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Westemeyer R, Hines M, Martens A, Zimmerman E. The association between infant non-nutritive suck and oral motor development. Infant Behav Dev 2024; 77:101993. [PMID: 39303546 DOI: 10.1016/j.infbeh.2024.101993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 09/13/2024] [Accepted: 09/14/2024] [Indexed: 09/22/2024]
Abstract
This study investigated if non-nutritive suck (NNS) at 3 months is related to subsequent oral motor and motor skills using caregiver-reported scores on the Child Oral and Motor Proficiency Scale (ChOMPS) at 12 months in a cohort of 69 full-term infants and their caregivers. Longer NNS burst durations were associated with lower oral motor coordination and total ChOMPS scores. More NNS cycles per minute was associated with lower complex motor movement scores. More NNS bursts, cycles per burst, and cycles per minute were related with lower total ChOMPS scores. Early NNS outcomes can provide valuable insight in future neuromotor development.
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Affiliation(s)
- Ross Westemeyer
- Department of Communication Sciences and Disorders, University of Northern Iowa, Cedar Falls, IA, USA.
| | - Morgan Hines
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, USA.
| | - Alaina Martens
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, USA.
| | - Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, USA.
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Hines M, Martens A, Zimmerman E. Infant Bottle-Feeding: A Prospective Study of Infant Physiology and Parental Report Metrics. Compr Child Adolesc Nurs 2023; 46:309-319. [PMID: 37498287 PMCID: PMC10592442 DOI: 10.1080/24694193.2023.2232457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/24/2023] [Indexed: 07/28/2023]
Abstract
The aim of this study was to examine associations between parent reports of bottle-feeding behaviors and infant non-nutritive suck (NNS) on a pacifier as well as oral feeding skills during bottle-feeding. A prospective study was conducted. Full-term infants with no prior diagnosed feeding disorders were recruited at 3-months. Parents reported their infant's bottle-feeding behaviors using the Neonatal Eating Assessment Tool-Bottle-Feeding (NeoEAT-Bottle-Feeding), consisting of five domains: Infant Regulation, Energy and Physiologic Stability, Gastrointestinal Tract Function, Sensory Responsiveness, and Compelling Symptoms of Problematic Feeding. Infant NNS was measured using a custom pacifier, pressure transducer device, which yields the following NNS variables: duration (sec), frequency (Hz), amplitude (cmH20), cycles per burst, cycle amount, and burst amount. The Oral Feeding Skills (OFS) scale was used to measure the initial volume, transfer volume, proficiency, and rate of milk transfer during bottle feeding. Fifty-two infants (58% male) with reported prior bottle experience completed this study. NeoEAT-Bottle-Feeding Total score was significantly positively associated with NNS burst duration and NNS cycles per burst. The NeoEAT-Bottle-Feeding Energy and Physiologic Stability domain was significantly positively correlated with NNS cycles per burst. NeoEAT-Bottle-Feeding Gastrointestinal Tract Function domain score was significantly positively correlated with NNS duration, amplitude, and cycles per burst. There were no significant associations between NeoEAT-Bottle-Feeding domains and the OFS scale. The findings demonstrate that parent reports of problematic feeding at 3 months of age are associated with aspects of infant NNS physiology and not with oral feeding metrics during bottle-feeding. Parent reports of bottle-feeding behaviors, particularly pertaining to gastrointestinal issues, were associated with aspects of infant NNS. These data together will allow for a more nuanced understanding of infant feeding and will be beneficial in determining if infants have a feeding delay.
