difficulties that usually have a spontaneous resolution by the second year of life, especially associated to genes different than PTPN11 and SOS1. More severe manifestations often require artificial enteral nutrition in infancy are observed in Costello syndrome, mostly associated to c.34G>A substitution in the HRAS gene. In cardio-facio-cutaneous syndrome feeding issues are usually present (90-100% of cases), especially in individuals carrying variants in BRAF, MAP2K1, and MAP2K2 genes, and artificial enteral intervention, even after scholar age, may be required. Moreover, disorders associated with gastrointestinal dysmotility as gastro-esophageal reflux and constipation are commonly reported in all the above-mentioned syndromes. Given the impact on growth and on the quality of life of these patients, early evaluation and prompt personalized management plans are fundamental.
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Affiliation(s)
- Roberta Onesimo
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Valentina Giorgio
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Germana Viscogliosi
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Elisabetta Sforza
- DIpartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eliza Kuczynska
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Gaia Margiotta
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Mariella Iademarco
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Proli
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Donato Rigante
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,DIpartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Zampino
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,DIpartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Leoni
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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14
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Alemdar DK, İnal S, Bulut M. Clinical validation of the infant-driven feeding scales© in Turkey. J Pediatr Nurs 2022; 67:148-154. [PMID: 36122545 DOI: 10.1016/j.pedn.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/20/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Supporting the development of feeding skills among preterm infants is an important component of neonatal care. The selection of appropriate and supportive feeding interventions begins with a comprehensive assessment of the infant's skills. PURPOSE This study aimed to adapt the Infant-Driven Feeding Scales© (IDFS) to the Turkish language. METHODS This was a methodological, observational, single-center cross-sectional study. The study included 80 infants born at a gestational age ≥ 32 weeks, consecutively admitted to a tertiary Neonatal Intensive Care Unit (NICU). Research data were collected using a premature infant descriptive information form (IDIF), IDFS, and LATCH Score for Breastfeeding Assessment. For the Turkish validity-reliability of the IDF, the translate-back translate method was used with the content validity index (CVI) assessed. RESULTS The scale had CVI values between 0.90 and 1.00 with a mean CVI = 0.96. For measures 1 and 2, there were significant positive and high-level correlations between IFDS-R and IFDS-Q correlation values (r = 0.553-0.958; p = 0.001) and significant negative, low-level correlations between IFDS-R and IFDS-Q with the LATCH scale (r = 0.439-0.532; p = 0.001). According to inter-observer compatibility analyses, the kappa value was 0.94-1.00 for the first measure and 0.96-1.00 for the second measure (p = 0.001). There were negative significant correlations between IDFS-R points with gestational age and postmenstrual age (PMA) (p = 0.001), and gestational age and PMA were explanatory factors for 13.8% of IDFS-R points (F = 7.30, p = 0.001). CONCLUSIONS The IDFS is recommended for use as a valid and reliable tool to ease the safe and successful development of oral feeding skills in preterm infants and to plan evidence-based interventions. IMPLICATIONS FOR PRACTICE The IDFS appears to be a beneficial measurement device for use in assessing the state of readiness of preterm infants for oral feeding and for early determination of risks that may occur due to delayed feeding independence of infants.
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Affiliation(s)
- Dilek Küçük Alemdar
- Associate Professor, Ordu University Faculty of Health Sciences, Department of Pediatric Nursing, Ordu, Turkey.
| | - Sevil İnal
- Professor, İstanbul-Cerrah Paşa University Faculty of Health Sciences, Department of Midwifery, İstanbul, Turkey
| | - Muhammet Bulut
- MD, Associate Professor, Giresun University Faculty of Medicine, Department of Pediatrics, Giresun, Turkey
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15
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Rinat S, Mackay M, Synnes A, Holsti L, Zwicker JG. Early feeding behaviours of extremely preterm infants predict neurodevelopmental outcomes. Early Hum Dev 2022; 173:105647. [PMID: 36029558 DOI: 10.1016/j.earlhumdev.2022.105647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/31/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Infants born extremely preterm are at high risk for early feeding difficulties, as well as poor neurodevelopmental outcomes in childhood. Feeding, a complex motor skill, may be predictive of later neuromotor outcomes. AIMS To determine the relationship between feeding behaviours of extremely preterm-born infants (<28 weeks gestational age) at 4-months corrected age (CA) and neurodevelopmental outcomes at 4-5 years. STUDY DESIGN Retrospective cohort design with prospectively collected data. SUBJECTS Infants born extremely preterm from September 1999 - October 2013 [n = 412, mean gestational age 25.4 (1.3) weeks; mean birth weight 771 (168) grams]. Oral feeding was assessed at 4-months CA by an experienced occupational therapist; infants were classified as either having poor suck-swallow ('feeding difficulties') or no feeding difficulties. OUTCOME MEASURES Motor outcomes were assessed at 4-5 years using the Movement Assessment Battery for Children (MABC). Children were categorized as: (1) typical motor development (TMD; n = 214); (2) Developmental Coordination Disorder (DCD; n = 116); or (3) major neurodevelopmental disorder (MND; n = 82). RESULTS Feeding behaviour at 4-months CA predicted DCD (OR = 2.95, CI 1.13-7.68) and MND (OR = 3.67, CI 1.35-9.96) after controlling for confounders. Infants with feeding difficulties were more likely to be diagnosed with DCD (40 % of poor feeders) or MND (36 %) at 4-5 years, compared to infants without feeding issues. CONCLUSIONS Early feeding behaviours significantly predicted motor outcomes at 4-5 years. Infants born extremely preterm with early feeding difficulties should be identified as at high risk for poor motor outcomes later in childhood and screened for early diagnosis and intervention.
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Affiliation(s)
- Shie Rinat
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Margot Mackay
- Neonatal Follow-Up Program, BC Women's Hospital, Vancouver, Canada
| | - Anne Synnes
- Neonatal Follow-Up Program, BC Women's Hospital, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada; Brain, Behaviour, & Development Theme, BC Children's Hospital Research Institute, Vancouver, Canada
| | - Liisa Holsti
- Department of Pediatrics, University of British Columbia, Vancouver, Canada; Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada
| | - Jill G Zwicker
- Department of Pediatrics, University of British Columbia, Vancouver, Canada; Brain, Behaviour, & Development Theme, BC Children's Hospital Research Institute, Vancouver, Canada; Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, Canada.
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16
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Morais RD, Goulart AL, Kopelman BI. Spontaneous Orofacial Movements at Writhing and Fidgety General Movements Age in Preterm and Full-Term Infants. CHILDREN 2022; 9:children9081175. [PMID: 36010065 PMCID: PMC9406397 DOI: 10.3390/children9081175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022]
Abstract
Background: As general spontaneous movements at the writhing and fidgety ages have been important for the early identification of neurodevelopmental impairment of both full-term and preterm infants, the knowledge of the spontaneous orofacial movements at these ages also seems to be important for the diagnosis of oral function, particularly in preterm infants. Therefore, we decided to first classify preterm and full-term infants according to general movements ages, and then to record, describe, compare, and discuss their spontaneous orofacial movements. Methods: This cross-sectional study included 51 preterm infants (born between 28 and 36 weeks) and 43 full-term infants who were classified at the writhing and fidgety ages of Prechtl’s method of general movements assessment. Their spontaneous orofacial movements were recorded on video, and The Observer XT software (Noldus) was used to record the quantitative values of the movements. Results: Poor repertoires of writhing movements were more frequent in the preterm infants (90.9%) compared to full-term ones (57.9%). Positive fidgety movements were observed in 100% of both preterm and full-term infants. Oral movements were similar for both preterm and full-term infants, regardless of their movement stage. Conclusion: All spontaneous orofacial movements were present both in preterm and full-term infants, albeit with higher frequency, intensity, and variability at fidgety age.
