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Zhao S, Jiang H, Miao Y, Liu W, Li Y, Zhang Y, Wang A, Cui X. Effects of implementing non-nutritive sucking on oral feeding progression and outcomes in preterm infants: A systematic review and meta-analysis. PLoS One 2024; 19:e0302267. [PMID: 38626172 PMCID: PMC11020483 DOI: 10.1371/journal.pone.0302267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/29/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Preterm infants have imperfect neurological development, uncoordinated sucking-swallowing-breathing, which makes it difficult to realize effective oral feeding after birth. How to help preterm infants achieve complete oral feeding as soon as possible has become an important issue in the management of preterm infants. Non-nutritive sucking (NNS), as a useful oral stimulation, can improve the effect of oral feeding in preterm infants. This review aimed to explore the effect of NNS on oral feeding progression through a meta-analysis. METHODS We systematically searched PubMed, CINHAL, Web of Science, Embase, Cochrane databases, China's National Knowledge Infrastructure (CNKI), Wanfang and VIP database from inception to January 20, 2024. Search terms included 'non-nutritive sucking' 'oral feeding' and 'premature.' Eligibility criteria involved randomized controlled studies in English or Chinese. Studies were excluded if they were reviews, case reports, or observational studies from which valid data could not be extracted or outcome indicators were poorly defined. The meta-analysis will utilize Review Manager 5.3 software, employing either random-effects or fixed-effects models based on observed heterogeneity. We calculated the mean difference (MD) and 95% confidence interval (CI) for continuous data, and estimated pooled odds ratios (ORs) for dichotomous data. Sensitivity and publication bias analyses were conducted to ensure robust and reliable findings. We evaluated the methodological quality of randomized controlled trials (RCTs) utilizing the assessment tool provided by the Cochrane Collaboration. RESULTS A total of 23 randomized controlled trials with 1461 preterm infants were included. The results of the meta-analysis showed that NNS significantly shortened time taken to achieve exclusive oral feeding (MD = -5.37,95%CI = -7.48 to-3.26, p<0.001), length of hospital stay(MD = -4.92, 95% CI = -6.76 to -3.09, p<0.001), time to start oral feeding(MD = -1.41, 95% CI = -2.36 to -0.45, p = 0.004), time to return to birth weight(MD = -1.72, 95% CI = -2.54 to -0.91, p<0.001). Compared to the NNS group, the control group had significant weight gain in preterm infants, including weight of discharge (MD = -61.10, 95% CI = -94.97 to -27.23, p = 0.0004), weight at full oral feeding (MD = -86.21, 95% CI = -134.37 to -38.05, p = 0.0005). In addition, NNS reduced the incidence of feeding intolerance (OR = 0.22, 95% CI = 0.14 to 0.35, p<0.001) in preterm infants. CONCLUSION NNS improves oral feeding outcomes in preterm infants and reduces the time to reach full oral feeding and hospitalization length. However, this study was limited by the relatively small sample size of included studies and did not account for potential confounding factors. There was some heterogeneity and bias between studies. More studies are needed in the future to validate the effects on weight gain and growth in preterm infants. Nevertheless, our meta-analysis provides valuable insights, updating existing evidence on NNS for improving oral feeding in preterm infants and promoting evidence-based feeding practices in this population.
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Affiliation(s)
- Shuliang Zhao
- Nursing Department, Affiliated Hospital of Shandong Second Medical University, Weifang, China
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Huimin Jiang
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Yiqun Miao
- School of Nursing, Capital Medical University, Beijing, China
| | - Wenwen Liu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yanan Li
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Yuanyuan Zhang
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Aihua Wang
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Xinghui Cui
- Nursing Department, Affiliated Hospital of Shandong Second Medical University, Weifang, China
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Talej M, Smith ER, Lauria ME, Chitale R, Ferguson K, He S. Responsive Feeding for Preterm or Low Birth Weight Infants: A Systematic Review and Meta-analysis. Pediatrics 2022; 150:188648. [PMID: 35921679 DOI: 10.1542/peds.2022-057092f] [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] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Responsive feeding may improve health outcomes in preterm and low birth weight (LBW) infants. Our objective was to assess effects of responsive compared with scheduled feeding in preterm and LBW infants. METHODS Data sources include PubMed, Scopus, Web of Science, CINAHL, LILACS, and MEDICUS. Randomized trials were screened. Primary outcomes were mortality, morbidity, growth, neurodevelopment. Secondary outcomes were feed intolerance and duration of hospitalization. Data were extracted and pooled with random-effects models. RESULTS Eleven eligible studies were identified, and data from 8 randomized control trials with 455 participants were pooled in the meta-analyses. At discharge, the mean difference in body weight between the intervention (responsive feeding) and comparison (scheduled feeding) was -2.80 g per day (95% CI -3.39 to -2.22, I2 = 0%, low certainty evidence, 4 trials, 213 participants); -0.99 g/kg per day (95% CI -2.45 to 0.46, I2 = 74%, very low certainty evidence, 5 trials, 372 participants); -22.21 g (95% CI -130.63 to 86.21, I2 = 41%, low certainty evidence, 3 trials, 183 participants). The mean difference in duration of hospitalization was -1.42 days (95% CI -5.43 to 2.59, I2 = 88%, very low certainty evidence, 5 trials, 342 participants). There were no trials assessing other growth outcomes (eg, length and head circumference) mortality, morbidity or neurodevelopment. Limitations include a high risk of bias, heterogeneity, and small sample size in included studies. CONCLUSIONS Overall, responsive feeding may decrease in-hospital weight gain. Although the evidence is very uncertain, responsive feeding may slightly decrease the duration of hospitalization. Evidence was insufficient to understand the effects of responsive compared with scheduled feeding on mortality, morbidity, linear growth, and neurodevelopmental outcomes in preterm and LBW infants.
