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Martens A, Phillips H, Hines M, Zimmerman E. An examination of the association between infant non-nutritive suck and developmental outcomes at 12 months. PLoS One 2024; 19:e0298016. [PMID: 38315689 PMCID: PMC10843074 DOI: 10.1371/journal.pone.0298016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To determine the association between infant non-nutritive suck (NNS) dynamics at 3 months and developmental outcomes at 12 months of age in full-term infants. We hypothesized that infants with more mature NNS at 3 months, as evidence by shorter burst duration, fewer cycles per burst, cycles per minute, higher amplitude, and more bursts, would have higher (better) scores on the developmental outcomes at 12 months. METHODS This was a prospective study that utilized objective and self-report measures. A five-minute NNS sample was collected from 67 infants (54% male) at 3 months of age (average age 2.99 (0.27) months). At 12 months (average age 11.91 (0.26) months), the Development Profile-3 was administered through caregiver interview. RESULTS Infant NNS burst duration, cycles per burst, and cycles per minute were significantly negatively associated with the Development Profile-3 cognitive domain and general scores at 12 months. This is consistent with our hypothesis that infants who have more efficient NNS (fewer bursts and cycles) at 3 months would have higher (better) scores on the Development Profile-3 at 12 months. CONCLUSIONS Findings from this work complement emerging research linking infant NNS with subsequent neurodevelopmental outcomes. This is the first time that these associations have been examined using a quantitative and physiologic-based measure of NNS. These results seem to indicate that specific NNS metrics, which demonstrate maturation of this complex skill, may be useful predictors of neurodevelopment later in life.
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Affiliation(s)
- Alaina Martens
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, United States of America
| | - Hannah Phillips
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, United States of America
| | - Morgan Hines
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, United States of America
| | - Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, United States of America
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Barlow SM, Liao C, Lee J, Kim S, Maron JL, Song D, Jegatheesan P, Govindaswami B, Wilson BJ, Bhakta K, Cleary JP. Spectral features of non-nutritive suck dynamics in extremely preterm infants. PEDIATRIC MEDICINE (HONG KONG, CHINA) 2023; 6:23. [PMID: 37900782 PMCID: PMC10611428 DOI: 10.21037/pm-21-91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Background Non-nutritive suck (NNS) is used to promote ororhythmic patterning and assess oral feeding readiness in preterm infants in the neonatal intensive care unit (NICU). While time domain measures of NNS are available in real time at cribside, our understanding of suck pattern generation in the frequency domain is limited. The aim of this study is to model the development of NNS in the frequency domain using Fourier and machine learning (ML) techniques in extremely preterm infants (EPIs). Methods A total of 117 EPIs were randomized to a pulsed or sham orocutaneous intervention during tube feedings 3 times/day for 4 weeks, beginning at 30 weeks post-menstrual age (PMA). Infants were assessed 3 times/week for NNS dynamics until they attained 100% oral feeding or NICU discharge. Digitized NNS signals were processed in the frequency domain using two transforms, including the Welch power spectral density (PSD) method, and the Yule-Walker PSD method. Data analysis proceeded in two stages. Stage 1: ML longitudinal cluster analysis was conducted to identify groups (classes) of infants, each showing a unique pattern of change in Welch and Yule-Walker calculations during the interventions. Stage 2: linear mixed modeling (LMM) was performed for the Welch and Yule-Walker dependent variables to examine the effects of gestationally-aged (GA), PMA, sex (male, female), patient type [respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD)], treatment (NTrainer, Sham), intervention phase [1, 2, 3], cluster class, and phase-by-class interaction. Results ML of Welch PSD method and Yule-Walker PSD method measures revealed three membership classes of NNS growth patterns. The dependent measures peak_Hz, PSD amplitude, and area under the curve (AUC) are highly dependent on PMA, but show little relation to respiratory status (RDS, BPD) or somatosensory intervention. Thus, neural regulation of NNS in the frequency domain is significantly different for each identified cluster (classes A, B, C) during this developmental period. Conclusions Efforts to increase our knowledge of the evolution of the suck central pattern generator (sCPG) in preterm infants, including NNS rhythmogenesis will help us better understand the observed phenotypes of NNS production in both the frequency and time domains. Knowledge of those features of the NNS which are relatively invariant vs. other features which are modifiable by experience will likewise inform more effective treatment strategies in this fragile population.