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Affiliation(s)
- Regina Donnamaria Morais
- Premature Clinic, Escola Paulista de Medicina, Federal University of São Paulo (Unifesp), São Paulo 04023-060, Brazil
- Correspondence: ; Tel.: +55-11-9-9420-8676
| | - Ana Lucia Goulart
- Neonatal Department, Premature Clinic, Escola Paulista de Medicina, Federal University of São Paulo (Unifesp), São Paulo 04023-060, Brazil
| | - Benjamin Israel Kopelman
- Pediatrics, Escola Paulista de Medicina, Federal University of São Paulo (Unifesp), São Paulo 04023-060, Brazil
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17
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Deglutition-related cardiorespiratory events. Early Hum Dev 2022; 171:105602. [PMID: 35749800 DOI: 10.1016/j.earlhumdev.2022.105602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Le Q, Zheng SH, Zhang L, Wu LF, Zhou FJ, Kang M, Lu CH. Effects of oral stimulation with breast milk in preterm infants oral feeding: a randomized clinical trial. J Perinat Med 2022; 50:486-492. [PMID: 34954933 DOI: 10.1515/jpm-2020-0282] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/20/2021] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Qiong Le
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | | | - Lan Zhang
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Li-Fen Wu
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Feng-Juan Zhou
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Min Kang
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Cai-Hong Lu
- Department of Surgical, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
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19
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Thandaveshwara D, Ganeshan S, Doreswamy SM, Krishnegowda S. Comparison of Efficacy Between Paladai and Syringe Feeding in Stable Preterm Neonates-A Randomized Control Trial. Breastfeed Med 2022; 17:247-251. [PMID: 34871100 DOI: 10.1089/bfm.2021.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Feeding abilities of preterm neonates differ based on their gestational and postnatal maturity. Maturity of sucking pattern and improved coordination between sucking and swallowing and breathing, which is seen in babies with a gestation of 32 weeks onward, makes trial of oral feeds more successful in these babies. The oral feeds can be given either with a cup and spoon or a paladai. However, we observed that the milk spilt during feeding was an issue due to a wider spout of the paladai. Feeding through syringe is practiced in many neonatal units. However, there is a lack of scientific literature regarding the syringe feeding of neonates. We hypothesized that giving oral feeds using a syringe could reduce the spillage of milk. This study was done to compare the volume of feeds wasted (spillover) during oral feeding between paladai and syringe feeding. Methods: The order of feeding of 75 nurse baby pairs was randomized to either the syringe or the paladai groups. The volume of milk spilt was assessed by weighing a gauze pad placed under the neck of the baby before and after feeds. Time taken to complete the feeds, the rate of feeding, and events like vomiting and choking after feeding were noted. Feeding satisfaction among the nurses was recorded on a 5-point Likert scale. Results: The average mean time for completion of feeds by paladai was 9 minutes against 8.9 minutes in syringe feeding. The median rate of feeding was 3.57 minutes in the paladai group and 3.5 minutes in the syringe group. The median spillover volume was 3.33 mL in the paladai feeds and 3.23 mL in the intervention group. Seventy percent of the nurses reported better satisfaction with syringe feeds compared to paladai feeds. Conclusion: This study demonstrates that the milk spillover (wastage) during syringe feeding is not different from paladai feeds. However, the majority of nurses felt the syringe feeding was more satisfactory than paladai feeding. CTRI Reg. No: CTRI/2021/05/033479 dated 07.05.2021.
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Affiliation(s)
- Deepti Thandaveshwara
- Department of Pediatrics, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
| | - Shivangi Ganeshan
- Department of Pediatrics, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
| | - Srinivasa Murthy Doreswamy
- Department of Pediatrics, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
| | - Sushma Krishnegowda
- Department of Pediatrics, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
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20
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Abstract
Premature infants or infants born with complex medical problems are at increased risk of having delayed or dysfunctional oral feeding ability. These patients typically require assisted enteral nutrition in the form of a nasogastric tube (NGT) during their NICU hospitalization. Historically, once these infants overcame their initial reason(s) for admission, they were discharged from the NICU only after achieving full oral feedings or placement of a gastrostomy tube. Recent programs show that these infants can be successfully discharged from the hospital with partial NGT or gastrostomy tube feedings with the assistance of targeted predischarge education and outpatient support. Caregiver opinions have also been reported as satisfactory or higher with this approach. In this review, we discuss the current literature and outcomes in infants who are discharged with an NGT and provide evidence for safe practices, both during the NICU hospitalization, as well as in the outpatient setting.
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Affiliation(s)
- Anna Ermarth
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Con Yee Ling
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
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21
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Çelik F, Sen S, Karayagiz Muslu G. Effects of Oral Stimulation and Supplemental Nursing System on the Transition Time to Full Breast of Mother and Sucking Success in Preterm Infants: A Randomized Controlled Trial. Clin Nurs Res 2021; 31:891-900. [PMID: 34784787 DOI: 10.1177/10547738211058312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the effect of oral stimulation and a supplemental nursing system on the time to full maternal breastfeeding and sucking success in preterm infants. The sample consisted of 70 preterm babies. Oral motor stimulation and a supplemental nursing system were applied to the preterm infants in the experimental group, while no intervention was applied to those in the control group. Significant differences were found between the two groups concerning transition time to oral feeding, transition weight, transition time to full maternal breast, discharge age, duration, and weight, LATCH mean scores, continuing to suck in the first month after discharge, and weight averages. Oral stimulation and a supplemental nursing system shortened the transition period to oral feeding and full breastfeeding, increased breastfeeding rates and the sustainability of breastfeeding, and did not affect the period of discharge and vital signs during feeding in preterm babies.
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Affiliation(s)
| | - Selma Sen
- Celal Bayar University, Manisa, Turkey
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The Effect of Training on Neonatal Nurses' Knowledge about Transitioning Preterm Infants to Oral Feeding. J Pediatr Nurs 2021; 61:185-190. [PMID: 34111838 DOI: 10.1016/j.pedn.2021.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Neonatal nurses require knowledge of evidence-based interventions that can be utilized for supporting oral feeding skills in preterm infants. Little is known about the impact of education/training programs on neonatal nurses' knowledge of this topic. PURPOSE This study was conducted to determine the effect of a training program about evidence-based interventions for the transition to and support of oral feeding in preterm infants on the knowledge levels of neonatal nurses. METHODS We conducted a pretest-posttest studywith 73 neonatal nurses in a research and training hospital. Participants completed a demographic information form and their knowledge about oral feeding in preterm infants was assessed before and after a 240-min training about the transition to oral feeding and evidence-based therapeutic interventions to promote preterm infants' oral feeding skills. RESULTS Posttest scores evaluated at 1 week (81.6 ± 6.8) and 1 month (79.5 ± 6.5) after the training were significantly higher than pre-test scores (66.8 ± 6.9) (p < 0.001). CONCLUSION Neonatal nurses showed higher levels of knowledge about evidence-based interventions for supporting oral feeding skills in preterm infants at 1 week and 1 month after the training program compared to their knowledge before training. IMPLICATIONS FOR PRACTICE Providing training to neonatal intensive care nurses on the transition to oral feeding in preterm infants will increase their level of knowledge and ensure that oral feeding interventions for preterm infants can be implemented using evidence-based therapeutic methods.
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Li L, Wang L, Niu C, Liu C, Lv T, Ji F, Yu L, Yan W, Dou YL, Wang Y, Cao Y, Huang G, Hu X. Early skin contact combined with mother's breastfeeding to shorten the process of premature infants ≤ 30 weeks of gestation to achieve full oral feeding: the study protocol of a randomized controlled trial. Trials 2021; 22:637. [PMID: 34535164 PMCID: PMC8447630 DOI: 10.1186/s13063-021-05605-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Most hospitalized preterm infants experience difficulties in transitioning from tube feeding to full oral feeding. Interventions to promote full oral feeding in preterm infants in the neonatal intensive care unit (NICU) are limited to pacifier use or bottle-feeding exercises. Skin contact has been shown to be beneficial to start and maintain lactation and provide preterm infants with the opportunity to suck on the mother’s breast, which may promote further development of the preterm infant’s suckling patterns. The objective of this study is to compare and evaluate the effects of skin contact combined with breastfeeding (suck on the mother’s empty breast) as compared to the routine pacifier suckling training model in achieving full oral feeding for infants whose gestational age are ≤ 30 weeks. Methods This is a single-center, randomized controlled clinical trial conducted in the NICU and designed according to the SPIRIT Statement. The subjects included in the study are premature infants born between April 2020 and July 2021 with a gestational age of ≤30 weeks, birth weight of <1500 g, admission age of <72 h, and absence of congenital malformations. Those with oxygenation indices of >40 and those born to mothers with poor verbal communication skills will be excluded. A sample of 148 infants is needed. The infants will be randomized to the intervention (skin contact combined with mother’s breastfeeding model) or control group (routine pacifier sucking training model). The primary outcome is the time required to achieve full oral feeding. The secondary outcomes are the breastfeeding abilities of preterm infants as assessed by the Preterm Infant Breastfeeding Behavior Scale (PIBBS), breastfeeding rates at 3 and 6 months corrected gestational age, complication rates, duration of oxygen requirement, days of hospital stay, and satisfaction of parents. Discussion This paper describes the first single-center, open-label, randomized clinical trial on this topic and will provide crucial information to support the implementation of skin contact combined with the breastfeeding model in the NICU setting. Trial registration ClinicalTrials.gov NCT 04283682. Registered on 8 February 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05605-x.
