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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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Benfer KA, Whittingham K, Ware RS, Ghosh AK, Chowdhury S, Moula G, Samanta S, Khan NZ, Bell KL, Oftedal S, Bandaranayake S, Salt AT, Bhattacharya A, Maiti P, Tripathi SK, Morgan C, Novak I, Boyd RN. Efficacy of Early Intervention for Infants With Cerebral Palsy in an LMIC: An RCT. Pediatrics 2024; 153:e2023063854. [PMID: 38516717 DOI: 10.1542/peds.2023-063854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE To test efficacy of a parent-delivered multidomain early intervention (Learning through Everyday Activities with Parents [LEAP-CP]) for infants with cerebral palsy (CP) compared with equal-dose of health advice (HA), on (1) infant development; and (2) caregiver mental health. It was hypothesized that infants receiving LEAP-CP would have better motor function, and caregivers better mental health. METHODS This was a multisite single-blind randomized control trial of infants aged 12 to 40 weeks corrected age (CA) at risk for CP (General Movements or Hammersmith Infant Neurologic Examination). Both LEAP-CP and HA groups received 15 fortnightly home-visits by a peer trainer. LEAP-CP is a multidomain active goal-directed intervention. HA is based on Key Family Practices, World Health Organization. Primary outcomes: (1) infants at 18 months CA: Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT mobility); and (2) caregiver: Depression Anxiety and Stress Scale. RESULTS Of eligible infants, 153 of 165 (92.7%) were recruited (86 males, mean age 7.1±2.7 months CA, Gross Motor Function Classification System at 18 m CA: I = 12, II = 25, III = 9, IV = 18, V = 32). Final data were available for 118 (77.1%). Primary (PEDI-CAT mobility mean difference = 0.8 (95% CI -1.9 to 3.6) P = .54) and secondary outcomes were similar between-groups. Modified-Intention-To-Treat analysis on n = 96 infants with confirmed CP showed Gross Motor Function Classification System I and IIs allocated to LEAP-CP had significantly better scores on PEDI-CAT mobility domain (mean difference 4.0 (95% CI = 1.4 to 6.5), P = .003) compared with HA. CONCLUSIONS Although there was no overall effect of LEAP-CP compared with dose-matched HA, LEAP-CP lead to superior improvements in motor skills in ambulant children with CP, consistent with what is known about targeted goal-directed training.
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Affiliation(s)
- Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | | | - Sayak Chowdhury
- Indian Institute of Cerebral Palsy, Kolkata, India
- SSKM Postgraduate Institute of Medical Education and Research, Kolkata, India
| | | | - Sandip Samanta
- Dr B.C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India
| | | | - Kristie L Bell
- Children's Nutrition Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Stina Oftedal
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Sasaka Bandaranayake
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, Brisbane, Australia
| | | | | | - Pradip Maiti
- Dr B.C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India
| | | | - Cathy Morgan
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
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Ghazi S, Faramarzi R, Knoll BL, Taghipour A, Hajebi S, Sobhani-Rad D. Comparing the effects of 5-minute premature infant oral motor intervention with 15-minute Fucile treatment in term infants with feeding difficulties: A multi-arm randomised clinical trial. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-9. [PMID: 38509706 DOI: 10.1080/17549507.2024.2311937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
PURPOSE The aim of the present study was to investigate whether term infants with feeding difficulties who received either a 5-minute premature infant oral motor intervention (PIOMI) or a 15-minute Fucile treatment had different outcomes, compared to term infants in a nontreatment group. METHOD Stable term infants (N = 51) born between 37-41 weeks of gestational age with feeding difficulties were randomly assigned into one of two intervention groups and a control group. One intervention group received PIOMI and the other group received Fucile treatment once a day for seven consecutive days; the control group received usual care only. The volume of milk intake, the amount of weight gain, and the length of hospital stay were compared across all groups. RESULT Findings indicated that the volume of milk intake and weight gain showed significant improvement in all three groups. However, pairwise comparison revealed that infants in the Fucile group had significantly higher volume of milk intake and weight gain compared to infants in both the control and PIOMI groups. Length of hospital stay was not significantly different amongst all groups. CONCLUSION The effects of Fucile treatment were more considerable than for usual care or PIOMI. This finding raises the possibility that prolonged exercise may facilitate improvement in feeding skills for term infants with feeding difficulties.
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Affiliation(s)
- Shamim Ghazi
- Department of Speech Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Speech Therapy, School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Raheleh Faramarzi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Ali Taghipour
- Department of Epidemiology, School of Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran, and
| | - Saeedeh Hajebi
- Student Research Committee, Department of Biostatistics, School of Health, Mashhad, Iran
| | - Davood Sobhani-Rad
- Department of Speech Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
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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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Berber Çiftci H, Topbaş S, Taştekin A. Effect of Nonnutritive Sucking on Oral Feeding in Neonates With Perinatal Asphyxia: A Randomized Controlled Trial. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:406-417. [PMID: 38039979 DOI: 10.1044/2023_ajslp-23-00213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
AIMS The effect of nonnutritive sucking (NNS) stimulation is unclear in infants with perinatal asphyxia. Thus, the aim of this study was to assess the effect of NNS stimulation on oral intake, discharge time, and early feeding skills in infants with perinatal asphyxia. DESIGN A randomized controlled study was conducted. METHOD Of the 94 infants, 47 were included in the experimental group and given NNS stimulation once a day before tube feeding by a speech-language therapist (SLT) in addition to hypothermia treatment. Infants' feeding performances on the days of first oral intake and discharge were evaluated with the Early Feeding Skills Scale (EFS). RESULTS The time from tube feeding to oral intake was significantly lower in the experimental group compared to the control group (p < .05). EFS scores at discharge were significantly higher in the experimental group than in the control group (p < .05). There was no significant difference between the experimental and control groups in terms of discharge and weight gain (p > .05). CONCLUSIONS The findings indicated that the NNS stimulation positively affected oral intake and early feeding skills in infants with perinatal asphyxia, as in preterms. However, NNS stimulation had no significant effect on discharge and weight gain in infants with asphyxia. This finding may be attributed to other factors. It is recommended to use NNS by an SLT in a neonatal intensive care unit within a multidisciplinary team to accelerate the transition to oral feeding and improve feeding skills in infants with perinatal asphyxia. Further studies on the effect of NNS stimulation in infants with perinatal asphyxia are needed to corroborate its effects on discharge time and weight gain.