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Affiliation(s)
- Steven M. Barlow
- Department of Communication Disorders and Department of Biological Systems Engineering, Center for Brain, Biology & Behavior, University of Nebraska, Lincoln, NE, USA
| | - Chunxiao Liao
- Department of Biochemistry, Baylor College of Medicine, Houston, TX, USA
| | - Jaehoon Lee
- Department of Educational Psychology, Leadership & Counseling, Texas Tech University, Lubbock, TX, USA
| | - Seungman Kim
- Department of Educational Psychology, Leadership & Counseling, Texas Tech University, Lubbock, TX, USA
| | - Jill L. Maron
- Division of Newborn Medicine, Tufts Medical Center, Boston, MA, USA
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, USA
- Division of Newborn Medicine, Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - Dongli Song
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Priya Jegatheesan
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Balaji Govindaswami
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Bernard J. Wilson
- Division of Neonatal-Perinatal Medicine, CHI Health St. Elizabeth, Lincoln, NE, USA
| | - Kushal Bhakta
- Neonatology, Children’s Hospital of Orange County, Orange, CA, USA
- Department of Pediatrics, University of California-Irvine, Irvine, CA, USA
| | - John P. Cleary
- Neonatology, Children’s Hospital of Orange County, Orange, CA, USA
- Department of Pediatrics, University of California-Irvine, Irvine, CA, USA
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Zimmerman E, Aguiar A, Aung MT, Geiger SD, Hines M, Woodbury ML, Martens A, Huerta-Montanez G, Cordero JF, Meeker JD, Schantz SL, Alshawabkeh AN. Examining the association between prenatal maternal stress and infant non-nutritive suck. Pediatr Res 2023; 93:1285-1293. [PMID: 34916626 PMCID: PMC9200902 DOI: 10.1038/s41390-021-01894-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study examined the relationship between prenatal maternal stress (PREMS) and non-nutritive suck (NNS) and tested its robustness across 2 demographically diverse populations. METHODS The study involved 2 prospective birth cohorts participating in the national Environmental influences on Child Health Outcomes (ECHO) Program: Illinois Kids Development Study (IKIDS) and ECHO Puerto Rico (ECHO-PROTECT). PREMS was measured during late pregnancy via the 10-item Perceived Stress Scale (PSS-10). NNS was sampled from 1- to 8-week-olds using a custom pacifier for ~5 min. RESULTS Overall, 237 mother-infant dyads completed this study. Despite several significant differences, including race/ethnicity, income, education, and PREMS levels, significant PREMS-NNS associations were found in the 2 cohorts. In adjusted linear regression models, higher PREMS, measured through PSS-10 total scores, related to fewer but longer NNS bursts per minute. CONCLUSIONS A significant association was observed between PREMS and NNS across two diverse cohorts. This finding is important as it may enable the earlier detection of exposure-related deficits and, as a result, earlier intervention, which potentially can optimize outcomes. More research is needed to understand how NNS affects children's neurofunction and development. IMPACT In this double-cohort study, we found that higher maternal perceived stress assessed in late pregnancy was significantly associated with fewer but longer sucking bursts in 1- to 8-week-old infants. This is the first study investigating the association between prenatal maternal stress (PREMS) and infant non-nutritive suck (NNS), an early indicator of central nervous system integrity. Non-nutritive suck is a potential marker of increased prenatal stress in diverse populations. Non-nutritive suck can potentially serve as an early indicator of exposure-related neuropsychological deficits allowing for earlier interventions and thus better prognoses.
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Affiliation(s)
- Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, USA.
| | - Andréa Aguiar
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Max T Aung
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Sarah Dee Geiger
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Morgan Hines
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, USA
| | - Megan L Woodbury
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Alaina Martens
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, USA
| | | | - José F Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Susan L Schantz
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Kim C, Zimmerman E, Huerta-Montañez G, Rosario-Pabón ZY, Vélez-Vega CM, Alshawabkeh AN, Cordero JF, Meeker JD, Watkins DJ. Associations between biomarkers of prenatal metals exposure and non-nutritive suck among infants from the PROTECT birth cohort in Puerto Rico. FRONTIERS IN EPIDEMIOLOGY 2022; 2:1057515. [PMID: 38455310 PMCID: PMC10911005 DOI: 10.3389/fepid.2022.1057515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/15/2022] [Indexed: 03/09/2024]
Abstract