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Affiliation(s)
- Liling Li
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Li Wang
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Conway Niu
- King Edward Memorial Hospital, Western Australia, Subiaco, Australia
| | - Chan Liu
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Tianchan Lv
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Futing Ji
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Ling Yu
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Weili Yan
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Ya Lan Dou
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Yin Wang
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Yun Cao
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Guoying Huang
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Xiaojing Hu
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China.
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Rodriguez Gonzalez P, Perez-Cabezas V, Chamorro-Moriana G, Ruiz Molinero C, Vazquez-Casares AM, Gonzalez-Medina G. Effectiveness of Oral Sensory-Motor Stimulation in Premature Infants in the Neonatal Intensive Care Unit (NICU) Systematic Review. CHILDREN-BASEL 2021; 8:children8090758. [PMID: 34572190 PMCID: PMC8465336 DOI: 10.3390/children8090758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
| | - Veronica Perez-Cabezas
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, Avda. Ana de Viya, 52, 11009 Cadiz, Spain; (C.R.M.); (G.G.-M.)
- Investigation Group, [CTS1038] eMpOwering Health by Physical Activity, Exercise and Nutrition, University of Cadiz, 11009 Cadiz, Spain
- Correspondence: ; Tel.: +34-676-719-119
| | - Gema Chamorro-Moriana
- Department of Physiotherapy, University of Seville, Avenzoar, 6, 41009 Seville, Spain;
| | - Carmen Ruiz Molinero
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, Avda. Ana de Viya, 52, 11009 Cadiz, Spain; (C.R.M.); (G.G.-M.)
| | | | - Gloria Gonzalez-Medina
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, Avda. Ana de Viya, 52, 11009 Cadiz, Spain; (C.R.M.); (G.G.-M.)
- Investigation Group CTS-986, Physical Therapy and Health (FISA), University Institute of Research in Social Sustainable Development (INDESS), University of Cadiz, 11009 Cadiz, Spain
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Richards R, Foster JP, Psaila K. Continuous versus bolus intermittent intragastric tube feeding for preterm and low birth weight infants with gastro-oesophageal reflux disease. Cochrane Database Syst Rev 2021; 8:CD009719. [PMID: 34355390 PMCID: PMC8407337 DOI: 10.1002/14651858.cd009719.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Gastro-oesophageal reflux disease is a particularly common condition among preterm and low birth weight infants. These infants are more likely to have excessive regurgitation, as they do not have a fully developed antireflux mechanism. Preterm and low birth weight infants who are unable to suck oral feeds are required to be fed via an intragastric tube for varying lengths of time. Intragastric tube feeding can be delivered by the intermittent bolus method or by the continuous feeding method. Use of continuous or intermittent bolus intragastric feeding may have a positive or negative effect on the incidence or severity of gastro-oesophageal reflux disease. OBJECTIVES • To determine whether continuous or intermittent bolus intragastric tube feeding reduces the number of episodes and the duration of gastro-oesophageal reflux disease (GORD) in preterm and low birth weight infants • To perform subgroup analyses for gestational age; birth weight; age in days from birth at full enteral feeding via intragastric tube (breast versus bottle); frequency of intermittent bolus feed; and type of medication for treatment of GORD (only if medication was prescribed and was given similarly to both intervention groups) SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 7), in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), on 8 July 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-RCTs. SELECTION CRITERIA Published and unpublished RCTs and quasi-RCTs were eligible for inclusion in this review, as were cluster-randomised and cross-over randomised trials that compared the effects of continuous versus intermittent bolus intragastric tube feeding on gastro-oesophageal reflux disease in preterm and low birth weight infants. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility and quality. We planned to use the GRADE approach to assess the certainty of evidence. MAIN RESULTS We found no trials that met the inclusion criteria for this review. AUTHORS' CONCLUSIONS We did not identify any randomised trials that evaluated the effects of continuous versus intermittent bolus intragastric tube feeding on gastro-oesophageal reflux disease in preterm and low birth weight infants. Well-designed and adequately powered trials are needed.
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Affiliation(s)
- Robyn Richards
- Newborn Care, Liverpool Hospital, South Western Sydney Area Health Service, Liverpool, Australia
| | - Jann P Foster
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
- Ingham Research Institute, Liverpool, Australia
- NSW Centre for Evidence Based Health Care School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Kim Psaila
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
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Silveira BLD, Santos RCS, Araújo MGS, Lacerda GAND, Mascarenhas MLVDC, Guedes BLDS. Correlation of facial anthropometry data of late preterm newborns and oral feeding readiness. Rev Bras Enferm 2021; 74:e20201120. [PMID: 34320151 DOI: 10.1590/0034-7167-2020-1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/18/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To correlate nine facial anthropometric measurements with the readiness for oral feeding of late preterm newborns using an orogastric tube. METHODS Observational study, carried out in two institutions in Maceió, Alagoas. Fifty-two newborns participated. A single measuring of nine facial measurements and daily measuring of the interface area for fixing the tube was performed. For readiness assessment, the Premature Oral Feeding Readiness Assessment Scale was used. RESULTS An average readiness of 28.81 (± 3.18) was observed in the first evaluation and 30.65 (± 3.23) in the second. Most facial measurements are correlated with weight. There was a positive and slight correlation between glabella-subnasale distance and readiness. No correlation was observed between the area of the tube fixation interface and facial measurements. CONCLUSION It is concluded that the glabella-subnasale measurement is positively correlated with the readiness for oral feeding in late preterm newborns who used an orogastric tube for feeding.
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Mohamed MA, Teumer KK, Leone M, Akram N, Rahamn MH, Abdelatif D, Condie K. Cue-Based Feeding as Intervention to Achieve Full Oral Feeding in Preterm Infants Primarily Managed with Bubble CPAP. Am J Perinatol 2021; 40:766-772. [PMID: 34130317 DOI: 10.1055/s-0041-1731046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Cue-based feeding aims at matching introduction of per oral (PO) feeding with physiological readiness of preterm infants to facilitate PO intake and avoid oral aversion. It was claimed that cue-based feeding may lead to delay in the initiation or achieving full PO feeding in clinical setting primarily using bubble nasal continuous positive airway pressure (CPAP). The study aimed to examine the association of cue-based feeding with time of introduction and completing oral feeding in infants primarily managed with bubble CPAP. STUDY DESIGN A retrospective analysis where outcomes of preterm infants ≤32 weeks' gestational age (GA) and ≤2,000 g birth weight (BW) were compared after a practice change from volume-based feeding advancement to cue-based feeding. Continuous variables were compared by using t-test and multilinear regression analysis to control for confounding variables. RESULTS Of the 311 preterm infants who met inclusion and exclusion criteria, 194 were in the cue-based feeding group and 117 were in the volume-based advancement historical comparison group. There were no differences between groups regarding demographic or clinical variables. Postmenstrual age (PMA) of initial feeding assessment was less in the cue-based feeding group. Age of first PO feeding and when some PO was achieved every feed was mildly delayed in the cue-based feeding compared with comparison group, 34 (±1.3) versus 33.7 (±1.2) weeks, and 36.2 (±2.3) versus 36.0 (±2.4) weeks, (p < 0.01) respectively. However, the age of achieving full PO did not differ between groups, 36.8 (±2.2) versus 36.4 (±2.4) weeks (p = 0.13). There was no difference between groups regarding growth parameters at 36 weeks' PMA or at discharge. Similar results were obtained when examining subcategories of infants ≤1,000 g and 1,001 to 2,000 g. CONCLUSION Cue-based feeding may not be associated with a delay in achieving full oral feeding or prolongation of the length of stay in preterm infants managed with CPAP. KEY POINTS · Cue-based feeding matches introduction of PO feeding with physiological readiness.. · Cue-based feeding may not be associated with a delay in achieving full oral feeding in preterm infants.. · Cue-based feeding is not associated with prolongation of the length of stay in preterm infants.. · Cue based feeding in preterm infants managed with noninvasive bubble CPAP is examined..