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Affiliation(s)
- Morgan Hines
- Speech and Neurodevelopment lab, Department of Communication Sciences and Disorders, Northeastern University, 360 Huntington Avenue, Boston, MA 02115
| | - Alaina Martens
- Speech and Neurodevelopment lab, Department of Communication Sciences and Disorders, Northeastern University, 360 Huntington Avenue, Boston, MA 02115
| | - Emily Zimmerman
- Speech and Neurodevelopment lab, Department of Communication Sciences and Disorders, Northeastern University, 360 Huntington Avenue, Boston, MA 02115
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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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Lee KJ, Shin YB, Park HE, Choi S, de Oliveira JG, Hong D, Kim S, Yoon JA. Quantitative non-nutritive sucking measurement as a predictor of oral feeding readiness in newborns. Front Pediatr 2023; 11:1143416. [PMID: 37635795 PMCID: PMC10450951 DOI: 10.3389/fped.2023.1143416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Background and purpose The purpose of this study is to examine the relationship between the parameters of a silver nanowire-based flexible pressure sensor developed to measure the non-nutritive sucking (NNS) performance and predict the nutritive sucking status in preterm infants. Methods Preterm infants who were referred for feeding difficulty during the transition period from tubal feeding to oral feeding were enrolled in our study. A flexible pressure sensor was used to measure the non-nutritive sucking parameters of neonates. The evaluator stimulated the infants' lips and tongue with a pacifier integrated with a sucking pressure sensor, to check whether non-nutritive sucking had occurred. When the sucking reflex was induced, it was measured. The infants' sucking characteristics were subdivided into classifications according to the NOMAS criteria and full oral feeding (FOF) status. Quantitative NNS measurement according to the feeding state was compared between groups. Results When comparing the quantitative NNS measurement by feeding characteristics, the average sucking pressure was significantly higher in infants in the FOF capable group than those in the incomplete FOF group. In addition, the maximum and average sucking pressure was significantly higher in infants with a normal sucking pattern compared to those with a disorganized sucking pattern. The average NNS pressure was divided over the range of 0-3 kPa and the same weight was assigned to each item. When the optimal cut-off value for the sensitivity and specificity of the average NNS pressure to estimate the FOF was set, a pressure of 1.5 kPa yielded the highest sensitivity (84.62%) and specificity (67.65%) on the receiver operating characteristic (ROC) curve. The area under the curve (AUC) was 0.786, and this result was statistically significant. Conclusions This study presents a quantitative parameter for non-nutritive sucking in preterm infants with the use of a flexible pressure sensor. Results show possible quantitative indicators that can aid in predicting when preterm infants can transition to oral feeding and their prognosis. This will serve as a basis for future research on determining the feeding transition period of newborns with health conditions that affect oral feeding.
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Affiliation(s)
- Kyeong Jae Lee
- Department of Robotics and Mechatronics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu, Republic of Korea
| | - Yong Beom Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Ho Eun Park
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Suro Choi
- School of Undergraduate Studies, DGIST, Daegu, Republic of Korea
| | - Jean G. de Oliveira
- Department of Robotics and Mechatronics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu, Republic of Korea
| | - Daun Hong
- Department of Robotics and Mechatronics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu, Republic of Korea
| | - Sohee Kim
- Department of Robotics and Mechatronics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu, Republic of Korea
| | - Jin A Yoon
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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Akbarzadeh S, Lyu T, Farhoodi R, Awais M, Abbasi SF, Zhao X, Chen C, Amara A, Akay Y, Akay M, Chen W. Predicting Feeding Conditions of Premature InfantsThrough Non-Nutritive Sucking Skills Using a Sensitized Pacifier. IEEE Trans Biomed Eng 2022; 69:2370-2378. [PMID: 35044910 DOI: 10.1109/tbme.2022.3144094] [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: 11/05/2022]
Abstract
Due to the lack of enough physical or suck central pattern generator (SCPG) development, premature infants require assistance in improving their sucking skills as one of the first coordinated muscular activities in infants. Hence, we need to quantitatively measure their sucking abilities for future studies on their sucking interventions. Here, we present a new device that can measure both intraoral pressure (IP) and expression pressure (EP) as ororhithmic behavior parameters of non-nutritive sucking skills in infants. Our device is low-cost, easy-to-use, and accurate, which makes it appropriate for extensive studies. To showcase one of the applications of our device, we collected weekly data from 137 premature infants from 29 week-old to 36 week-old. Around half of the infants in our study needed intensive care even after they were 36 week-old. We call them full attainment of oral feeding (FAOF) infants. We then used the Non-nutritive sucking (NNS) features of EP and IP signals of infants recorded by our device to predict FAOF infants' sucking conditions. We found that our pipeline can predict FAOF infants several weeks before discharge from the hospital. Thus, this application of our device presents a robust and inexpensive alternative to monitor oral feeding ability in premature infants.