Background/Aim Infant non-nutritive suck (NNS) has been used as an early marker of neonatal brain function. Although there is an established relationship between prenatal exposure to certain metals and brain development, the association between metal exposure and NNS has not been explored. Therefore, in this study we assessed associations between maternal urinary metal(loid) concentrations and NNS measurements among infants from the Puerto Rico PROTECT birth cohort. We hypothesized that maternal urinary metal(loid) concentrations are significantly associated with infant NNS measures in a sex-dependent manner. Methods We measured urinary concentrations of 14 metal(loid)s in pregnant women at up to three time points in pregnancy. The geometric mean of each metal(loid) for each pregnant woman was calculated and used as an exposure measurement across gestation. NNS measurements (duration, frequency, amplitude, bursts/min, cycles/burst, cycles/min) were collected from infants between 4 and 6 (±2 weeks) weeks of age using our custom research pacifier. Linear regression was used to estimate associations between urinary metal(loid) concentrations across pregnancy and continuous NNS variables. Sex-specific effects were estimated using interaction terms between NNS variables and infant sex. Results We observed significant positive associations between mercury, manganese, and tin with NNS duration (mercury: %Δ = 1.08, 95% CI: 0.42, 1.74; manganese: %Δ = 0.67, 95% CI: 0.15, 1.20; tin: %Δ = 0.83, 95% CI: 0.17, 1.49) and NNS cycles/burst (mercury: %Δ = 1.85, 95% CI: 0.58, 3.11; manganese: (%Δ = 1.37, 95% CI: 0.40, 2.34; tin: %Δ = 1.68, 95% CI: 0.46, 2.91). Furthermore, the association between NNS cycles/min with cadmium (%Δ = 8.06, 95% CI: 3.33, 12.78), manganese (%Δ = 4.44, 95% CI: 1.40, 7.47), and tin (%Δ = 4.50, 95% CI: 0.81, 8.18) were in the opposite direction from its association with zinc (%Δ = -9.30, 95% CI: -14.71, -3.89), as well as with copper (%Δ = -6.58, 95% CI: -12.06, -1.10). For the sex-stratified analysis, the negative associations between metal(loid)s and NNS duration were predominantly driven by male infants; however, the negative associations between metal(loid)s and NNS bursts/min were mainly driven by female infants. Conclusion We observed significant associations between prenatal metal(loid) exposure and NNS measurements among infants from the ongoing Puerto Rico PROTECT cohort. Similar to previous studies that have demonstrated associations between NNS and subsequent neurodevelopment, this study highlights the potential of NNS as a quantitative index to measure altered neurodevelopment from prenatal metal(loid) exposures. We believe this study will inform future efforts aimed at reducing health risks related to early life metal exposures, such as developing early identification of metal-induced adverse outcomes in child neurodevelopment.
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Affiliation(s)
- Christine Kim
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, United States
| | - Gredia Huerta-Montañez
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, United States
| | - Zaira Y. Rosario-Pabón
- UPR Medical Sciences Campus, University of Puerto Rico Graduate School of Public Health, San Juan, Puerto Rico
| | - Carmen M. Vélez-Vega
- UPR Medical Sciences Campus, University of Puerto Rico Graduate School of Public Health, San Juan, Puerto Rico
| | | | - José F. Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, United States
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Deborah J. Watkins
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
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Wahyuni LK, Mangunatmadja I, Kaban RK, Rachmawati EZK, Harini M, Laksmitasari B, Geraldyne A, Sangwidjojo IA, Utami DP, Poernomo VP, Sudjono AP. Non-nutritive sucking milestones of preterm infants in Indonesia: a descriptive study. PAEDIATRICA INDONESIANA 2022. [DOI: 10.14238/pi62.5.2022.311-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Non-nutritive sucking (NNS) maturity has been used as one of the markers of oral feeding readiness in infants. Prematurity may hinder the attainment of NNS milestones. Depending on gestational age (GA) at birth, preterm infants may display various degrees of immaturity, potentially affecting the strength, coordination, and efficiency of skills required for NNS.
Objective To identify the progression of NNS patterns across gestational age groups of preterm infants in Indonesia by comparing NNS parameters between moderate-to-late preterm and very preterm infants.
Methods NNS evaluation was conducted in 120 preterm infants born at 28-34 weeks gestational age in five tertiary hospitals in Jakarta, Indonesia. Three aspects of NNS (suction pressure, number of suctions per burst, and time between bursts) were documented and arranged to present a descriptive overview. A suction pressure measurement device was used to record, identify, and analyze NNS parameters. We hypothesize that maturity, as determined by GA, positively affected the attainment of NNS milestones.
Results Moderate-to-late preterm infants (GA 32 to <37 weeks), compared to very preterm infants (GA 28 to <32 weeks), had higher mean NNS pressure (-79.8 vs. -72.7 mmHg, respectively, P=0.041) and shorter mean time between bursts (6.63 vs. 7.36 s, respectively, P=0.030). Mean number of suctions per burst were also significantly different between the two GA groups (8.90 vs. 8.99 sucks/burst, respectively, P=0.048).
Conclusion Maturity, as reflected by GA, had a positive effect on the attainment of NNS milestones in preterm infants in Indonesia. Significant differences in the three NNS parameters: number of suctions per burst, time between bursts, and suction pressure were found between moderate-to-late preterm and very preterm infants.