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Affiliation(s)
- Mohamed A Mohamed
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Kirsten K Teumer
- Department of Rehabilitation, the George Washington University Hospital, Washington, District of Columbia
| | - Mariana Leone
- Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Nabi Akram
- Columbian College of Arts and Science, the George Washington University, Washington, District of Columbia
| | - Mohamed H Rahamn
- Columbian College of Arts and Science, the George Washington University, Washington, District of Columbia
| | - Dinan Abdelatif
- Department of Obstetrics and Gynecology, the George Washington University Hospital, Washington, District of Columbia
| | - Kimberly Condie
- Department of Rehabilitation, the George Washington University Hospital, Washington, District of Columbia
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Canning A, Clarke S, Thorning S, Chauhan M, Weir KA. Oral feeding for infants and children receiving nasal continuous positive airway pressure and high flow nasal cannula: a systematic review. BMC Pediatr 2021; 21:83. [PMID: 33596866 PMCID: PMC7887825 DOI: 10.1186/s12887-021-02531-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this systematic review was to determine whether introduction of oral feeding for infants and children receiving nasal continuous positive airway pressure (nCPAP) or high flow nasal cannula (HFNC) respiratory support facilitates achievement of full oral feeding without adverse effects, compared to no oral feeding (NPO; nil per oral) on CPAP or HFNC. METHODS A protocol was lodged with the PROSPERO International Prospective Register of Systematic Reviews. We searched Medline, Embase, CINAHL, CENTRAL and AustHealth from database inception to 10th June 2020. Study population included children (preterm to < 18 years) on nCPAP or HFNC who were orally feeding. Primary outcomes included full or partial oral feeding and oropharyngeal aspiration. Secondary outcomes examined adverse events including clinical signs of aspiration, aspiration pneumonia and deterioration in respiratory status. RESULTS The search retrieved 1684 studies following duplicate removal. Title and abstract screening identified 70 studies for full text screening and of these, 16 were included in the review for data extraction. Methods of non-invasive ventilation (NIV) included nCPAP (n = 6), nCPAP and HFNC (n = 5) and HFNC (n = 5). A metanalysis was not possible as respiratory modes and cohorts were not comparable. Eleven studies reported on adverse events. Oral feeding safety was predominantly based on retrospective data from chart entries and clinical signs, with only one study using an instrumental swallow evaluation (VFSS) to determine aspiration status. CONCLUSIONS Findings are insufficient to conclude whether commencing oral feeding whilst on nCPAP or HFNC facilitates transition to full oral feeding without adverse effects, including oropharyngeal aspiration. Further research is required to determine the safety and efficacy of oral feeding on CPAP and HFNC for infants and children. TRIAL REGISTRATION PROSPERO registration number: CRD42016039325 .
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Affiliation(s)
- Angie Canning
- Speech Pathology, Gold Coast University Hospital, Gold Coast Health, Gold Coast, Australia.
| | - Sally Clarke
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
| | - Sarah Thorning
- Library Services, Gold Coast University Hospital, Gold Coast Health, Gold Cost, Australia
| | - Manbir Chauhan
- Newborn Care Unit, Gold Coast University Hospital, Gold Coast Health, Gold Coast, Australia
| | - Kelly A Weir
- Allied Health Sciences & Menzies Health Institute Queensland Griffith University, Gold Coast, Australia.,Allied Health Research Gold Coast Health, Gold Coast, Australia
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Granger CL, Embleton ND, Palmer JM, Lamb CA, Berrington JE, Stewart CJ. Maternal breastmilk, infant gut microbiome and the impact on preterm infant health. Acta Paediatr 2021; 110:450-457. [PMID: 33245565 DOI: 10.1111/apa.15534] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/27/2020] [Accepted: 08/12/2020] [Indexed: 12/12/2022]
Abstract
AIM This narrative review summarises the benefits of maternal breastmilk to both the infant and the mother, specifically the benefits that relate to modification of the infant microbiome, and how this might vary in the preterm infant. METHODS We used PubMed to primarily identify papers, reviews, case series and editorials published in English until May 2020. Based on this, we report on the components of breastmilk, their associated hypothesised benefits and the implications for clinical practice. RESULTS Breastmilk is recommended as the exclusive diet for newborn infants because it has numerous nutritional and immunological benefits. Additionally, exposure to the maternal breastmilk microbiome may confer a lasting effect on gut health. In the preterm infant, breastmilk is associated with a significant reduction in necrotising enterocolitis, an inflammatory gastrointestinal disease and reduction in other key morbidities, together with improved neurodevelopmental outcomes. CONCLUSION These impacts have long-term benefits for the child (and the mother) even after weaning. This benefit is likely due, in part, to modification of the infant gut microbiome by breastmilk microbes and bioactive components, and provide potential areas for research and novel therapies in preterm and other high-risk infants.
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Affiliation(s)
- Claire L. Granger
- Clinical and Translational Research Institute Newcastle University Newcastle upon Tyne UK
- Department of Neonatal Medicine Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK
| | - Nicholas D. Embleton
- Department of Neonatal Medicine Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK
- Population Health Sciences Institute Newcastle University Newcastle upon Tyne UK
| | - Jeremy M. Palmer
- Clinical and Translational Research Institute Newcastle University Newcastle upon Tyne UK
| | - Christopher A. Lamb
- Clinical and Translational Research Institute Newcastle University Newcastle upon Tyne UK
- Department of Gastroenterology Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK
| | - Janet E. Berrington
- Clinical and Translational Research Institute Newcastle University Newcastle upon Tyne UK
- Department of Neonatal Medicine Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK
| | - Christopher J. Stewart
- Clinical and Translational Research Institute Newcastle University Newcastle upon Tyne UK
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Orofacial characteristics of the very low-birth-weight preterm infants. J Pediatr (Rio J) 2021; 97:96-102. [PMID: 32084437 PMCID: PMC9432322 DOI: 10.1016/j.jped.2019.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/12/2019] [Accepted: 12/26/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the orofacial characteristics of very low-birth-weight preterm infants through anthropometric facial measures, orofacial anteroposterior analysis and the relationship between the gum pads. METHOD Orofacial examinations was performed in 154 infants, classified into two groups: Group A comprised 54 very low-birth-weight infants who were examined after clinical stabilization and before hospital discharge, and Group B comprised 100 full-term infants. RESULTS The average anthropometricmeasurements in millimetres for Group A and Group B were as follows: upper third:30.2 and 31.1; middle third: 24.2 and 25.9; lower third: 27.6 and 29.9; facial width: 64.8and 81.4. Regarding the orofacial anteroposterior analysis, the results showed that in99% of these infants, the mandible was in a retrognathic position relative to the maxilla.Group A and Group B had the following distributions of the relationship between thegum pads: overbite-overjet: 43% and 77%; overjet: 39% and 17%; open bite: 15% and3%; end-to-end: 2% and 1%; overbite: both 2%. CONCLUSION The very low-birth-weight preterm infants showed the upper third with the highest values in the facialharmony analysis, followed by the lower third and the middle third; and exhibited themandible in a retrognathic position relative to the maxilla, and with overbite-overjet themost prevalent type of gum pad relationship. The study emphasizes the importance of orofacial examination during neonatal hospitalization and the investigation of birth weight and gestational age in a multidisciplinary therapeutic approach that includes orofacial neonatal evaluation and actions that promote oral health, besides foster follow-up studies.