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Affiliation(s)
- Hilal Berber Çiftci
- Department of Speech and Language Therapy, Graduate School of Health Sciences, Istanbul Medipol University, Turkey
- Department of Speech and Language Therapy, School of Health Sciences, Tarsus University, Mersin, Turkey
| | - Seyhun Topbaş
- Department of Speech and Language Therapy, Graduate School of Health Sciences, Istanbul Medipol University, Turkey
| | - Ayhan Taştekin
- Department of Neonatology, International School of Medicine, İstanbul Medipol University, Turkey
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Tsai YL, Hsieh PC, Chen TY, Lin YC. Effects of Complete Oral Motor Intervention and Nonnutritive Sucking Alone on the Feeding Performance of Premature Infants: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 11:4. [PMID: 38275425 PMCID: PMC10814782 DOI: 10.3390/children11010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024]
Abstract
We explore the effect of complete oral motor intervention (OMI) and nonnutritive sucking (NNS) alone on oral feeding in preterm infants through a meta-analysis. We searched the Embased, Medline, Cochrane Library, and Web of Science databases for randomized controlled trials up to 8 August 2023, based on established selection criteria. Quality evaluations of the studies were carried out by applying both the Cochrane risk of bias assessment tool and the Jadad scale. The outcome measures of three clinical indicators included transition time to oral feeding, weight gain, and hospitalization duration. We conducted a meta-analysis using a random-effects model to determine the pooled effect sizes, expressed as standardized mean differences (SMDs) and their corresponding confidence intervals (CIs). Additionally, we undertook a subgroup analysis and meta-regression to investigate any potential moderating factors. Eight randomized controlled trials with 419 participants were selected. Meta-analysis revealed that receiving a complete OMI had significantly reduced transition time compared with those receiving NNS alone in preterm newborns (SMD, -1.186; 95% CI, -2.160 to -0.212, p = 0.017). However, complete OMI had no significant effect on shortened hospitalization duration (SMD, -0.394; 95% CI, -0.979 to 0.192, p = 0.188) and increased weight gain (SMD, 0.346; 95% CI, -0.147 to 0.838, p = 0.169) compared with NNS alone. In brief, a complete OMI should not be replaced by NNS alone. However, we were unable to draw decisive conclusions because of the limitations of our meta-analysis. Future well-designed randomized controlled trials are necessary to confirm our conclusion.
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Affiliation(s)
- Yu-Lin Tsai
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan;
| | - Pei-Chun Hsieh
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; (P.-C.H.); (T.-Y.C.)
| | - Ting-Yen Chen
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; (P.-C.H.); (T.-Y.C.)
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; (P.-C.H.); (T.-Y.C.)
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Sheikh-Mohamed SO, Wilson H, Fucile S. Interventions to Enhance Achievement to Independent Oral Feeds in Premature Infants: A Scoping Review. Phys Occup Ther Pediatr 2023; 44:295-315. [PMID: 37867325 DOI: 10.1080/01942638.2023.2271064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
AIM To assess the effectiveness of interventions aimed at facilitating the transition from full tube to independent oral feeds in premature infants. METHODS Scoping review methodology using the Preferred Reporting items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA_ScR). A search of six databases (EMBASE, MEDLINE, CINAHL, Web of Science, COCHRANE, and OT Seeker), using keywords related to oral feeding and premature infants retrieved 11,870 articles. Full-text screening was completed for 36 articles, and 21 articles were included in this review. RESULTS Review of the 21 articles revealed five intervention types: oral stimulation (n = 14), swallow/gustatory stimulation (n = 3), olfactory stimulation (n = 2), tactile/kinesthetic stimulation (n = 1), and auditory stimulation (n = 1). Oral stimulation had the most studies with consistent evidence supporting its beneficial effect to facilitate achievement to independent oral feeds, swallow/gustatory stimulation appeared to have some benefit, but evidence for olfactory, tactile/kinesthetic, and auditory stimulation was sparse. CONCLUSION Oral stimulation has the most studies with consistent evidence, and thus is suggested as a suitable early intervention strategy that can be used by health providers to facilitate the achievement to independent oral feeds in premature infants. The alternate forms of stimulation have limited evidence and necessitate further studies to confirm their benefits.
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Affiliation(s)
| | - Hillary Wilson
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Sandra Fucile
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
- Department of Pediatrics, Queen's University, Kingston, Canada
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Greene Z, O'Donnell CP, Walshe M. Oral stimulation for promoting oral feeding in preterm infants. Cochrane Database Syst Rev 2023; 6:CD009720. [PMID: 37338236 PMCID: PMC10281084 DOI: 10.1002/14651858.cd009720.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Preterm infants (< 37 weeks' post-menstrual age (PMA)) are often delayed in attaining oral feeding. Normal oral feeding is suggested as an important outcome for the timing of discharge from the hospital and can be an early indicator of neuromotor integrity and developmental outcomes. A range of oral stimulation interventions may help infants to develop sucking and oromotor co-ordination, promoting earlier oral feeding and earlier hospital discharge. This is an update of our 2016 review. OBJECTIVES To determine the effectiveness of oral stimulation interventions for attainment of oral feeding in preterm infants born before 37 weeks' PMA. SEARCH METHODS Searches were run in March 2022 of the following databases: CENTRAL via CRS Web; MEDLINE and Embase via Ovid. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. Searches were limited by date 2016 (the date of the search for the original review) forward. Note: Due to circumstances beyond our control (COVID and staffing shortages at the editorial base of Cochrane Neonatal), publication of this review, planned for mid 2021, was delayed. Thus, although searches were conducted in 2022 and results screened, potentially relevant studies found after September 2020 have been placed in the section, Awaiting Classification, and not incorporated into our analysis. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing a defined oral stimulation intervention with no intervention, standard care, sham treatment or non-oral intervention (e.g. body stroking protocols or gavage adjustment protocols) in preterm infants and reporting at least one of the specified outcomes. DATA COLLECTION AND ANALYSIS Following the updated search, two review authors screened the titles and abstracts of studies and full-text copies when needed to identify trials for inclusion in the review. The primary outcomes of interest were time (days) to exclusive oral feeding, time (days) spent in NICU, total hospital stay (days), and duration (days) of parenteral nutrition. All review and support authors contributed to independent extraction of data and analysed assigned studies for risk of bias across the five domains of bias using the Cochrane Risk of Bias assessment tool. The GRADE system was used to rate the certainty of the evidence. Studies were divided into two groups for comparison: intervention versus standard care and intervention versus other non-oral or sham intervention. We performed meta-analysis using a fixed-effect model. MAIN RESULTS We included 28 RCTs (1831 participants). Most trials had methodological weaknesses, particularly in relation to allocation concealment and masking of study personnel. Oral stimulation compared with standard care Following meta-analysis, it is uncertain whether oral stimulation reduces the time to transition to oral feeding compared with standard care (mean difference (MD) -4.07 days, 95% confidence interval (CI) -4.81 to -3.32 days, 6 studies, 292 infants; I2 =85%, very low-certainty evidence due to serious risk of bias and inconsistency). Time (days) spent in the neonatal intensive care unit (NICU) was not reported. It is uncertain whether oral stimulation reduces the duration of hospitalisation (MD -4.33, 95% CI -5.97 to -2.68 days, 5 studies, 249 infants; i2 =68%, very low-certainty evidence due to serious risk of bias and inconsistency). Duration (days) of parenteral nutrition was not reported. Oral stimulation compared with non-oral intervention Following meta-analysis, it is uncertain whether oral stimulation reduces the time to transition to exclusive oral feeding compared with a non-oral intervention (MD -7.17, 95% CI -8.04 to -6.29 days, 10 studies, 574 infants; I2 =80%, very low-certainty evidence due to serious risk of bias, inconsistency and precision). Time (days) spent in the NICU was not reported. Oral stimulation may reduce the duration of hospitalisation (MD -6.15, 95% CI -8.63 to -3.66 days, 10 studies, 591 infants; I2 =0%, low-certainty evidence due to serious risk of bias). Oral stimulation may have little or no effect on the duration (days) of parenteral nutrition exposure (MD -2.85, 95% CI -6.13 to 0.42, 3 studies, 268 infants; very low-certainty evidence due to serious risk of bias, inconsistency and imprecision). AUTHORS' CONCLUSIONS There remains uncertainty about the effects of oral stimulation (versus either standard care or a non-oral intervention) on transition times to oral feeding, duration of intensive care stay, hospital stay, or exposure to parenteral nutrition for preterm infants. Although we identified 28 eligible trials in this review, only 18 provided data for meta-analyses. Methodological weaknesses, particularly in relation to allocation concealment and masking of study personnel and caregivers, inconsistency between trials in effect size estimates (heterogeneity), and imprecision of pooled estimates were the main reasons for assessing the evidence as low or very low certainty. More well-designed trials of oral stimulation interventions for preterm infants are warranted. Such trials should attempt to mask caregivers to treatment when possible, paying particular attention to blinding of outcome assessors. There are currently 32 ongoing trials. Outcome measures that reflect improvements in oral motor skill development as well as longer term outcome measures beyond six months of age need to be defined and used by researchers to capture the full impact of these interventions.
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Affiliation(s)
- Zelda Greene
- Neonatology, National Maternity Hospital, Dublin, Ireland
- Adjunct Assistant Professor in Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Colm Pf O'Donnell
- Department of Neonatology, National Maternity Hospital, Dublin 2, Ireland
- University College Dublin, Dublin, Ireland
| | - Margaret Walshe
- Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Effect of the Premature Infant Oral Motor Intervention on Sucking Capacity in Preterm Infants in Turkey: A Randomized Controlled Trial. Adv Neonatal Care 2022; 22:E196-E206. [PMID: 36260947 DOI: 10.1097/anc.0000000000001036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Preterm infants have oral feeding difficulty that often delays discharge, indicating a need for evidence-based interventions for oral-motor development. PURPOSE To test the Premature Infant Oral Motor Intervention (PIOMI) on the development of oral-motor function, feeding, and anthropometric outcomes using sucking manometry. METHODS A single-blind randomized experimental design was conducted with a sample of 60 preterm infants from 2 neonatal intensive care units between May 2019 and March 2020. The experimental group received PIOMI for 5 min/d for 14 consecutive days. Sucking capacity, anthropometrics (weight and head circumference), bottle feeding, breast/chest feeding initiation, and length of hospital stay were measured. The Yakut Sucking Manometer (PCT/TR2019/050678) was developed specifically for this study and tested for the first time. RESULTS The experimental group had a statistically significant percent increase over controls in sucking power (69%), continuous sucking before releasing the bottle (16%), sucking time (13%), and sucking amount (12%) with partial η 2 values of interaction between the groups of 0.692, 0.164, 0.136, and 0.121, respectively. The experimental group had a higher increase in weight (89%) and head circumference (81%) over controls ( F = 485.130, P < .001; F = 254.754, P < .001, respectively). The experimental group transitioned to oral feeding 9.9 days earlier than controls ( t = -2.822; P = .007), started breast/chest feeding 10.8 days earlier ( t = 3.016; P = .004), and were discharged 3.0 days earlier. IMPLICATIONS FOR RESEARCH/PRACTICE The PIOMI had a significant positive effect on anthropometrics, sucking capacity, readiness to initiate bottle and breast/chest feeding, and a 3-day reduction in length of hospital stay.
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Non-Pharmacological and Non-Surgical Feeding Interventions for Hospitalized Infants with Pediatric Feeding Disorder: A Scoping Review. Dysphagia 2022; 38:818-836. [PMID: 36044080 DOI: 10.1007/s00455-022-10504-7] [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: 07/26/2021] [Accepted: 07/25/2022] [Indexed: 11/27/2022]
Abstract
Infants born prematurely or with complex medical conditions often require treatment to facilitate safe and efficient feeding. Practice is based on evidence, so frontline clinicians look to the literature to make informed clinical decisions. The aim of this scoping review was to map and describe the literature base for infant feeding and swallowing interventions and to identify areas for further research. Four electronic databases were searched from the sources' inceptions through April 2020 using a search strategy designed by a health sciences research librarian. Thirteen grey literature sources were searched and forward and backward citation chasing was performed. Inclusion criteria were English-language studies reporting non-pharmacological and non-surgical interventions for hospitalized infants. Exclusion criteria included interventions exclusively for infants with cleft lip or palate or for infants being fed exclusively though enteral feeding. Data were extracted using a form created a priori and data were reported descriptively. We reviewed 6654 abstracts: 725 were chosen for full-text review and 136 met inclusion. Most studies explored interventions for infants born prematurely (n = 128). Studies were stratified by intervention domain: bridging (n = 91) and feeding/swallowing (n = 45); intervention approach: direct (n = 72), indirect (n = 31), or combination (n = 33); and outcome: feeding performance (n = 125), physiologic stability (n = 40), and swallowing physiology (n = 12). The body of research in infant feeding has grown; however, a need remains for research focused on populations of infants with various medical complexities and for frequently used interventions that lack supporting evidence.