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Hines M, Hardy N, Martens A, Zimmerman E. Birth Order Effects on Breastfeeding Self-Efficacy, Parent Report of Problematic Feeding and Infant Feeding Abilities. JOURNAL OF NEONATAL NURSING : JNN 2022; 28:16-20. [PMID: 35095321 PMCID: PMC8797021 DOI: 10.1016/j.jnn.2021.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The goal of this prospective study was to identify effects of birth order on breastfeeding self-efficacy, parental-report of infant feeding behaviors, infant non-nutritive sucking and oral feeding skills in full-term infants at 3-months. Mothers were separated into primipara and multipara groups, and infants were grouped into siblings and no siblings groups. Parents completed the Breastfeeding Self-Efficacy Scale-Short Form, and Neonatal Eating Assessment Tool-Breastfeeding and Bottle-feeding scales. Non-nutritive sucking was assessed using a custom research pacifier and researchers completed the Oral Feeding Skills scale to assess feeding performance. Fifty-six mother-infant dyads (55% male) were included. Primipara mothers reported significantly lower breastfeeding self-efficacy and more feeding problems across breast and bottle-feeds on the Neonatal Eating Assessment Tool. There were no significant differences in non-nutritive sucking or oral feeding skills between infant groups. First-time mothers require more infant feeding support as they exhibited lower breastfeeding self-efficacy and reported more problematic feeding behaviors.
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Zimmerman E, Watkins DJ, Huerta-Montanez G, Rosario Pabon Z, Feric Z, Manjourides J, Velez-Vega CM, Figueroa A, Hines M, Martens A, Cordero J, Alshwabekah A, Meeker JD. Associations of gestational phthalate exposure and non-nutritive suck among infants from the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) birth cohort study. ENVIRONMENT INTERNATIONAL 2021; 152:106480. [PMID: 33740674 PMCID: PMC8713051 DOI: 10.1016/j.envint.2021.106480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/15/2021] [Accepted: 02/19/2021] [Indexed: 06/10/2023]
Abstract
BACKGROUND Infant non-nutritive suck (NNS), or sucking on a pacifier with no nutrients being delivered, has been used as in index of brain function and has been linked to subsequent neurodevelopment. Yet, no data are available connecting NNS to environmental exposures in utero. The goal of this study was to examine the relationship between gestational exposure to phthalates (a group of chemicals found in personal care products, PVC plastics, and other products) and NNS among infants in a birth cohort study in Puerto Rico. METHODS Urinary phthalate metabolite levels were measured in women at up to three time points in pregnancy as a measure of in utero exposure to the child. We calculated the geometric mean of each metabolite for each woman as a measure of exposure across gestation. Infants had their NNS sampled using our custom research pacifier between 4-6 (± 2 weeks) weeks of age, yielding the following NNS dependent measures: cycles/burst, frequency, amplitude, bursts/min, and cycles/min. RESULTS Two hundred and eight mother-infant dyads completed this study We used multiple linear regression to assess associations between individual phthalate metabolites and NNS measurements, adjusting for infant sex, birthweight, and urinary specific gravity. An interquartile range (IQR) increase in mono carboxyisononyl phthalate across pregnancy was associated with 3.5% (95%CI: -6.2, -0.8%) lower NNS frequency and 8.9% (0.6, 17.3%) higher NNS amplitude. Similarly, an IQR increase in mono-2-ethylhexyl phthalate was also associated with 3.4% (-6.5, -0.2%) lower NNS frequency, while an IQR increase in di-2-ethylhexyl terephthalate metabolites was associated with 11.2% (2.9, 19.5%) higher NNS amplitude. Gestational exposure to phthalates may alter NNS amplitude and frequency in full-term infants. These findings indicate that the infants may be increasing their NNS amplitude to compensate for their slower NNS frequency. These preliminary findings could have important clinical implications for earlier detection of exposure-related deficits in neurofunction as well as implications for subsequent neurodevelopment and related interventions.
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Affiliation(s)
- Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts, USA.