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Skaaning D, Kronborg H, Brødsgaard A, Solmer R, Pryds O, Carlsen EM. No long-term effect of oral stimulation on the intra-oral vacuum in healthy premature infants. Acta Paediatr 2020; 109:2025-2032. [PMID: 32259301 DOI: 10.1111/apa.15289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/28/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
AIM Exclusive breastfeeding is recommended for the first 6 months of life, but the breastfeeding rate in premature infants is low. We examined the effect of oral stimulation on infant's strength of suction and the relation between this intra-oral vacuum and breastfeeding duration. METHOD Between 2016 and 2018, 211 infants in a Danish neonatal unit were randomised 1:1 and of these 108 to oral stimulation intervention and 103 to control. Suction was measured as peak vacuum at enrolment and a corrected age of 6 weeks. Breastfeeding duration was registered. RESULTS Vacuum increased from enrolment to a corrected age of 6 weeks in all infants, and no effect of oral stimulation intervention was demonstrated P = .08. Infants born ≤32 gestational weeks had lower vacuum compared with infants born after, 350 vs 398 mbar P < .001. For infants born after 32 gestational weeks, the odds ratio for exclusive breastfeeding at 6 months was 1.99 per 100 mbar increase in vacuum P = .01. CONCLUSION In our study, infant's intra-oral vacuum increased with age and was not affected by the oral stimulation intervention. For infants born after 32 gestational weeks, the exclusive breastfeeding rate was positively associated with a strong vacuum.
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Affiliation(s)
- Diana Skaaning
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Hvidovre Denmark
| | - Hanne Kronborg
- Department of Public Health Faculty of Health Sciences Aarhus University Aarhus Denmark
| | - Anne Brødsgaard
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Hvidovre Denmark
- Department of Public Health Faculty of Health Sciences Aarhus University Aarhus Denmark
| | - Rasmus Solmer
- Department of Product Development Technical University of Denmark Lyngby Denmark
| | - Ole Pryds
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Hvidovre Denmark
| | - Emma Malchau Carlsen
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Hvidovre Denmark
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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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Hill RR, Park J, Pados BF. Bottle-Feeding Challenges in Preterm-Born Infants in the First 7 Months of Life. Glob Pediatr Health 2020; 7:2333794X20952688. [PMID: 32953946 PMCID: PMC7479869 DOI: 10.1177/2333794x20952688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/03/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022] Open
Abstract
Preterm infants frequently experience oral feeding challenges while in the
neonatal intensive care unit, with research focusing on infant feeding during
this hospital stay. There is little data on symptoms of problematic feeding in
preterm-born infants in the months after discharge. The purpose of this study
was to describe symptoms of problematic bottle-feeding in the first 7 months of
life in infants born preterm, compared to full-term infants. Parents of infants
less than 7 months old completed an online survey that included the Neonatal
Eating Assessment Tool—Bottle-feeding and questions about the infant’s medical
and feeding history. General linear models were used to evaluate differences in
NeoEAT—Bottle-feeding total score and subscale scores by preterm category,
considering other significant factors. Very preterm infants had more symptoms of
problematic bottle-feeding than other infants. Current age, presence of
gastroesophageal reflux, and anomalies of the face/mouth were associated with
problematic bottle-feeding.
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Affiliation(s)
- Rebecca R. Hill
- MGH Institute of Health Professions,
Boston, MA, USA
- Rebecca R. Hill, DNP, FNP-C, MGH Institute
of Health Professions, 36 First Avenue, Boston, MA 02129, USA.
| | - Jinhee Park
- William F. Connell School of Nursing,
Boston College, Chestnut Hill, MA, USA
| | - Britt F. Pados
- William F. Connell School of Nursing,
Boston College, Chestnut Hill, MA, USA
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Edmonds CE, Catchpole EA, Gould FDH, Bond LE, Stricklen BM, German RZ, Mayerl CJ. Preterm Birth Impacts the Timing and Excursion of Oropharyngeal Structures during Infant Feeding. Integr Org Biol 2020; 2:obaa028. [PMID: 33103058 PMCID: PMC7568519 DOI: 10.1093/iob/obaa028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Swallowing in mammals requires the precise coordination of multiple oropharyngeal structures, including the palatopharyngeal arch. During a typical swallow, the activity of the palatopharyngeus muscle produces pharyngeal shortening to assist in producing pressure required to swallow and may initiate epiglottal flipping to protect the airway. Most research on the role of the palatopharyngeal arch in swallowing has used pharyngeal manometry, which measures the relative pressures in the oropharynx, but does not quantify the movements of the structures involved in swallowing. In this study, we assessed palatopharyngeal arch and soft palate function by comparing their movements in a healthy population to a pathophysiological population longitudinally through infancy (term versus preterm pigs). In doing so, we test the impact of birth status, postnatal maturation, and their interaction on swallowing. We tracked the three-dimensional (3D) movements of radiopaque beads implanted into relevant anatomical structures and recorded feeding via biplanar high-speed videofluoroscopy. We then calculated the total 3D excursion of the arch and soft palate, the orientation of arch movement, and the timing of maximal arch constriction during each swallow. Soft palate excursion was greater in term infants at both 7 and 17 days postnatal, whereas arch excursion was largely unaffected by birth status. Maximal arch constriction occurred much earlier in preterm pigs relative to term pigs, a result that was consistent across age. There was no effect of postnatal age on arch or soft palate excursion. Preterm and term infants differed in their orientation of arch movement, which most likely reflects both differences in anatomy and differences in feeding posture. Our results suggest that the timing and coordination of oropharyngeal movements may be more important to feeding performance than the movements of isolated structures, and that differences in the neural control of swallowing and its maturation in preterm and term infants may explain preterm swallowing deficits.
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Affiliation(s)
- C E Edmonds
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA
| | - E A Catchpole
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA
| | - F D H Gould
- Department of Cell Biology and Neuroscience, Rowan School of Osteopathic Medicine, Stratford, NJ 08854, USA
| | - L E Bond
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA
| | - B M Stricklen
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA
| | - R Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA
| | - C J Mayerl
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA
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Turkish Neonatal Nurses' Knowledge and Practices Regarding the Transition to Oral Feeding in Preterm Infants: A Descriptive, Cross-sectional Study. J Pediatr Nurs 2020; 53:e179-e185. [PMID: 32321668 DOI: 10.1016/j.pedn.2020.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE Neonatal nurses play an important role in preterm infants' safe and successful transition to oral feeding. Little is known about neonatal nurses' knowledge and practices regarding the transition to oral feeding in preterm infants. The aim of this study was to determine neonatal nurses' knowledge levels and clinical practices related to the process of transitioning preterm infants to oral feeding. DESIGN AND METHOD This descriptive cross-sectional study was conducted with 275 neonatal nurses working in the neonatal intensive care units of 9 different hospitals in Istanbul, Turkey. Data were collected using a participant demographic form and a questionnaire about the neonatal nurses' knowledge and practices regarding oral feeding. RESULTS The mean knowledge score of the nurses in this study was 64.7 out of 100 (SD = ±8.7; range = 40-87.5). Rates of correct responses were particularly low for items related to cue-based feeding, interventions to promote oral-motor development, non-nutritive sucking, and infant positioning for oral feeding. All of the NICU nurses participating in the study did not use the protocols developed for transitioning preterm infants to oral feeding. CONCLUSIONS Nurses need knowledge and practical training on evidence-based therapeutic interventions that promote oral feeding skills in preterm infants during the transition to oral feeding. The use of protocols developed for transitioning preterm infants to oral feeding is limited in NICUs. PRACTICE IMPLICATIONS In order to facilitate safe and successful feeding, nurses should improve their knowledge and practical skills regarding the transition to oral feeding and evidence-based therapeutic interventions for preterm infants.
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Lau C. To Individualize the Management Care of High-Risk Infants With Oral Feeding Challenges: What Do We Know? What Can We Do? Front Pediatr 2020; 8:296. [PMID: 32582596 PMCID: PMC7297031 DOI: 10.3389/fped.2020.00296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Chantal Lau
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
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Mayerl CJ, Myrla AM, Gould FDH, Bond LE, Stricklen BM, German RZ. Swallow Safety is Determined by Bolus Volume During Infant Feeding in an Animal Model. Dysphagia 2020; 36:120-129. [PMID: 32328794 DOI: 10.1007/s00455-020-10118-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/15/2020] [Indexed: 12/14/2022]
Abstract
Feeding difficulties are especially prevalent in preterm infants, although the mechanisms driving these difficulties are poorly understood due to a lack of data on healthy infants. One potential mechanism of dysphagia in adults is correlated with bolus volume. Yet, whether and how bolus volume impacts swallow safety in infant feeding is unknown. A further complication for safe infant swallowing is recurrent laryngeal nerve (RLN) injury due to patent ductus arteriosus surgery, which exacerbates the issues that preterm infants face and can increase the risk of dysphagia. Here, we used a validated animal model feeding freely to test the effect of preterm birth, postnatal maturation and RLN lesion and their interactions on swallow safety. We also tested whether bolus size differed with lesion or birth status, and the relationship between bolus size and swallow safety. We found very little effect of lesion on swallow safety, and preterm infants did not experience more penetration or aspiration than term infants. However, term infants swallowed larger boluses than preterm infants, even after correcting for body size. Bolus size was the primary predictor of penetration or aspiration, with larger boluses being more likely to result in greater degrees of dysphagia irrespective of age or lesion status. These results highlight that penetration and aspiration are likely normal occurrences in infant feeding. Further, when comorbidities, such as RLN lesion or preterm birth are present, limiting bolus size may be an effective means to reduce incidences of penetration and aspiration.