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Affiliation(s)
- Megan Talej
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Emily R Smith
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Molly E Lauria
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia.,ICF International, Rockville, Maryland
| | - Ramaa Chitale
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Kacey Ferguson
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Siran He
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
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Feeding outcomes in post-discharge feeding clinic for infants following cardiac surgery. Cardiol Young 2022; 32:628-635. [PMID: 34304751 DOI: 10.1017/s1047951121002833] [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: 11/07/2022]
Abstract
INTRODUCTION The aim of this study was to describe the development and assess the usefulness of a feeding clinic to help infants with CHD tolerate the highest level of oral feeding while achieving growth velocity and supporting neurodevelopment. MATERIALS AND METHODS This retrospective, cohort study assessed feeding outcomes for infants who underwent cardiac surgery at <30 days of age with cardiopulmonary bypass between February 2016 and April 2020. Diagnoses, age at surgery, hospitalisation variables, and feeding outcomes were compared between two cohorts, pre- and post-implementation of a specialised feeding clinic using Exact Wilcoxon signed-rank test, chi-squared, or Fisher's exact test. The association between time to full oral feed and risk factors was assessed using univariable and multivariable Cox regression model. RESULTS Post-clinic infants (n = 116) surgery was performed at a median of 6 days of life (interquartile range: 4, 8) with median hospital length of stay of 19 days (interquartile range: 16, 26). Infants' median age at first clinic visit was at 30 days old (interquartile range: 24, 40) and took median 10 days (interquartile range: 7, 12) after hospital discharge to first clinic visit. In the post-clinic cohort, the median time to 100% oral feeding was 47 days (interquartile range: 27, 96) compared to the 60 days (interquartile range: 20, 84) in the pre-clinic cohort (n = 22), but the difference was not statistically significant. DISCUSSION The cardiac feeding clinic was utilised by our neonatal surgery population and feasible in coordination with cardiology follow-up visits. Future assessment of cardiac feeding clinic impact should include additional measures of feeding and neurodevelopmental success.
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Chinea Jiménez B, Ferrández Ferrández S, Díez Sebastián J, Saenz de Pipaon M. Influence of Full Oral Feeding Acquisition on Growth of Premature Infants. Front Pediatr 2022; 10:928051. [PMID: 35911832 PMCID: PMC9330017 DOI: 10.3389/fped.2022.928051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/30/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The main objective was to describe the impact of full oral feeding achievement in very low birth weight infants on weight, length, and head circumference, measured as the change in z-score from 32 weeks to discharge, the time at which full oral feeding occurs. METHODS This was a longitudinal retrospective observational study on infants younger than 30 weeks of gestational age, admitted to the Neonatology Unit of La Paz University Hospital, Madrid (Spain), from January 1, 2019 to December 31, 2019. The infant's anthropometric characteristics (weight, height, and head circumference) were compared at birth, at 32, 34, and 36 weeks of gestational age, at the time of full oral feeding, and at discharge from the unit. RESULTS A total of 66 infants were included, gestational age at birth range from 24 to 30. Full oral intake occurred at 37.1 ± 2.1 weeks postmenstrual age (PMA). We found an inverse correlation between gestational age at birth and birth weight with PMA at which full oral feeding (FOF) is achieved. PMA at discharge was 38.6 ± 2.5 weeks. Age of full oral intake and discharge occurred later in infants who had patent ductus arteriosus, retinopathy of prematurity, and sepsis or received a blood transfusion. A positive correlation was found between days of oxygen and both parameters. However, we found no relationship between necrotizing enterocolitis or intraventricular hemorrhage with age at full oral feeding or age at discharge. CONCLUSIONS The transition from gastric tube to oral intake did not affect growth. We found a close relationship between preterm infants birth, earlier younger than 30 weeks of gestational age, and low birth weight, with a delay in full oral feeding achievement that correlated with age at discharge.