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Morton S, Honda T, Zimmerman E, Kirwa K, Huerta-Montanez G, Martens A, Hines M, Ondras M, Eum KD, Cordero JF, Alshawabekeh A, Suh HH. Non-nutritive suck and airborne metal exposures among Puerto Rican infants. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 789:148008. [PMID: 34082200 PMCID: PMC8295239 DOI: 10.1016/j.scitotenv.2021.148008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 06/12/2023]
Abstract
Air pollution has been shown to impact multiple measures of neurodevelopment in young children. Its effects on particularly vulnerable populations, such as ethnic minorities, however, is less studied. To address this gap in the literature, we assess the associations between infant non-nutritive suck (NNS), an early indicator of central nervous system integrity, and air pollution exposures in Puerto Rico. Among infants aged 0-3 months enrolled in the Center for Research on Early Childhood Exposure and Development (CRECE) cohort from 2017 to 2019, we examined associations between exposure to fine particulate matter (PM2.5) and its components on infant NNS in Puerto Rico. NNS was assessed using a pacifier attached to a pressure transducer, allowing for real-time visualization of NNS amplitude, frequency, duration, cycles/burst, cycles/min and bursts/min. These data were linked to 9-month average prenatal concentrations of PM2.5 and components, measured at three community monitoring sites. We used linear regression to examine the PM2.5-NNS association in single pollutant models, controlling for infant sex, maternal age, gestational age, and season of birth in base and additionally for household smoke exposure, age at testing, and NNS duration in full models. Among 198 infants, the average NNS amplitude and burst duration was 17.1 cmH2O and 6.1 s, respectively. Decreased NNS amplitude was consistently and significantly associated with 9-month average exposure to sulfur (-1.026 ± 0.507), zinc (-1.091 ± 0.503), copper (-1.096 ± 0.535) vanadium (-1.157 ± 0.537), and nickel (-1.530 ± 0.501). Decrements in NNS frequency were associated with sulfur exposure (0.036 ± 0.018), but not other examined PM components. Our findings provide new evidence that prenatal maternal exposure to specific PM components are associated with impaired neurodevelopment in Puerto Rican infants soon after birth.
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Affiliation(s)
- Sarah Morton
- Department of Civil and Environmental Engineering, Tufts University, 200 College Ave, Medford, MA 02155, USA
| | - Trenton Honda
- Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA 02115, USA
| | - Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, 360 Huntington Ave, Boston, MA 02115, USA
| | - Kipruto Kirwa
- Department of Environmental and Occupational Health Sciences, University of Washington, Box 351618, Seattle, WA 98195, USA
| | - Gredia Huerta-Montanez
- Department of Civil and Environmental Engineering, Northeastern University, 360 Huntington Ave, Boston, MA 02115, USA
| | - Alaina Martens
- Department of Communication Sciences and Disorders, Northeastern University, 360 Huntington Ave, Boston, MA 02115, USA
| | - Morgan Hines
- Department of Communication Sciences and Disorders, Northeastern University, 360 Huntington Ave, Boston, MA 02115, USA
| | - Martha Ondras
- Health Effects Institute, 75 Federal Street, Suite 1400, Boston, MA 02110, USA
| | - Ki-Do Eum
- Department of Civil and Environmental Engineering, Tufts University, 200 College Ave, Medford, MA 02155, USA
| | - Jose F Cordero
- Departmentof Epidemiology, University of Georgia, 101 Buck Rd, Athens, GA 30602, USA
| | - Akram Alshawabekeh
- Department of Civil and Environmental Engineering, Northeastern University, 360 Huntington Ave, Boston, MA 02115, USA
| | - Helen H Suh
- Department of Civil and Environmental Engineering, Tufts University, 200 College Ave, Medford, MA 02155, USA.
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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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