| | - Deborah J Watkins
- University of Michigan School of Public Health, Department of Environmental Health Sciences, Ann Arbor, Michigan, USA
| | - Gredia Huerta-Montanez
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA
| | - Zaira Rosario Pabon
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA
| | - Zlatan Feric
- College of Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Justin Manjourides
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Carmen M Velez-Vega
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, Puerto Rico
| | - Abigail Figueroa
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, Puerto Rico
| | - Morgan Hines
- Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts, USA
| | - Alaina Martens
- Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts, USA
| | - José Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA
| | - Akram Alshwabekah
- College of Engineering, Northeastern University, Boston, Massachusetts, USA
| | - John D Meeker
- University of Michigan School of Public Health, Department of Environmental Health Sciences, Ann Arbor, Michigan, USA
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Non-nutritive suck and voice onset time: Examining infant oromotor coordination. PLoS One 2021; 16:e0250529. [PMID: 33905427 PMCID: PMC8078818 DOI: 10.1371/journal.pone.0250529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/08/2021] [Indexed: 11/19/2022] Open
Abstract
The variability of a child’s voice onset time (VOT) decreases during development as they learn to coordinate upper vocal tract and laryngeal articulatory gestures. Yet, little is known about the relationship between VOT and other early motor tasks. The aims of this study were to evaluate the relationship between infant vocalization and another early oromotor task, non-nutritive suck (NNS). Twenty-five full-term infants (11 male, 14 female) completed this study. NNS was measured with a customized pacifier at 3 months to evaluate this early reflex. Measures of mean VOT and variability of VOT (measured via coefficient of variation) were collected from 12-month-old infants using a Language Environmental Analysis device. Variability of VOTs at 12 months was significantly related to NNS measures at 3-months. Increased VOT variability was primarily driven by increased NNS intraburst frequency and increased NNS burst duration. There were no relationships between average VOT or range of VOT and NNS measures. Findings from this pilot study indicate a relationship between NNS measures of intraburst frequency and burst duration and VOT variability. Infants with increased NNS intraburst frequency and NNS burst duration had increased VOT variability, suggesting a relationship between the development of VOT and NNS in the first year of life. Future work is needed to continue to examine the relationship between these early oromotor actions and to evaluate how this may impact later speech development.
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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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Zimmerman E, Carpenito T, Martens A. Changes in infant non-nutritive sucking throughout a suck sample at 3-months of age. PLoS One 2020; 15:e0235741. [PMID: 32645061 PMCID: PMC7347146 DOI: 10.1371/journal.pone.0235741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 06/22/2020] [Indexed: 11/21/2022] Open
Abstract
The goal of this study was to compare how infants’ non-nutritive suck (NNS) changes throughout a suck sample. Fifty-four full-term infants (57% male) completed this study at, on average, 3.03 (SD .31) months of age. These infants sucked on our custom research pacifier for approximately five minutes. Infants produced, on average, 14.50 suck bursts during the sample. NNS data was pooled across subjects and breakpoint analyses were completed to determine if there were changes in their NNS patterning. Breakpoints were evident for NNS cycles per burst at burst numbers 18 and 34, and for amplitude (cmH20) at burst numbers 18 and 29. No breakpoints were present for NNS frequency. Infants exhibit changes in their suck physiology across burst number. When assessing suck, developmental specialists should observe more than one suck burst to attain a more valid and appropriate scope of the infant’s suck ability.
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Affiliation(s)
- Emily Zimmerman
- Department of Communication Sciences & Disorders, Northeastern University, Boston, Massachusetts, United States of America
- * E-mail:
| | - Thomas Carpenito
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America
| | - Alaina Martens
- Department of Communication Sciences & Disorders, Northeastern University, Boston, Massachusetts, United States of America
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Abstract
In the United States, preterm birth rates have steadily increased since 2014. Despite the recent advances in neonatal-perinatal care, more than 40% of very low-birth-weight infants develop chronic lung disease (CLD) and almost 25% have feeding difficulties resulting in delayed achievement of full oral feeds and longer hospital stay. Establishment of full oral feeds, a major challenge for preterm infants, becomes magnified among those on respiratory support and/or with CLD. The strategies to minimize aerodigestive disorders include supporting nonnutritive sucking, developing infant-directed feeding protocols, sensory oromotor stimulation, and early introduction of oral feeds.
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Liao C, Rosner AO, Maron JL, Song D, Barlow SM. Automatic Nonnutritive Suck Waveform Discrimination and Feature Extraction in Preterm Infants. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2019; 2019:7496591. [PMID: 30863456 PMCID: PMC6378788 DOI: 10.1155/2019/7496591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/08/2018] [Accepted: 12/26/2018] [Indexed: 11/18/2022]
Abstract
Background and Objective: The emergence of the nonnutritive suck (NNS) pattern in preterm infants reflects the integrity of the brain and is used by clinicians in the neonatal intensive care unit (NICU) to assess feeding readiness and oromotor development. A critical need exists for an integrated software platform that provides NNS signal preprocessing, adaptive waveform discrimination, feature detection, and batch processing of big data sets across multiple NICU sites. Thus, the goal was to develop and describe a cross-platform graphical user interface (GUI) and terminal application known as NeoNNS for single and batch file time series and frequency-domain analyses of NNS compression pressure waveforms using analysis parameters derived from previous research on NNS dynamics. Methods. NeoNNS was implemented with Python and the Tkinter GUI package. The NNS signal-processing pipeline included a low-pass filter, asymmetric regression baseline correction, NNS peak detection, and NNS burst classification. Data visualizations and parametric analyses included time- and frequency-domain view, NNS spatiotemporal index view, and feature cluster analysis to model oral feeding readiness. Results. 568 suck assessment files sampled from 30 extremely preterm infants were processed in the batch mode (<50 minutes) to generate time- and frequency-domain analyses of infant NNS pressure waveform data. NNS cycle discrimination and NNS burst classification yield quantification of NNS waveform features as a function of postmenstrual age. Hierarchical cluster analysis (based on the Tsfresh python package and NeoNNS) revealed the capability to label NNS records for feeding readiness. Conclusions. NeoNNS provides a versatile software platform to rapidly quantify the dynamics of NNS development in time and frequency domains at cribside over repeated sessions for an individual baby or among large numbers of preterm infants at multiple hospital sites to support big data analytics. The hierarchical cluster feature analysis facilitates modeling of feeding readiness based on quantitative features of the NNS compression pressure waveform.