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Affiliation(s)
- Christopher J Mayerl
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, USA.
| | - Alexis M Myrla
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, USA
| | - Francois D H Gould
- Department of Cell Biology and Neuroscience, Rowan School of Osteopathic Medicine, Stratford, NJ, USA
| | - Laura E Bond
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, USA
| | - Bethany M Stricklen
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, USA
| | - Rebecca Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, USA
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Mayerl CJ, Myrla AM, Bond LE, Stricklen BM, German RZ, Gould FDH. Premature birth impacts bolus size and shape through nursing in infant pigs. Pediatr Res 2020; 87:656-661. [PMID: 31645052 PMCID: PMC7082200 DOI: 10.1038/s41390-019-0624-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/16/2019] [Accepted: 09/29/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND The formation of a bolus of food is critical for proper feeding function, and there is substantial variation in the size and shape of a bolus prior to a swallow. Preterm infants exhibit decreased abilities to acquire and process food, but how that relates to their bolus size and shape is unknown. Here, we test two hypotheses: (1) that bolus size and shape will differ between term and preterm infants, and (2) bolus size and shape will change longitudinally through development in both term and preterm infants. METHODS To test these hypotheses, we measured bolus size and shape in preterm and term infant pigs longitudinally through nursing using high-speed videofluoroscopy. RESULTS Preterm infant pigs swallowed smaller volumes of milk. Although term infants increased the amount of milk per swallow as they aged, preterm infants did not. These changes in bolus volume were also correlated with changes in bolus shape; larger boluses became more elongate as they better filled the available anatomical space of the valleculae. CONCLUSIONS These results suggest that preterm birth reduces the ability of preterm pigs to increase bolus size as they grow, affecting development in this fragile population. These results highlight that studies on term infant feeding may not translate to preterm infants.
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Affiliation(s)
- Christopher J Mayerl
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH, 44272, USA.
| | - Alexis M Myrla
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH, 44272, USA
| | - Laura E Bond
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH, 44272, USA
| | - Bethany M Stricklen
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH, 44272, USA
| | - Rebecca Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH, 44272, USA
| | - Francois D H Gould
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH, 44272, USA
- Department of Cell Biology and Neuroscience, Rowan University School of Osteopathic Medicine, 42 East Laurel Road, Stratford, NJ, 08084, USA
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Development of Swallowing Function in Infants with Oral Feeding Difficulties. Int J Pediatr 2020; 2020:5437376. [PMID: 32089712 PMCID: PMC7023804 DOI: 10.1155/2020/5437376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/14/2019] [Accepted: 01/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background Discharge of preterm infants is often delayed because of their oral feeding difficulties. Independent oral feeding is the last obstacle to pass after managing acute and chronic morbidities. We conducted this study to determine the prevalence, characteristics, and risk factors of swallowing dysfunction and suggest proper interventions to reduce aspiration and chronic lung injury. Methods Infants admitted to the neonatal intensive care unit (January 2016 to December 2018) who were performed modified barium swallow study due to oral feeding difficulties were enrolled. Modified barium swallow study was done ≥ postmenstrual age 37 weeks to limit radiation exposure. Clinical data were collected retrospectively. Swallowing dysfunction was defined as inadequate epiglottic closure, laryngeal penetration, or tracheal aspiration according to result of the modified barium swallow study. Results Among a total of 54 infants enrolled, nine (16.7%) were term infants, 13 (24.1%) were late preterm infants (gestational age, 34-36 weeks), and 32 (59.3%) were early preterm infants (gestational age < 34 weeks). Gestational age and birth weight were smaller in infants with swallowing dysfunction. Total duration of mechanical ventilation and duration of invasive ventilation were longer in infants with swallowing dysfunction. The risk of swallowing dysfunction increased by 11.2 times for infants with gestational age < 29 weeks compared to infants with gestational age ≥ 29 weeks. Swallowing dysfunction was improved in most infants after they became matured. They showed different time and rate of maturation with the help of rehabilitation through swallow therapy and dietary modification with thickened formula. Conclusion Preterm infants with gestational age < 29 weeks or with longer ventilation duration are at a higher risk of aspiration. Rehabilitation of swallow therapy and dietary modification with thickened formula can be helpful interventions to prevent aspiration and chronic lung injury and reassure parents until independent oral feeding is possible.
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Chericoni A, Tosi J, Visco AM, Lubrano R, Taffoni F. Assessment of feeding teats: an experimental study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:3726-3729. [PMID: 31946684 DOI: 10.1109/embc.2019.8857796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This work aims to present a quantitative metric to assess the impact of feeding teats on the nutritive sucking of newborns. Two different teat models are compared: a classical model (model C), and a model provided with two opposite recesses to match the anatomical characteristics of the mouth of a newborn (model I). This latter feeding teat model has been specifically designed to promote the attachment of the baby, thus improving her/his nutritive sucking performance.Feeding teats are instrumented with a device to assess nutritive sucking (the Feeding Assessment Monitor, FAM). The device records feeding pressures and a software extracts quantitative features already used and validated in clinical applications.Comparative cross-over analysis on 30 healthy newborns, demonstrates the appropriateness of the proposed metric to reveal differences in the teat models. In particular, our data confirm the better attachment of newborns when fed with the I model: they show a longer feeding, with higher level of depressurization, higher regularity, and higher number of sucking events.
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Tamilia E, Parker MS, Rocchi M, Taffoni F, Hansen A, Grant PE, Papadelis C. Nutritive sucking abnormalities and brain microstructural abnormalities in infants with established brain injury: a pilot study. J Perinatol 2019; 39:1498-1508. [PMID: 31462720 DOI: 10.1038/s41372-019-0479-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/14/2019] [Accepted: 07/20/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine the relationship between nutritive sucking and microstructural integrity of sensorimotor tracts in newborns with brain injury. STUDY DESIGN Diffusion imaging was performed in ten newborns with brain injury. Nutritive sucking was assessed using Nfant®. The motor, sensory, and corpus callosum tracts were reconstructed via tractography. Fractional anisotropy, radial, axial, and mean diffusivity were estimated for these tracts. Multiple regression models were developed to test the association between sucking features and diffusion parameters. RESULTS Low-sucking smoothness correlated with low-fractional anisotropy of motor tracts (p = 0.0096). High-sucking irregularity correlated with high-mean diffusivity of motor (p = 0.030) and corpus callosum tracts (p = 0.032). For sensory tracts, high-sucking irregularity (p = 0.018) and low-smoothness variability (p = 0.002) correlated with high-mean diffusivity. INTERPRETATION We show a correlation between neuroimaging-demonstrated microstructural brain abnormalities and variations in sucking patterns of newborns. The consistency of this relationship should be shown on larger cohorts.
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Affiliation(s)
- Eleonora Tamilia
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marianna S Parker
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maria Rocchi
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fabrizio Taffoni
- Laboratory of Biomedical Robotics and Biomicrosystems, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Anne Hansen
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - P Ellen Grant
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christos Papadelis
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. .,Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. .,Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, USA.