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Affiliation(s)
- Bibiana Chinea Jiménez
- La Paz University Hospital, Madrid, Spain.,Department of Nursing, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Jesús Díez Sebastián
- La Paz University Hospital, Madrid, Spain.,Department of Pediatrics, Universidad Autónoma de Madrid, Madrid, Spain
| | - Miguel Saenz de Pipaon
- La Paz University Hospital, Madrid, Spain.,Department of Pediatrics, Universidad Autónoma de Madrid, Madrid, Spain
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Hao G, Ni A, Chang YJ, Hall K, Lee SH, Chiu HT, Yang SF, Sheu KL, Chen SC. Improve the clinical effective decision of the oral feeding readiness in preterm infants: Revise and validate the TC-POFRAS. J Neonatal Perinatal Med 2021; 15:317-325. [PMID: 34719446 DOI: 10.3233/npm-210869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Currently there is limited information to guide health professionals regarding the optimal time frame to initiate safe and effective oral feedings to preterm infants. The study aims to revise and validate a streamlined version of the Traditional Chinese-Preterm Oral Feeding Readiness Assessment Scale, the TC-POFRAS®, and evaluate its construct validity in the clinical decisions regarding feeding readiness of preterm infants. METHODS Eighty-one clinically stable preterm infants were assessed using the TC-POFRAS for oral feeding readiness. Item-total correlation analysis was used to check if any item was inconsistent with the averaged TC-POFRAS scores. Cronbach's α coefficient was used to evaluate the inter-item consistency. Exploratory factor analysis was used to determine the coherence of variables to reorganize assessment domains. The revised version of TC-POFRAS (TC-POFRAS®) was developed and a new cut-off score based on discriminant accuracy was established. RESULTS Based on the results from statistical analysis, five items ("lips posture," "tongue posture," "biting reflex," "gag reflex," and "tongue cupping") were deleted from the original TC-POFRAS to form the TC-POFRAS®. The TC-POFRAS®'s global accuracy was 92.1%. The cut-off value of 19 was the one that presented the most optimization of sensitivity based on specificity. The TC-POFRAS® was reconstructed into corrected gestational age and five behavioral domains. CONCLUSIONS The TC-POFRAS® is considered a valid, safe, and accurate objective instrument to assist health professionals to initiate oral feeding of preterm infants.
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Affiliation(s)
- G Hao
- Department of Communication Sciences and Disorders, College of Health and Sciences, North Carolina Central University, NC, USA
| | - A Ni
- Department of Communication Sciences and Disorders, College of Health and Sciences, North Carolina Central University, NC, USA
| | - Y J Chang
- Department of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan, ROC.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - K Hall
- Department of Communication Sciences and Disorders, College of Health and Sciences, North Carolina Central University, NC, USA
| | - S H Lee
- School of Nursing, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - H T Chiu
- Neonatal Intensive Care Unit, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - S F Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - K L Sheu
- Department of Family and Community Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - S C Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.,Department of Family and Community Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
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Chandran R, Alagesan J. Oro-Motor Intervention Protocol to Improve Sucking Behavior among Neonates with Immature Sucking: An Experimental Protocol. Int J Surg Protoc 2021; 25:129-134. [PMID: 34327289 PMCID: PMC8300586 DOI: 10.29337/ijsp.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Oro-motor intervention methods were previously adopted to improve the sucking pattern but there is still a lag in the structured protocol for improving sucking behavior in infants with immature sucking. Thus, this study is aimed to develop a structured protocol for the Oro-motor intervention to improve sucking behavior. Method: Using the prospective observational study design, neonates with poor suck (producing less than 10 sucks per minute), under NG tube feeding, and maintaining oxygen saturation at room air were included. A total of 6 subjects were enrolled in this study and they were treated with Oro-motor intervention protocol. The Sucking rate and LATCH score were taken as the outcome measures and measured at beginning of intervention and after 2 weeks of intervention. Result: The mean pre-test and post-test values for sucking rate were is (8.66), (32.5) and LATCH were (4.66), (8.16) respectively. The data collected showed that the protocol framed for Oro-motor intervention was significantly effective in improving quality of feeding among infants with immature sucking behavior. Conclusion: The structured Oro-motor intervention protocol improves the feeding performance in infants with poor sucking behavior and improves the LATCH score. All the infants included in this study where under nasogastric tube feeding, thus the structured protocol can be considered to be helpful in weaning from NG tube feeding.