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Affiliation(s)
- Chunxiao Liao
- Department of Computer Science and Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588-0115, USA
| | - Austin O. Rosner
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA 02111, USA
| | - Jill L. Maron
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA 02111, USA
| | - Dongli Song
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA 95128, USA
| | - Steven M. Barlow
- Department of Communication Disorders, University of Nebraska-Lincoln, Lincoln, NE 68583-0738, USA
- Department of Biological Systems Engineering, University of Nebraska-Lincoln, Lincoln, NE 68583-0726, USA
- Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, NE 68588-0156, USA
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Maturation Modulates Pharyngeal-Stimulus Provoked Pharyngeal and Respiratory Rhythms in Human Infants. Dysphagia 2017; 33:63-75. [PMID: 28828751 DOI: 10.1007/s00455-017-9833-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
Abstract
Pharyngeal-provocation induced aerodigestive symptoms in infants remain an enigma. Sources of pharyngeal provocation can be anterograde as with feeding, and retrograde as in gastroesophageal reflux. We determined maturational and dose-response effects of targeted pharyngeal-stimulus on frequency, stability, and magnitude of pharyngeal and respiratory waveforms during multiple pharyngeal swallowing responses in preterm-born infants when they were of full-term postmenstrual age (PMA). Eighteen infants (11 male) were studied longitudinally at 39.8 ± 4.8 weeks PMA (time-1) and 44.1 ± 5.8 weeks PMA (time-2). Infants underwent concurrent pharyngo-esophageal manometry, respiratory inductance plethysmography, and nasal airflow thermistor methods to test sensory-motor interactions between the pharynx, esophagus, and airway. Linear mixed models were used and data presented as mean ± SEM or %. Overall, responses to 250 stimuli were analyzed. Of the multiple pharyngeal swallowing responses (n = 160), with maturation (a) deglutition apnea duration decreases (p < 0.01), (b) number of pharyngeal waveform peaks and duration decreases for initial responses (p < 0.01), and subsequent responses have lesser variation and greater stability (p < 0.01). With increment in stimulus volumes we noted (a) increased prevalence (%) of pharyngeal responses (p < 0.05), (b) increased number of pharyngeal peaks (p < 0.05), yet pharyngeal frequency (Hz), variability, and stability remain unaffected (p > 0.05), and (c) respiratory changes were unaffected (p > 0.05). Initial and subsequent pharyngeal responses and respiratory rhythm interactions become more distinct with maturation. Interval oromotor experiences and volume-dependent increase in adaptive responses may be contributory. These mechanisms may be important in modulating and restoring respiratory rhythm normalcy.