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11
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Promoting enteral tube feeding safety and performance in preterm infants: a systematic review. Int J Nurs Stud 2022; 128:104188. [DOI: 10.1016/j.ijnurstu.2022.104188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 11/23/2022]
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12
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Segala F, Bolzan GDP, Nascimento MD, Gonçalves DDS, Melchior A, de Moraes MVM, Weinmann ARM. Influence of taste stimulation on sucking pressure in newborn infants at term. Codas 2022; 34:e20210002. [PMID: 35043860 PMCID: PMC9769435 DOI: 10.1590/2317-1782/20212021002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 07/15/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To verify the influence of a taste stimulus on the suction pressure, during the non-nutritive sucking (SNN), in newborns, healthy and with weight appropriate to the gestational age. METHODS Quasi-experimental study of the non-randomized clinical trial type with a convenience sample of 60 newborns (NB), 30 allocated in the study group (EG) and 30 in the control group (CG). The NB were evaluated for sucking pressure during the SNN in a pacifier. For the EG, a gustatory stimulus was added to the pacifier, moistened with colostrum. The CG did not receive any stimulus, other than the pacifier itself. The average, minimum and maximum pressures were measured with the equipment S-Flex®. RESULTS The SG presented mean and maximum sucking pressure significantly higher than the CG. In addition, there was a statistically significant difference between the groups for the second measurement of mean sucking pressure. CONCLUSION The results showed that the NB of the SG presented sucking pressures, average and maximum, significantly higher, when compared to the CG. The use of a taste stimulus associated with SNN modified the sucking pressure and seems to enhance oral skills.
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Affiliation(s)
- Fernanda Segala
- Programa de Pós-graduação em Distúrbios da Comunicação, Universidade Federal de Santa Maria – UFSM - Santa Maria (RS), Brasil.
| | - Geovana de Paula Bolzan
- Departamento de Fonoaudiologia, Universidade Federal de Santa Maria – UFSM - Santa Maria (RS), Brasil.
| | | | - Daniela da Silva Gonçalves
- Departamento de Fisioterapia, Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria – UFSM - Santa Maria (RS), Brasil.
| | - Amanda Melchior
- Programa de Residência Multiprofissional, Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria – UFSM - Santa Maria (RS), Brasil.
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Pham A, Ecochard-Dugelay E, Bonnard A, Le Roux E, Gelas T, Rousseau V, Thomassin N, Cabon-Boudard I, Nicolas A, Guinot A, Rebeuh J, Le Mandat A, Djeddi DD, Fouquet V, Boucharny A, Irtan S, Lemale J, Comte A, Bridoux-Henno L, Dupont-Lucas C, Dimitrov G, Turquet A, Borderon C, Pelatan C, Chaillou Legault E, Jung C, Willot S, Montalva L, Mitanchez D, Gottrand F, Bellaiche M. Feeding disorders in children with oesophageal atresia: a cross-sectional study. Arch Dis Child 2022; 107:52-58. [PMID: 33863700 DOI: 10.1136/archdischild-2020-320609] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/19/2021] [Accepted: 03/04/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION With advances in surgical and neonatal care, the survival of patients with oesophageal atresia (OA) has improved over time. Whereas a number of OA-related conditions (delayed primary anastomosis, anastomotic stricture and oesophageal dysmotility) may have an impact on feeding development and although children with OA experience several oral aversive events, paediatric feeding disorders (PFD) remain poorly described in this population. The primary aim of our study was to describe PFD in children born with OA, using a standardised scale. The secondary aim was to determine conditions associated with PFD. METHODS The Feeding Disorders in Children with Oesophageal Atresia Study is a national cohort study based on the OA registry from the French National Network. Parents of children born with OA between 2013 and 2016 in one of the 22 participating centres were asked to complete the French version of the Montreal Children's Hospital Feeding Scale. RESULTS Of the 248 eligible children, 145 children, with a median age of 2.3 years (Q1-Q3 1.8-2.9, min-max 1.1-4.0 years), were included. Sixty-one children (42%) developed PFD; 13% were tube-fed (n=19). Almost 40% of children with PFD failed to thrive (n=23). The presence of chronic respiratory symptoms was associated with the development of PFD. Ten children with PFD (16%) had no other condition or OA-related complication. CONCLUSION PFD are common in children with OA, and there is no typical profile of patients at risk of PFD. Therefore, all children with OA require a systematic screening for PFD that could improve the care and outcomes of patients, especially in terms of growth.