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Czajkowska M, Fonfara A, Królak-Olejnik B, Michnikowski M, Gólczewski T. The impact of early therapeutic intervention on the central pattern generator in premature newborns - a preliminary study and literature review. DEVELOPMENTAL PERIOD MEDICINE 2019. [PMID: 31654996 PMCID: PMC8522407 DOI: 10.34763/devperiodmed.20192303.178183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim: To study the effect of therapeutic intervention on the improvement of the rhythmicity of non-nutritive and nutritive sucking in premature newborns and on the suck central pattern generator. PATIENTS AND METHODS Material and methods: Stimulation of the breast zone was performed in two premature newborns by means of the Vojta method. Intraoral pressure was measured during non-nutritive and nutritive sucking before and after this therapeutic intervention. The maximum negative pressures generated during individual sucks and the intervals between sucks were analysed. RESULTS Results: The stimulation of the breast zone using the Vojta method seems to have no impact on the duration of individual sucking episodes. However, a significant improvement in the rhythmicity and regularity of sucking was observed in both newborns: the coefficient of quartile deviation for the intervals decreased from 15% and 11% to 13% and 6%, respectively, and for the maximum negative pressures it decreased from 24% and 27% to 9% and 19%, respectively. Additionally, the median value of the maximum negative pressure decreased in both newborns: from -39 and -37 mmHg to -45 and -60 mmHg, respectively. CONCLUSION Conclusions: The stimulation of the breast zone using the Vojta method seems to have a direct impact on the central pattern generator, which improves the rhythmicity as well as the regularity of both non-nutritive and nutritive sucking.
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Affiliation(s)
- Magdalena Czajkowska
- Department of Neonatology, Wroclaw Medical University, Wroclaw, Poland,Magdalena Czajkowskaul. Oleska 97C/205, 45-222 Opole tel. kont. +48 601-744-820
| | - Anna Fonfara
- Department of Neonatology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Marcin Michnikowski
- Nałęcz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Tomasz Gólczewski
- Nałęcz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
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Prabhakar V, Hasenstab KA, Osborn E, Wei L, Jadcherla SR. Pharyngeal contractile and regulatory characteristics are distinct during nutritive oral stimulus in preterm-born infants: Implications for clinical and research applications. Neurogastroenterol Motil 2019; 31:e13650. [PMID: 31131508 PMCID: PMC6793932 DOI: 10.1111/nmo.13650] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/07/2019] [Accepted: 05/16/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Maturation of pharyngeal swallowing during neonatal oral feeding is unknown. Our objective was to evaluate pharyngeal functioning using high-resolution manometry (HRM) during nutritive oral stimulus and test the hypothesis that pharyngeal contractility and regulation are distinct in preterm-born infants. METHODS High-resolution manometry data during oral milk feeding were analyzed for pharyngeal contractile (PhCI, mm Hg cm s) and regulatory (number and frequency of pharyngeal contractions and bursts, pharyngeal activity-to-quiescence ratio, upper esophageal sphincter nadir pressure) characteristics in 23 preterm (<38 weeks' gestation) and 18 full-term-born infants at term maturation. Mixed linear models and stepwise regression methods were used. RESULTS Despite more oral feeding experiences (P < 0.05), preterm infants (vs full-term), consumed less milk volume (P < 0.001), had lesser pharyngeal contractions within bursts (P = 0.04), lower pharyngeal contraction frequency (P < 0.01), and lower pharyngeal activity (P = 0.03), but higher PhCI per individual contraction (P = 0.01). PhCI is higher for longer PMA (P < 0.05), higher UES nadir pressures (P < 0.05), and lower pharyngeal contraction frequency (P < 0.05). CONCLUSIONS Nutritive oral milk stimulus provoked pharyngeal contractility characteristics is distinct in preterm-born. Despite more oral nutritive experiences, preterm infants had underdeveloped excitatory and inhibitory rhythmic activity. Cranial nerve IX and X effects on sensory-motor responses and feedback (excitation-inhibitory rhythm regulation) remain immature among preterm-born even at full-term maturational status. We speculate the relationship between PhCI and UES regulatory activity contributes to the observed differences in preterm and full-term infants.
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Affiliation(s)
- Varsha Prabhakar
- Innovative Infant Feeding Disorders Research Program, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Kathryn A. Hasenstab
- Innovative Infant Feeding Disorders Research Program, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Erika Osborn
- Innovative Infant Feeding Disorders Research Program, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Lai Wei
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Sudarshan R. Jadcherla
- Innovative Infant Feeding Disorders Research Program, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,Division of Neonatology, Pediatric Gastroenterology and Nutrition, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
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Catchpole E, Bond L, German R, Mayerl C, Stricklen B, Gould FDH. Reduced Coordination of Hyolaryngeal Elevation and Bolus Movement in a Pig Model of Preterm Infant Swallowing. Dysphagia 2019; 35:334-342. [PMID: 31297599 DOI: 10.1007/s00455-019-10033-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/30/2019] [Accepted: 07/02/2019] [Indexed: 01/13/2023]
Abstract
Preterm infants often have dysphagia. Because reducing lifetime cumulative exposure to radiation in the context of diagnosis and treatment is a continuing goal of all medical fields which use X-ray imaging, efforts exist to reduce reliance on the gold standard diagnostic tool for dysphagia, VFSS. Alternatives, such as video of external hyolaryngeal movement using video recordings of the anterior surface of the neck, must be evaluated and validated against videofluoroscopy, a task for which non-human animal models are appropriate. In this study, we tested the hypotheses that (1) swallows could be identified equally well from video of external hyolaryngeal movement and bolus movement in videofluoroscopy, and that (2) the two measures would be tightly temporally linked in both term and preterm infant pigs. We recorded 222 swallows in simultaneous and precisely synchronized high-speed videofluoroscopy and high-speed camera films of 4 preterm and 3 term infant pigs drinking milk from a bottle. In term pigs, the two measures consistently identified the same swallows in each image stream. However, in preterm pigs there was a high rate of false positives (~ 10% per feeding sequence) and false negatives (~ 27% per feeding sequence). The timing of hyolaryngeal elevation (external video) and bolus movement (videofluoroscopy) was correlated and consistent in terms pigs, but not in preterm pigs. Magnitude of hyolaryngeal elevation was less in preterm pig swallows than term pig swallows. Absence of epiglottal inversion in preterm pigs was not linked to variation in the timing of the two swallow events. Video of external hyolaryngeal movement, though a reliable swallow indicator in term infant pigs, was unreliable in preterm infant pigs. The coordination of swallowing events differs in preterm and term infant pigs. More research is needed into the distinctive biomechanics of preterm infant pigs.
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Affiliation(s)
| | | | | | | | | | - François D H Gould
- Department of Cell Biology and Neuroscience, Rowan University School of Osteopathic Medicine, 42 East Laurel road, Stratford, NJ, 08084, USA.
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Mayerl CJ, Gould FDH, Bond LE, Stricklen BM, Buddington RK, German RZ. Preterm birth disrupts the development of feeding and breathing coordination. J Appl Physiol (1985) 2019; 126:1681-1686. [PMID: 31018743 DOI: 10.1152/japplphysiol.00101.2019] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
All mammals must breathe and breathe continuously from birth. Similarly, all mammals, including infants, have high functional demands for feeding. However, the pathway that food takes through the pharynx interrupts respiration. The coordination between swallowing and breathing is therefore critical for all infant mammals. Clinically, this coordination differs between term and preterm infants. However, the neurological mechanisms underlying this coordination and how it matures as infants grow are poorly understood. Here, we integrate high-resolution data from multiple physiologic processes across a longitudinal time frame to study suck-swallow-breathe dynamics in a preterm animal model, the infant pig. In doing so, we test the hypothesis that preterm birth will have an impact on some, but not all, behaviors associated with suck-swallow-breath performance. We hypothesize that coordination will be disrupted, reflecting incomplete connections in the brainstem. We found that preterm pigs became rhythmic and mature in sucking and swallowing behaviors, suggesting substantial postnatal maturation in the coordination of these behaviors. However, their ability to coordinate swallowing and breathing never developed. These results have implications for the nature of clinical care of human infants, as well as for how feeding processes develop in mammals. Clinically, they provide a foundation for developing interventions for preterm infants. Additionally, these results suggest that the lack of coordination between swallowing and breathing may be a significant factor in determining the minimum gestation time across mammals. NEW & NOTEWORTHY Preterm infants face a variety of challenges associated with safe feeding, but obtaining high-resolution longitudinal data to understand these challenges in humans is challenging. We used a pig model to acquire high-speed videofluoroscopic and respiratory inductance plethysmograph data throughout the nursing period to show that preterm birth does not have substantial impacts on the ability of infants to perform isolated behaviors. However, it does decrease the ability of preterm infants to coordinate among behaviors during feeding.