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Barlow SM, Maron JL, Alterovitz G, Song D, Wilson BJ, Jegatheesan P, Govindaswami B, Lee J, Rosner AO. Somatosensory Modulation of Salivary Gene Expression and Oral Feeding in Preterm Infants: Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e113. [PMID: 28615158 PMCID: PMC5489710 DOI: 10.2196/resprot.7712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/28/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite numerous medical advances in the care of at-risk preterm neonates, oral feeding still represents one of the first and most advanced neurological challenges facing this delicate population. Objective, quantitative, and noninvasive assessment tools, as well as neurotherapeutic strategies, are greatly needed in order to improve feeding and developmental outcomes. Pulsed pneumatic orocutaneous stimulation has been shown to improve nonnutritive sucking (NNS) skills in preterm infants who exhibit delayed or disordered nipple feeding behaviors. Separately, the study of the salivary transcriptome in neonates has helped identify biomarkers directly linked to successful neonatal oral feeding behavior. The combination of noninvasive treatment strategies and transcriptomic analysis represents an integrative approach to oral feeding in which rapid technological advances and personalized transcriptomics can safely and noninvasively be brought to the bedside to inform medical care decisions and improve care and outcomes. OBJECTIVE The study aimed to conduct a multicenter randomized control trial (RCT) to combine molecular and behavioral methods in an experimental conceptualization approach to map the effects of PULSED somatosensory stimulation on salivary gene expression in the context of the acquisition of oral feeding habits in high-risk human neonates. The aims of this study represent the first attempt to combine noninvasive treatment strategies and transcriptomic assessments of high-risk extremely preterm infants (EPI) to (1) improve oral feeding behavior and skills, (2) further our understanding of the gene ontology of biologically diverse pathways related to oral feeding, (3) use gene expression data to personalize neonatal care and individualize treatment strategies and timing interventions, and (4) improve long-term developmental outcomes. METHODS A total of 180 extremely preterm infants from three neonatal intensive care units (NICUs) will be randomized to receive either PULSED or SHAM (non-pulsing) orocutaneous intervention simultaneous with tube feedings 3 times per day for 4 weeks, beginning at 30 weeks postconceptional age. Infants will also be assessed 3 times per week for NNS performance, and multiple saliva samples will be obtained each week for transcriptomic analysis, until infants have achieved full oral feeding status. At 18 months corrected age (CA), infants will undergo neurodevelopmental follow-up testing, the results of which will be correlated with feeding outcomes in the neo-and post-natal period and with gene expression data and intervention status. RESULTS The ongoing National Institutes of Health funded randomized controlled trial R01HD086088 is actively recruiting participants. The expected completion date of the study is 2021. CONCLUSIONS Differential salivary gene expression profiles in response to orosensory entrainment intervention are expected to lead to the development of individualized interventions for the diagnosis and management of oral feeding in preterm infants. TRIAL REGISTRATION ClinicalTrials.gov NCT02696343; https://clinicaltrials.gov/ct2/show/NCT02696343 (Archived by WebCite at http://www.webcitation.org/6r5NbJ9Ym).
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Affiliation(s)
- Steven Michael Barlow
- Center for Brain, Biology, and Behavior, Department of Special Education and Communication Disorders, Biological Systems Engineering, University of Nebraska, Lincoln, NE, United States
| | - Jill Lamanna Maron
- Tufts Medical Center, Division of Neonatology, Department of Pediatrics, Boston, MA, United States
| | - Gil Alterovitz
- Center for Biomedical Informatics, Harvard Medical School, Boston, MA, United States
| | - Dongli Song
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Bernard Joseph Wilson
- CHI Health St. Elizabeth, Division of Neonatal-Perinatal Medicine, Lincoln, NE, United States
| | - Priya Jegatheesan
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Balaji Govindaswami
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Jaehoon Lee
- IMMAP, Department of Educational Psychology and Leadership, Texas Tech University, Lubbock, TX, United States
| | - Austin Oder Rosner
- Tufts Medical Center, Division of Neonatology, Department of Pediatrics, Boston, MA, United States
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Grassi A, Cecchi F, Sgherri G, Guzzetta A, Gagliardi L, Laschi C. Sensorized pacifier to evaluate non-nutritive sucking in newborns. Med Eng Phys 2016; 38:398-402. [DOI: 10.1016/j.medengphy.2015.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/09/2015] [Accepted: 12/31/2015] [Indexed: 11/30/2022]
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Barlow SM, Lee J, Wang J, Oder A, Oh H, Hall S, Knox K, Weatherstone K, Thompson D. Effects of Oral Stimulus Frequency Spectra on the Development of Non-nutritive Suck in Preterm Infants with Respiratory Distress Syndrome or Chronic Lung Disease, and Preterm Infants of Diabetic Mothers. JOURNAL OF NEONATAL NURSING : JNN 2014; 20:178-188. [PMID: 25018662 PMCID: PMC4085795 DOI: 10.1016/j.jnn.2013.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The precocial nature of orofacial sensorimotor control underscores the biological importance of establishing ororythmic activity in human infants. The purpose of this study was to assess the effects of comparable doses of three forms of orosensory experience, including a low-velocity spectrally reduced orocutaneous stimulus (NT1), a high-velocity broad spectrum orocutaneous stimulus (NT2), and a SHAM stimulus consisting of a blind pacifier. Each orosensory experience condition was paired with gavage feedings 3x/day for 10 days in the neonatal intensive care unit (NICU). Four groups of preterm infants (N=214), including those with respiratory distress syndrome (RDS), chronic lung disease (CLD), infants of diabetic mothers (IDM), and healthy controls (HI) were randomized to the type of orosensory condition. Mixed modeling, adjusted for gender, gestational age, postmenstrual age, and birth weight, demonstrated the most significant gains in non-nutritive suck (NNS) development among CLD infants who were treated with the NT2 stimulus, with smaller gains realized among RDS and IDM infants. The broader spectrum of the NT2 stimulus maps closely to known response properties of mechanoreceptors in lip, tongue, and oral mucosa and is more effective in promoting NNS development among preterm infants with impaired oromotor function compared to the low-velocity, spectrally reduced NT1 orosensory stimulus.