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Affiliation(s)
- Aurélie Pham
- AP-HP, Department of Neonatology, Armand-Trousseau Childrens Hospital, Paris, France
| | - Emmanuelle Ecochard-Dugelay
- AP-HP, Service des Maladies Digestives de l'Enfant, Hôpital Universitaire Mère-enfant Robert-Debré, Paris, France
| | - Arnaud Bonnard
- Department of General Pediatric Surgery, Robert Debre Children University Hospital, APHP, Paris, France
| | - Enora Le Roux
- AP-HP, Paris, France, Nord-Université de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, Inserm, CIC 1426, Robert-Debré Hospital, Paris, France
| | - Thomas Gelas
- Hôpital Femme-Mère-Enfant, Service de Chirurgie Pédiatrique, CHU Lyon, Lyon, France
| | - Véronique Rousseau
- Pediatric Surgery, APHP, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Nadège Thomassin
- Hépato-Gastroentérologie Pédiatrique, University Hospital Centre Grenoble Alpes, Grenoble, France
| | - Isabelle Cabon-Boudard
- AP-HM, Service de Pédiatrie, Hôpital de la Timone, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Audrey Nicolas
- Centre de Reference des Affections Chroniques et Malformatives de l'œsophage, CHU Lille, Lille, France
| | - Audrey Guinot
- Service de Chirurgie Infantile, CHU de Nantes, Hôpital Mère-enfant, Nantes, France
| | - Julie Rebeuh
- Department of Pediatrics, University Hospital Centre Strasbourg, Strasbourg, France
| | - Aurélie Le Mandat
- Service de Chirurgie Viscérale Pédiatrique, CHU de Toulouse, France, Hôpital des Enfants, Toulouse, France
| | - Djamal-Dine Djeddi
- Service de Pédiatrie Médicale, CHU Amiens Picardie, France, Pôle Femme Couple Enfant, Amiens, France
| | - Virginie Fouquet
- Paediatric Surgery, Paris South University Hospitals, Assistance Publique Hôpitaux de Paris, Le Kremlin Bicetre, France
| | - Aurélie Boucharny
- Service de Pédiatrie, CHU Dijon, France, Hôpital d'Enfants, Dijon, France
| | - Sabine Irtan
- Department of Pediatric Surgery, Armand-Trousseau Childrens Hospital, Paris, France
| | - Julie Lemale
- Department of Pediatric Gastroenterology, Armand-Trousseau Children's Hospital, Paris, France
| | - Aurélie Comte
- Service de Médecine Pédiatrique, CHU Besançon, Besançon, France
| | - Laure Bridoux-Henno
- Département de Médecine de l'Enfant et de l'Adolescent, CHU Rennes Unité de Nutrition, Rennes, France
| | - Claire Dupont-Lucas
- Pediatrics, Gastroenterology Unit, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Georges Dimitrov
- Service de Chirurgie Pédiatrique, CHR d'Orléans, Orléans, France
| | - Anne Turquet
- Service de Pédiatrie, CHU La Réunion, La Reunion, France
| | - Corinne Borderon
- Service de pédiatrie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Cécile Pelatan
- service de pédiatrie, CH Le Mans, Le Mans, Pays de la Loire, France
| | | | - Camille Jung
- Service de Pédiatrie, CH Intercommunal de Créteil, Creteil, France
| | - Stéphanie Willot
- Service de Médecine Pédiatrique, CHRU de Tours, Hôpital Clocheville, Tours, France
| | - Louise Montalva
- Department of General Pediatric Surgery, Robert Debre Children University Hospital, APHP, Paris, France
| | - Delphine Mitanchez
- Service de Néonatologie, CHRU de Tours, France, Hôpital Bretonneau, Tours, France
| | - Frederic Gottrand
- Centre de Reference des Affections Chroniques et Malformatives de l'œsophage, CHU Lille, Lille, France
| | - Marc Bellaiche
- AP-HP, Service des Maladies Digestives de l'Enfant, Hôpital Universitaire Mère-enfant Robert-Debré, Paris, France
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Fukatsu H, Nohara K, Tanaka N, Fujii N, Sakai T. The impact of different medical complications on the feasibility of removing the feeding tube from infants with dysphagia. J Pediatr Rehabil Med 2021; 14:371-377. [PMID: 34459423 DOI: 10.3233/prm-200786] [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: 11/15/2022] Open
Abstract
PURPOSE This study examined whether certain medical complications influence the feasibility of tube removal. METHODS 42 subjects with dysphagia who were under the age of 2.5 years were nourished entirely through feeding tubes. Additionally, they were judged to have no aspiration. The following data about the infants were collected through a retroactive survey: age at which oral feeding training commenced, gender, and whether certain medical complications (cardiovascular, respiratory, digestive, neurological, or oral) had been present at birth. The data were analyzed to determine which type of medical complication affected the likelihood of removing the feeding tube from the infant at 3 years of age. RESULTS Of the five medical complications examined, cardiovascular complications significantly affected the feasibility of tube removal (p = 0.049). CONCLUSION Pediatric dysphagia patients with cardiac complications, compared to those with other complications, may take longer to transition off tube feeding.
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Affiliation(s)
- Hikari Fukatsu
- Division for Oral and Facial Disorders, Osaka University Dental Hospital, Osaka, Japan
| | - Kanji Nohara
- Division for Oral and Facial Disorders, Osaka University Dental Hospital, Osaka, Japan
| | - Nobukazu Tanaka
- Division for Oral and Facial Disorders, Osaka University Dental Hospital, Osaka, Japan
| | - Nami Fujii
- Division for Oral and Facial Disorders, Osaka University Dental Hospital, Osaka, Japan
| | - Takayoshi Sakai
- Division of Functional Oral Neuroscience, Osaka University, Osaka University Graduate School of Dentistry, Osaka, Japan
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Bakker L, Jackson B, Miles A. Oral-feeding guidelines for preterm neonates in the NICU: a scoping review. J Perinatol 2021; 41:140-149. [PMID: 33288867 DOI: 10.1038/s41372-020-00887-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/14/2020] [Accepted: 11/20/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This scoping review describes the nature and evidence base of internationally available guidelines for the introduction of oral feeding for preterm infants in neonatal units. STUDY DESIGN Thirty-nine current infant oral feeding introduction guidelines were obtained, and their recommendations contrasted with available scientific literature. RESULT Documents were primarily from the USA, UK, Canada, and Australia, from hospitals, regional health authorities, and journal articles. Specifics of nonnutritive sucking, gestational age at first feed, exclusions to oral feeding, suggested interventions, and the definition of full oral feeding varied between documents. There was variable use of scientific evidence to back up recommendations. CONCLUSION Guidelines for oral feeding, whether written by clinicians or researchers, vary greatly in their recommendations and details of interventions. Areas more widely researched were more commonly discussed. Recommendations varied more when evidence was not available or weak. Guideline developers need to synthesize evidence and local variability to create appropriate guidelines.