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Affiliation(s)
- Christopher J Mayerl
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown Ohio
| | - Francois D H Gould
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown Ohio
| | - Laura E Bond
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown Ohio
| | - Bethany M Stricklen
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown Ohio
| | - Randal K Buddington
- University of Tennessee Health Science Center, College of Nursing , Memphis, Tennessee
| | - Rebecca Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown Ohio
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Perrella SL, Nancarrow K, Trevenen M, Murray K, Geddes DT, Simmer KN. Effect of vacuum-release teat versus standard teat use on feeding milestones and breastfeeding outcomes in very preterm infants: A randomized controlled trial. PLoS One 2019; 14:e0214091. [PMID: 30901356 PMCID: PMC6430377 DOI: 10.1371/journal.pone.0214091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/05/2019] [Indexed: 01/17/2023] Open
Abstract
Background Breast milk is important to infant health, yet shorter breastfeeding duration is reported for preterm infants. Both breast and bottle feeds are given in the neonatal unit, with full oral feeding often the last milestone to be achieved prior to discharge home. Unlike standard bottle teats, a vacuum release teat requires the application of negative intra-oral pressure to release milk, and so may facilitate breastfeeding in preterm infants. The objective of this study was to determine the effect of vacuum release teat use on timing of achievement of the first full oral feed and on first completion of 24 h full oral feeds. Feeding method at discharge home, 2 weeks, 6 weeks and 12 weeks corrected gestational age were also examined. Methods A randomized controlled trial was completed with mothers of preterm infants born 24–33 weeks gestation in the neonatal unit of a tertiary women’s hospital. Infants were randomized to one of two parallel groups using a vacuum release teat or standard teat for oral feeds when the mother was not available to breastfeed. Test weights were completed for all oral feeds. It was not possible to blind participants, care givers and outcome assessors to group assignment due to the nature of the study. Results The groups did not differ with regard to timing of achievement of first full oral feed or 24 h of full oral feeds. Significantly more infants in the vacuum release teat group were exclusively fed breast milk at discharge from hospital and breastfed at 3 months corrected gestational age. Conclusions Use of a vacuum release teat when the mother is not available to breastfeed may promote preterm breastfeeding skills, resulting in higher rates of exclusivity and longer breastfeeding duration. Trial registration The trial is registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000245594.
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Affiliation(s)
- Sharon Lisa Perrella
- School of Molecular Sciences, Faculty of Science, The University of Western Australia, Crawley, Western Australia, Australia
- * E-mail:
| | - Kathryn Nancarrow
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Michelle Trevenen
- School of Mathematics and Statistics, Faculty of Engineering and Mathematical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Kevin Murray
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Donna Tracy Geddes
- School of Molecular Sciences, Faculty of Science, The University of Western Australia, Crawley, Western Australia, Australia
| | - Karen Norrie Simmer
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
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48
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White BR, Zhang C, Presson AP, Friddle K, DiGeronimo R. Prevalence and outcomes for assisted home feeding in medically complex neonates. J Pediatr Surg 2019; 54:465-470. [PMID: 29937107 DOI: 10.1016/j.jpedsurg.2018.05.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/30/2018] [Accepted: 05/27/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To describe the prevalence and outcome of assisted home feeding (AHF) in medically complex neonatal intensive care unit (NICU) patients, and to identify variables associated with AHF in this population. STUDY DESIGN 1223 infants who survived to discharge from 2013 to 2015 were identified in our single-center, retrospective cohort study at a large tertiary referral NICU. Demographic and selected disease-specific variables were compared between infants discharged on full oral feeding (PO) versus AHF. RESULT 404 (33%) infants were discharged on AHF (NG = 201, GT = 186, NJ = 17). AHF neonates were born at an earlier gestational age, lower birth weight, had longer hospital admission, greater post-menstrual age at discharge, and had more associated co-morbidities compared to the PO group. CONCLUSION AHF was a frequently used and safe intervention in our large cohort of infants. LEVEL OF EVIDENCE Treatment Study Level III.
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Affiliation(s)
- Benjamin R White
- Department of Pediatrics, University of Utah, School of Medicine; Division of Neonatology, University of Utah, School of Medicine.
| | - Chong Zhang
- Department of Internal Medicine, Division of Epidemiology, University of Utah, School of Medicine
| | - Angela P Presson
- Department of Pediatrics, University of Utah, School of Medicine; Department of Internal Medicine, Division of Epidemiology, University of Utah, School of Medicine
| | - Kim Friddle
- University of Utah, College of Nursing, Salt Lake City, UT
| | - Robert DiGeronimo
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, WA
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49
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Khan Z, Sitter C, Dunitz‐Scheer M, Posch K, Avian A, Bresesti I, Urlesberger B. Full oral feeding is possible before discharge even in extremely preterm infants. Acta Paediatr 2019; 108:239-244. [PMID: 29953661 PMCID: PMC6585780 DOI: 10.1111/apa.14478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 05/17/2018] [Accepted: 06/26/2018] [Indexed: 12/01/2022]
Abstract
AIM This study described the steps needed to achieve full oral feeding before discharge in a group of very and extremely preterm (EPT) infants. We analysed the effects of oral feeding skills on discharge timing and on weight gain during their neonatal intensive care unit (NICU) stay. METHODS A prospective cross-sectional observational study of 100 infants who were <32 weeks of gestation (GA) was conducted at the Division of Neonatology, Graz, Austria, from March 2014 to February 2015. Patients were stratified into two groups: those who were <28 weeks at birth and those who were 28 weeks and over. Velocity of oral feeding skills attainment and weight gain were analysed. RESULTS All infants successfully acquired oral feeding skills during hospitalisation. The median GA at which full oral feeding skills were reached was 37 + 1 weeks in EPT and 34 + 5 weeks in very preterm infants. More immature neonates showed worse feeding performances and lower weight increments during oral feeding steps. CONCLUSION Our study confirmed the role of GA in the development of oral feeding skills in the most premature babies. It also raises the question of whether expected daily weight gain should be targeted according to GA.
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Affiliation(s)
- Zahra Khan
- Division of NeonatologyMedical University of GrazGrazAustria
- Department of Food Science and Human NutritionUniversity of Veterinary and Animal SciencesLahorePakistan
| | - Cornelia Sitter
- Division of NeonatologyMedical University of GrazGrazAustria
| | | | - Katrin Posch
- Division of NeonatologyMedical University of GrazGrazAustria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and DocumentationMedical University of GrazGrazAustria
| | - Ilia Bresesti
- Division of NeonatologyMedical University of GrazGrazAustria
- Division of NeonatologyV. Buzzi Children's HospitalASST‐FBF‐SaccoMilanItaly
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50
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Visser EE, Krüger EE, AM Kritzinger AM, Kritzinger AM. Feeding difficulties in infants with unrepaired cleft lip and palate and HIV-exposure. Afr Health Sci 2018; 18:1098-1108. [PMID: 30766576 PMCID: PMC6354895 DOI: 10.4314/ahs.v18i4.31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is limited description of the feeding characteristics of infants with unrepaired cleft lip and palate, exposed to HIV, but not necessarily infected. OBJECTIVE To compare the feeding characteristics of infants with unrepaired cleft lip and palate and HIV-exposure, to infants with unrepaired cleft lip and palate only. METHOD A two-group comparative design with a validated measure, the Neonatal Feeding Assessment Scale was used. The effectiveness of oral feeding skills were included as objective measure. Twelve participants with unrepaired cleft lip and palate and HIV-exposure and 13 with unrepaired cleft lip and palate were matched according to cleft type and use of feeding obturator. There were no differences between the groups for mean age, birth weight and gestation. Participants were between two and 89 days old, bottle fed, and had no syndrome/co-occurring disorder. RESULTS Nine (75%) participants in the research group and only two (15.38%) in the control grouppresented with the likelihood of oropharyngeal dysphagia. Apart from feeding difficulties as a result of structural impairment, the research group showed symptoms of neurological involvement. CONCLUSION The research group presented with distinctive symptoms of oropharyngeal dysphagia. More studies using different measuring tools are required to strengthen the evidence.
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Affiliation(s)
| | | | | | - A M Kritzinger
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria Private Bag X20, Hatfield 0028
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