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Affiliation(s)
- SM Barlow
- SPLH, Programs in Neuroscience, Human Biology, and Bioengineering, University of Kansas, Lawrence, Kansas USA
| | - Jaehoon Lee
- Center for Research Methods and Data Analysis, University of Kansas, Lawrence, Kansas USA
| | - Jingyan Wang
- SPLH, Programs in Neuroscience, Human Biology, and Bioengineering, University of Kansas, Lawrence, Kansas USA
| | - Austin Oder
- SPLH, Programs in Neuroscience, Human Biology, and Bioengineering, University of Kansas, Lawrence, Kansas USA
| | - Hyuntaek Oh
- SPLH, Programs in Neuroscience, Human Biology, and Bioengineering, University of Kansas, Lawrence, Kansas USA
| | - Sue Hall
- Stormont-Vail HealthCare, Topeka, Kansas USA
| | - Kendi Knox
- Stormont-Vail HealthCare, Topeka, Kansas USA
| | | | - Diane Thompson
- Overland Park Regional Medical Center, Overland Park, Kansas USA
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Barlow SM, Lee J, Wang J, Oder A, Hall S, Knox K, Weatherstone K, Thompson D. Frequency-modulated orocutaneous stimulation promotes non-nutritive suck development in preterm infants with respiratory distress syndrome or chronic lung disease. J Perinatol 2014; 34:136-42. [PMID: 24310444 PMCID: PMC3946759 DOI: 10.1038/jp.2013.149] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 10/25/2013] [Accepted: 10/28/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE For the premature infant, extrauterine life is a pathological condition, which greatly amplifies the challenges to the brain in establishing functional oromotor behaviors. The extent to which suck can be entrained using a synthetically patterned orocutaneous input to promote its development in preterm infants who manifest chronic lung disease (CLD) is unknown. The objective of this study was to evaluate the effects of a frequency-modulated (FM) orocutaneous pulse train delivered through a pneumatically charged pacifier capable of enhancing non-nutritive suck (NNS) activity in tube-fed premature infants. STUDY DESIGN A randomized trial to evaluate the efficacy of pneumatic orocutaneous stimulation 3 × per day on NNS development and length of stay (LOS) in the neonatal intensive care unit among 160 newborn infants distributed among three sub-populations, including healthy preterm infants, respiratory distress syndrome (RDS) and CLD. Study infants received a regimen of orocutaneous pulse trains through a PULSED pressurized silicone pacifier or a SHAM control (blind pacifier) during gavage feeds for up to 10 days. RESULT Mixed modeling, adjusted for the infant's gender, gestational age, postmenstrual age and birth weight, was used to handle interdependency among repeated measures within subjects. A significant main effect for stimulation mode (SHAM pacifier vs PULSED orosensory) was found among preterm infants for NNS bursts per min (P=0.003), NNS events per min (P=0.033) and for total oral compressions per min (NNS+nonNNS) (P=0.016). Pairwise comparison of adjusted means using Bonferroni adjustment indicated RDS and CLD infants showed the most significant gains on these NNS performance indices. CLD infants in the treatment group showed significantly shorter LOS by an average of 2.5 days. CONCLUSION FM PULSED orocutaneous pulse train stimuli delivered through a silicone pacifier are effective in facilitating NNS burst development in tube-fed RDS and CLD preterm infants, with an added benefit of reduced LOS for CLD infants.
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Affiliation(s)
- Steven M Barlow
- Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, Lawrence, Kansas USA
- Program in Neuroscience, University of Kansas, Lawrence, Kansas USA
- Program in Human Biology, University of Kansas, Lawrence, Kansas USA
- Program in Bioengineering, University of Kansas, Lawrence, Kansas USA
| | - Jaehoon Lee
- Center for Research Methods and Data Analysis, University of Kansas, Lawrence, Kansas USA
| | - Jingyan Wang
- Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, Lawrence, Kansas USA
| | - Austin Oder
- Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, Lawrence, Kansas USA
| | - Sue Hall
- Stormont-Vail HealthCare, Topeka, Kansas USA
| | - Kendi Knox
- Stormont-Vail HealthCare, Topeka, Kansas USA
| | | | - Diane Thompson
- Overland Park Regional Medical Center, Overland Park, Kansas USA
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