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Affiliation(s)
- Lise Bakker
- The University of Auckland, Auckland, New Zealand.
| | | | - Anna Miles
- The University of Auckland, Auckland, New Zealand
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16
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Ziegler A, Maron JL, Barlow SM, Davis JM. Effect of Pacifier Design on Nonnutritive Suck Maturation and Weight Gain in Preterm Infants: A Pilot Study. Curr Ther Res Clin Exp 2020; 93:100617. [PMID: 33315968 PMCID: PMC7720017 DOI: 10.1016/j.curtheres.2020.100617] [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: 06/30/2020] [Accepted: 11/08/2020] [Indexed: 12/01/2022] Open
Abstract
Background Pacifiers are effective in promoting oral feeding by increasing the maturation of nonnutritive sucking to nutritive suck in preterm neonates. It is unclear whether pacifier design can influence suck dynamics and weight loss during the first week of life. Objectives This pilot study examined the feasibility of studying the effect of pacifier design on suck maturation and weight loss in preterm neonates. Methods Twenty-five preterm neonates (mean [SD] birth weight 1791 [344.9] grams, mean [SD] gestational age 33.1 [1.2] weeks) were studied in a single newborn intensive care unit. Neonates were assigned to either an orthodontic pacifier (n = 13) or a bulb-shaped pacifier (n = 12) immediately after birth. Suck dynamics (cycles per minute, total compressions per minute, cycle bursts, and amplitude) were assessed with an NTrainer (Innara Health, Olathe, Kansas). Weight was recorded during the first week of life on day 1.2 (±2.5 days) and day 6.0 (±2.1 days). Descriptive statistics were applied to analyze data. Results No significant differences were seen between groups with respect to birth weight and gestational age. Reproducible nonnutritive sucking measurements could be obtained with the NTrainer, with both types of pacifiers. No differences were detected in nonnutritive sucking dynamics or weight loss over time within each group or between groups. Conclusions Data indicate that it is feasible to measure nonnutritive sucking dynamics and associated weight loss in relation to pacifier design in preterm neonates. Larger trials over longer time periods are needed to determine whether pacifier design influences suck dynamics and maturation, oromotor function, feeding/weight loss, and dental formation in preterm neonates. (Curr Ther Res Clin Exp. 2020; 81:XXX–XXX)
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Affiliation(s)
- Alexander Ziegler
- Pediatric Dental Medicine, Tufts University School of Dental Medicine, Boston, Massachusetts
| | - Jill L Maron
- Department of Pediatrics, Tufts Children's Hospital, Boston, Massachusetts.,The Mother Infant Research Institute, Tufts Medical Center, Boston, Massachusetts
| | - Steven M Barlow
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, Nebraska.,Department of Biological Systems Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Jonathan M Davis
- Department of Pediatrics, Tufts Children's Hospital, Boston, Massachusetts.,The Tufts Clinical and Translational Science Institute, Tufts Medical Center, Boston, Massachusetts
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Gosa MM, Dodrill P, Lefton-Greif MA, Silverman A. A Multidisciplinary Approach to Pediatric Feeding Disorders: Roles of the Speech-Language Pathologist and Behavioral Psychologist. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:956-966. [PMID: 32650658 DOI: 10.1044/2020_ajslp-19-00069] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Pediatric feeding disorders (PFDs) present as a complex clinical challenge because of the heterogeneous underlying etiologies and their impact on health, safety, growth, and psychosocial development. A multidisciplinary team approach is essential for accurate diagnosis and prompt interventions to lessen the burdens associated with PFDs. The role of the speech-language pathologist (SLP) as a member of the multidisciplinary team will be highlighted. Method This clinical focus article reviews the definition of PFDs and pertinent literature on factors that contribute to the development of PFDs, the accurate diagnosis, and current interventions for infants and children. As part of the multidisciplinary team, the SLP has an integral role in determining whether a child cannot or will not eat and working with the team to identify and carryout appropriate interventions. Collaboration between SLPs and psychologists/behavioral specialists in conjunction with the parents/caregivers as part of the multidisciplinary team is essential to the advancement of therapeutic goals. Conclusions Due to their complex nature, the successful management of PFDs is only possible with the care and expertise of a multidisciplinary team, which includes parents/caregivers. SLPs are important members of these multidisciplinary teams and provide valuable input for the accurate identification and effective remediation of PFDs.
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Affiliation(s)
- Memorie M Gosa
- Department of Communicative Disorders, The University of Alabama, Tuscaloosa
| | - Pamela Dodrill
- Neonatal Intensive Care Unit, Brigham and Women's Hospital, Boston, MA
| | - Maureen A Lefton-Greif
- Departments of Pediatrics, Otolaryngology-Head & Neck Surgery, and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
| | - Alan Silverman
- Pediatrics, Gastroenterology, Hepatology & Nutrition, Medical College of Wisconsin, Wauwatosa
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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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Aguilar-Rodríguez M, León-Castro JC, Álvarez-Cerezo M, Aledón-Andújar N, Escrig-Fernández R, Rodríguez de Dios-Benlloch JL, Hervás-Marín D, Vento-Torres M. The Effectiveness of an Oral Sensorimotor Stimulation Protocol for the Early Achievement of Exclusive Oral Feeding in Premature Infants. A Randomized, Controlled Trial. Phys Occup Ther Pediatr 2020; 40:371-383. [PMID: 31814522 DOI: 10.1080/01942638.2019.1698688] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims: This study is aimed to investigate the effectiveness of an oral stimulation protocol in preterm infants compared to usual care, to reduce the time for achieving safe full oral feeding.Methods: 47 preterm infants (25- 30 weeks of gestational age) were randomized into two groups. Babies of the EG (n = 24) received a 10-minute oral stimulation protocol while the CG (n = 23) received the standard care. The primary outcome were the days from the initiation of the intervention until the achievement of full oral feeding. Secondary outcomes were: days from the first day the intervention started until achieving a first oral intake of 30% in the first 5 minutes, days from the first day the intervention started until achieving a first oral intake of 100%, and days of hospitalization. A parametric survival model with Gaussian distribution was used.Results: The EG achieved full oral feeding 8.3 days before the CG (p = 0.013). EG also achieved the first oral intake of 30% in the first five minutes, 6.03 days before (p = 0.019) and of 100%, 5.88 days before (p = 0.040). EG also spent 6.9 days less hospitalized than CG (p = 0.028).Conclusion: Oral stimulation in preterm infants significantly shortens the time to achieve full oral feeding and reduces the length of hospitalization.