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Affiliation(s)
- Ramya Chandran
- Saveetha College of physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India
| | - Jagatheesan Alagesan
- Saveetha College of physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India
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Celen R, Tas Arslan F, Soylu H. Effect of SINC Feeding Protocol on Weight Gain, Transition to Oral Feeding, and the Length of Hospitalization in Preterm Infants: A Randomized Controlled Trial. JPEN J Parenter Enteral Nutr 2020; 45:567-577. [PMID: 33236355 DOI: 10.1002/jpen.2049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/17/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The present study aims to test the effect of the Safe Individualized Nipple-Feeding Competence (SINC) protocol on the preterm infants' weight gain, transition to oral feeding, and duration of hospitalization. METHODS The procedure was designed as a single-blind, parallel-group randomized controlled trial. The trial was conducted in a neonatal intensive care unit (NICU) in Konya, Turkey. Data were collected from 80 preterm infants between February 2018 and March 2019. Infants (gestational weeks 28-33) were randomly assigned to the intervention (n = 39) and control groups (n = 41). The intervention group received the SINC feeding protocol, whereas the control group received the standard feeding. Data were collected using the Family Information Form, the Preterm Infant Follow-Up Form, and the SINC Protocol Evaluation Checklist. Infants were followed from hospitalization to discharge. The outcomes were weight gain, transition to oral feeding, and the length of hospitalization from birth to discharge. Pearson χ2 test, Fisher exact test, independent t-test, Mann-Whitney U test, and general linear model test were used in analyzing the data. RESULTS The main effects of groups on weight measurements were found to be statistically significant (P < .001). There were no significant differences in terms of the transition from gavage to full oral feeding and the length of hospitalization (P > .05). CONCLUSIONS SINC protocol positively influences weight gain in preterm infants. It is important to evaluate different evidence-based feeding methods both as they apply to the NICU stay and how they may affect long-term outcomes of preterm infant.
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Affiliation(s)
- Raziye Celen
- Department of Pediatric Nursing, Faculty of Nursing, Selçuk University, Konya, Turkey
| | - Fatma Tas Arslan
- Department of Pediatric Nursing, Faculty of Nursing, Selçuk University, Konya, Turkey
| | - Hanifi Soylu
- Department of Pediatrics, Faculty of Medicine, Selçuk University, Konya, Turkey
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Angot F, Van Vooren V, Castex C, Glorieux I, Casper C. Behavioral changes in preterm children during nasogastric tube feeding. Comparative study of manual administration by parents versus mechanical administration via electric syringe pump. Early Hum Dev 2020; 149:105151. [PMID: 32805594 DOI: 10.1016/j.earlhumdev.2020.105151] [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: 05/29/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Manual feeding by parents using a syringe, a widespread practice in Sweden since the 1980s, favors parents' involvement in childcare tasks. This approach is used in our neonatal unity since 2007. OBJECTIVE To study the behavioral changes of preterm children during nasogastric tube feeding: manual milk administration by parents (MAP) versus electric syringe administration (ESA) over a 30-minute period. METHOD This is a randomized, crossover study conducted in the neonatology unit of Toulouse. Preterm children under 33 weeks of age and over 7 days of life were included. A video recording was performed to assess the children's behavioral response, using the Dsilna score. The reviewer was blinded. RESULTS 15 preterm children with a median gestational age of 30.1 weeks and a median birth weight of 1.210 g were included from March to October 2012. The facility, environment, and state of alertness of children were similar in both groups. Signs of well-being were significantly more prevalent in the MAP group versus the ESA group (36.2 (±8.0) versus 30.7 (±9.5)), (p = 0.04), particularly "hand-to-mouth, mouth gestures, seeking suction and sucking". Although not significant, motor withdrawal signs were more apparent and fluctuating in the ESA group. Qualitative analysis of NIDCAP observations confirms this data. CONCLUSION There are behavior changes of preterm children during nasogastric tube feeding. This pilot study showed previously undescribed results: MAP is associated with more common well-being signs and could be more widely used in neonatal units.
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Affiliation(s)
- Florent Angot
- Department of Neonatology, University Hospital, Children Hospital, Toulouse, France.
| | - Virginie Van Vooren
- Department of Neonatology, University Hospital, Children Hospital, Toulouse, France
| | - Cécile Castex
- Department of Neonatology, University Hospital, Children Hospital, Toulouse, France; Nursery Hospital, Nîme, France
| | - Isabelle Glorieux
- Department of Neonatology, University Hospital, Children Hospital, Toulouse, France
| | - Charlotte Casper
- Department of Neonatology, University Hospital, Children Hospital, Toulouse, France; Department of Neonatology, University Hospital, Doha, Qatar
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