Factors associated with non-nutritive sucking habits at 2 years of age among very preterm children: EPIPAGE-2 cohort study.

Sandra Herrera,Monique Kaminski,Véronique Pierrat,Valérie Benhammou,Alice Germa,Anne‐Laure Bonnet,Pierre‐Yves Ancel

doi:10.1111/ppe.12725

Abstract

The association between prolonged non-nutritive sucking habits (NNSHs, ie, sucking pacifiers or fingers) and maxillofacial growth anomalies in the general population has been widely described. Because maturation of sucking abilities is not fully achieved in very preterm infants (<32 weeks' gestation), neonatal services worldwide rely on the use of pacifiers to promote the development of adequate sucking reflexes, possibly prolonging NNSHs during infancy. We aimed to describe the frequency and to identify factors associated with NNSHs at age 2 years in very preterm children. The study was based on data from EPIPAGE-2, a French national prospective cohort study of preterm births during 2011 that included 2593 children born between 24 and 31 weeks' gestation. The primary outcome was NNSHs at 2 years. Multivariable log-linear regression models with generalized estimation equations were used to study the association between the characteristics studied and NNSHs. Multiple imputations were used to take into account missing data. The frequency of NNSHs was 69% in the overall sample but higher among girls (adjusted risk ratio [RR] 1.12, 95% confidence interval [CI] 1.05, 1.17), children born from multiple pregnancies (eg, twins/triplets) (RR 1.07, 95% CI 1.00, 1.11), children who were fed by nasogastric tube (RR 1.07, 95% CI 1.01, 1.13), or those who benefitted from developmental care programmes (RR 1.10, 95% CI 1.02, 1.19). The NNSHs frequency was lower if mothers were not born in France (RR 0.70, 95% CI 0.64, 0.77), children had 2 or more older siblings (RR 0.88, 95% CI 0.82, 0.96), or children were breast-fed at discharge (RR 0.90, 95% CI 0.85, 0.95). NNSHs at 2 years seemed associated with cultural background, development care programmes, and breast feeding. Whether NNSHs at 2 years among very preterm children are associated with future maxillofacial growth anomalies deserves further attention.

Highlights

The association between prolonged non-nutritive sucking habits (NNSHs, i.e., sucking pacifiers or fingers) and maxillofacial growth anomalies in the general population has been widely described
Factors associated with a higher frequency of Non-nutritive sucking habits (NNSHs) among the general population have been described in studies from the United Kingdom, Australia and Brazil[10,11,12,13] and included low maternal age, maternal country of birth, high maternal education, female sex, very low birthweight and short periods of breast feeding
The frequency of NNSHs was higher for girls, children born from multiple pregnancies, children who were fed by nasogastric tube at 36 weeks’ corrected age (CA) and children who benefited from NIDCAP or Sensory-motor Development Care Programs

Summary

Introduction

The association between prolonged non-nutritive sucking habits (NNSHs, i.e., sucking pacifiers or fingers) and maxillofacial growth anomalies in the general population has been widely described. In a study from the United Kingdom, NNSHs at age 2 years was already found associated with a higher risk of subsequent maxillofacial anomalies.[9] Factors associated with a higher frequency of NNSHs among the general population have been described in studies from the United Kingdom, Australia and Brazil[10,11,12,13] and included low maternal age, maternal country of birth, high maternal education, female sex, very low birthweight and short periods of breast feeding

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Results

Conclusion