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Affiliation(s)
- Marta Aguilar-Rodríguez
- Rehabilitation Service, University and Polytechnic Hospital La Fe, Valencia, Spain.,Department of Physiotherapy, University of Valencia, Spain
| | - Juan Carlos León-Castro
- Rehabilitation Service, University and Polytechnic Hospital La Fe, Valencia, Spain.,Department of Physiotherapy, University of Valencia, Spain
| | - María Álvarez-Cerezo
- Rehabilitation Service, University and Polytechnic Hospital La Fe, Valencia, Spain.,Department of Physiotherapy, University of Valencia, Spain
| | - Nuria Aledón-Andújar
- Rehabilitation Service, University and Polytechnic Hospital La Fe, Valencia, Spain
| | | | | | - David Hervás-Marín
- Data Science, Biostatistics and Bioinformatics, Health Research Institute La Fe, Valencia, Spain
| | - Máximo Vento-Torres
- Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain
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Lessen Knoll BS, Daramas T, Drake V. Randomized Controlled Trial of a Prefeeding Oral Motor Therapy and Its Effect on Feeding Improvement in a Thai NICU. J Obstet Gynecol Neonatal Nurs 2019; 48:176-188. [DOI: 10.1016/j.jogn.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2019] [Indexed: 10/27/2022] Open
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Effect of Unimodal and Multimodal Sensorimotor Interventions on Oral Feeding Outcomes in Preterm Infants: An Evidence-Based Systematic Review. Adv Neonatal Care 2019; 19:E3-E20. [PMID: 30339552 DOI: 10.1097/anc.0000000000000546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Preterm infants often experience difficulty with the transition from tube to oral feeding. While many unimodal and multimodal sensorimotor interventions have been generated to optimize oral feeding skills, there has been little cohesion between interventions. PURPOSE The aims of this systematic review were to examine the effect of sensorimotor interventions on oral feeding outcomes and to determine whether multimodal interventions lead to better oral feeding performances than unimodal interventions. SEARCH STRATEGY A systematic search of CINAHL, Embase, MEDLINE, and PsycINFO databases was conducted. Studies were reviewed to assess the types of interventions used to improve transition to full oral feeding, volume intake, weight gain, and length of hospital stay. RESULTS The search identified 35 articles. Twenty-six studies examined a unimodal intervention, with the majority focusing on oral sensorimotor input and the others on tactile, auditory, and olfactory input. Nine studies assessed multimodal interventions, with the combination of tactile and kinesthetic stimulation being most common. Results varied across studies due to large differences in methodology, and caution is warranted when interpreting results across studies. The heterogeneity in the studies made it difficult to make any firm conclusions about the effects of sensorimotor interventions on feeding outcomes. Overall, evidence on whether multimodal approaches can lead to better oral feeding outcomes than a unimodal approach was insufficient. IMPLICATIONS FOR PRACTICE The use of sensorimotor interventions to optimize feeding outcomes in preterm infants varies based on methods used and modalities. These factors warrant caution by clinicians who use sensorimotor interventions in the neonatal intensive care unit. IMPLICATIONS FOR RESEARCH Large randomized clinical trials using a standardized approach for the administration of sensorimotor input are needed to further establish the effects on feeding outcomes in preterm infants.
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Acuña Carrillo P, Martina Luna M, de Luna Sánchez G, Braverman Bronstein A, Iglesias Leboreiro J, Bernárdez Zapata I. Terapia miofuncional para mejorar eficiencia en la succión en recién nacidos pretérmino. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2018. [DOI: 10.1016/j.rprh.2018.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Saboute M, Mazouri A, NaimiDehnavi F, Khalesi N, Farahani Z. Influence of high-dose oral erythromycin on feeding intolerance in preterm neonates: A randomized controlled trial. Med J Islam Repub Iran 2018; 32:9. [PMID: 30159260 PMCID: PMC6108263 DOI: 10.18869/mjiri.32.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Indexed: 12/13/2022] Open
Abstract
Background: Feeding intolerance is a common complication in preterm neonates and is responsible for prolonged hospitalization. This study aimed at assessing the effects of high-dose oral erythromycin on feeding intolerance in preterm infants. Methods: A randomized, double blinded, placebo-controlled trial was performed during 2014 and 2015 (Tehran-Iran). Preterm neonates aged >14 days, who met the feeding intolerance criteria were selected for the study and their medical records were randomly assigned into 2 groups by simple randomization. Infants in group A received 10 mg/kg oral erythromycin every 6 hours for 2 days, followed by 4 mg/kg oral erythromycin every 6 hours for 5 days; and infants in group B received placebo with the same route. The number of days until reaching complete oral feeding, day of discharge from NICU, and complications related to intervention were recorded and compared between the 2 groups. Independent samples t test, Mann-Whitney, Fischer exact test, and Chi square were used to analyze the relationships between variables. P-value less than 0.05 was considered statistically significant. Results: A total of 20 infants in group A received erythromycin and 20 infants in group B received placebo. Erythromycin could not alter the mean volume of feeding, duration of parental feeding, length of hospitalization, and frequency of feeding discontinuity (p>0.05); however, mean days to reach complete feeding in group A was significantly shorter than in group B (9.80 vs. 16.80 days; p=0.001). Conclusion: High-dose erythromycin as a rescue measure with no potential adverse effect is beneficial in reducing the time taken to achieve full enteral feeding. However, more extensive investigations are needed to determine the best administration dosage.
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Affiliation(s)
- Maryam Saboute
- Department of Pediatrics, Akbarabadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Mazouri
- Department of Pediatrics, Akbarabadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Nasrin Khalesi
- Aliasghar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Farahani
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Khodagholi Z, Zarifian T, Soleimani F, Khoshnood Shariati M, Bakhshi E. The Effect of Non-Nutritive Sucking and Maternal Milk Odor on the Independent Oral Feeding in Preterm Infants. IRANIAN JOURNAL OF CHILD NEUROLOGY 2018; 12:55-64. [PMID: 30279709 PMCID: PMC6160630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/19/2017] [Accepted: 09/05/2017] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Given the positive effects of stimulation with breast milk odor and non-nutritive sucking (NNS) on preterm feeding skills, we examined the effect of NNS and milk odor, on the time of achieving independent oral feeding in preterm infants. MATERIALS & METHODS This study was conducted at two Neonatal Intensive Care Units of Tehran, Iran in 2016. Overall, 32 neonates with gestational ages of 28-32 wk were enrolled in two groups; NNS with and without olfactory stimuli (breast milk odor). The simulations were performed in both groups during the first five minutes of gavage, three times per day, and over ten consecutive days. Weight gain, time of achieving oral feeding and chronological age at discharge were as measures of the effectiveness of the interventions. The results of the interventions were analyzed and compared using SPSS.18. RESULTS NNS with breast milk odor resulted to a lower post-menstrual age at the first oral feeding, independent oral feeding and discharge from the hospital, but had no effects on their daily weight gain and weight at the time of discharge. CONCLUSION These results show the effectiveness of combining milk odor and NNS as two important stimuli in achieving oral feeding and earlier discharge from the hospital.
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Affiliation(s)
- Zahra Khodagholi
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Talieh Zarifian
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Farin Soleimani
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Enayatollah Bakhshi
- Statistics Department, University of Social Welfare and Rehabilitation Sciences, Tehran
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Greene Z, O'Donnell CPF, Walshe M. Oral stimulation for promoting oral feeding in preterm infants. Cochrane Database Syst Rev 2016; 9:CD009720. [PMID: 27644167 PMCID: PMC6457605 DOI: 10.1002/14651858.cd009720.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Preterm infants (< 37 weeks' postmenstrual age) are often delayed in attaining oral feeding. Normal oral feeding is suggested as an important outcome for the timing of discharge from the hospital and can be an early indicator of neuromotor integrity and developmental outcomes. A range of oral stimulation interventions may help infants to develop sucking and oromotor co-ordination, promoting earlier oral feeding and earlier hospital discharge. OBJECTIVES To determine the effectiveness of oral stimulation interventions for attainment of oral feeding in preterm infants born before 37 weeks' postmenstrual age (PMA).To conduct subgroup analyses for the following prespecified subgroups.• Extremely preterm infants born at < 28 weeks' PMA.• Very preterm infants born from 28 to < 32 weeks' PMA.• Infants breast-fed exclusively.• Infants bottle-fed exclusively.• Infants who were both breast-fed and bottle-fed. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed (1966 to 25 February 2016), Embase (1980 to 25 February 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 25 February 2016). We searched clinical trials databases, conference proceedings and the reference lists of retrieved articles. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing a defined oral stimulation intervention with no intervention, standard care, sham treatment or non-oral intervention in preterm infants and reporting at least one of the specified outcomes. DATA COLLECTION AND ANALYSIS One review author searched the databases and identified studies for screening. Two review authors screened the abstracts of these studies and full-text copies when needed to identify trials for inclusion in the review. All review authors independently extracted the data and analysed each study for risk of bias across the five domains of bias. All review authors discussed and analysed the data and used the GRADE system to rate the quality of the evidence. Review authors divided studies into two groups for comparison: intervention versus standard care and intervention versus other non-oral or sham intervention. We performed meta-analysis using a fixed-effect model. MAIN RESULTS This review included 19 randomised trials with a total of 823 participants. Almost all included trials had several methodological weaknesses. Meta-analysis showed that oral stimulation reduced the time to transition to oral feeding compared with standard care (mean difference (MD) -4.81, 95% confidence interval (CI) -5.56 to -4.06 days) and compared with another non-oral intervention (MD -9.01, 95% CI -10.30 to -7.71 days), as well as the duration of initial hospitalisation compared with standard care (MD -5.26, 95% CI -7.34 to -3.19 days) and compared with another non-oral intervention (MD -9.01, 95% CI -10.30 to -7.71 days).Investigators reported shorter duration of parenteral nutrition for infants compared with standard care (MD -5.30, 95% CI -9.73 to -0.87 days) and compared with another non-oral intervention (MD -8.70, 95% CI -15.46 to -1.94 days). They could identify no effect on breast-feeding outcomes nor on weight gain. AUTHORS' CONCLUSIONS Although the included studies suggest that oral stimulation shortens hospital stay, days to exclusive oral feeding and duration of parenteral nutrition, one must interpret results of these studies with caution, as risk of bias and poor methodological quality are high overall. Well-designed trials of oral stimulation interventions for preterm infants are warranted. Such trials should use reliable methods of randomisation while concealing treatment allocation, blinding caregivers to treatment when possible and paying particular attention to blinding of outcome assessors.
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Affiliation(s)
- Zelda Greene
- Our Lady's Children's HospitalSpeech and Language Therapy DepartmentCrumlinDublinIreland
| | - Colm PF O'Donnell
- National Maternity HospitalDepartment of NeonatologyHolles StreetDublin 2Ireland
| | - Margaret Walshe
- Trinity College DublinClinical Speech and Language Studies7‐9 South Leinster StreetDublinIreland2
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Rustam LB, Masri S, Atallah N, Tamim H, Charafeddine L. Sensorimotor therapy and time to full oral feeding in <33weeks infants. Early Hum Dev 2016; 99:1-5. [PMID: 27372635 DOI: 10.1016/j.earlhumdev.2016.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previous research has shown that oral stimulation improves feeding skills in preterm infants. However, it remains unclear whether other sensorimotor therapies have similar effect. OBJECTIVE To investigate the effect of sensorimotor therapy on the time to reach full oral feeding (FOF) in infants <33weeks. METHODS Retrospective review compared two time periods between 2009 and 2014, before (PRE TX) and after (POST TX) initiation of sensorimotor therapy to infants <33weeks. Type and number of sensorimotor therapy, time to FOF and length of stay (LOS) were collected. Statistical analysis used SPSS 22 for descriptive, non-parametric testing, chi-square and multivariate linear regression computation. RESULTS Of 245 records, 137 were excluded due to death, record unavailability/incompleteness or transfer. The remaining 55 in PRE TX and 53 in POST TX infants differed by small for gestational age (SGA) (36.4% vs. 28.3%, p=0.02); sepsis (81.8% vs. 54.7%, p=0.002); patent ductus arteriosus (PDA) (5.5% vs. 22.6%, p=0.01) and bradycardia (47.3% vs. 83%, p<0.0001). Infants in (POST TX) achieved FOF in 6.3±4.3days vs. 8.8±6.6days in (PRE TX) (p=0.02); their LOS was 56.8±26.4 vs. 52.2±25.1 (p=0.36). Predictors of days to FOF were any number of therapy sessions (β=-4.31; 95% CI: -6.47:-2.15), LOS (β=0.05; 95% CI: 0.004:0.09), PDA (β=3.23; 95% CI: 0.27:6.19) and bradycardia (β=2.94; 95% CI: 0.62:5.26). CONCLUSION Providing any type of sensorimotor therapy decreased time to reach FOF in infants <33weeks. Structured guidelines may help optimize this effect.
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Affiliation(s)
| | - Saadieh Masri
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Nathalie Atallah
- School of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, Biostatistics Unit, American University of Beirut, Beirut, Lebanon
| | - Lama Charafeddine
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon.
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