Oral motor interventions used to support the development of oral feeding skills in preterm infants: An integrative review

Abstract

BackgroundOne criterion for infant NICU discharge is the ability to meet all nutritional needs by mouth, therefore, it is important to understand interventions that can improve the trajectory to full oral feeding. While many oral motor and feeding interventions are used in clinical practice, it remains unclear which are supported by the literature. AimThe aim of this integrative review was to identify and understand what oral motor interventions are defined in the literature to support positive outcomes for preterm infants and their parents. MethodsAn integrative review of studies published from 2002 to 2022 focusing on applied oral motor interventions and their impact on feeding-related outcomes was completed. The systematic search used databases including PubMed, Cochrane, CINAHL, Scopus, and Google Scholar. Studies were included if they used a study population of preterm infants born </= 32 weeks estimated gestational age (EGA) and imposed an oral motor intervention/exposure that commenced prior to 36 weeks postmenstrual age (PMA) while the infant was in the NICU with an outcome of time to full oral feeding, length of stay (LOS), feeding performance measures, feeding efficiency, weight gain, infant physiology, and/or parental outcomes. Studies were excluded if they were observational, pilot, or feasibility designs; if they enrolled a purposefully healthy sample of infants, had non-relevant outcomes including apnea and incidence of retinopathy of prematurity, had a sample size <30 without a priori calculation of power or had a calculated sample size that was not attained. ResultsForty articles met inclusion criteria with four different interventions (or a combination of them) identified: nonnutritive suck, oral motor stimulation [Fucile's protocol, Premature Infant Oral Motor Intervention (PIOMI)], NTrainer, and swallowing exercises. DiscussionAll interventions were associated with positive outcomes and began between 29- and 30-weeks PMA. Detailed information on adverse events (both physiologic and behavioral) in future research could allow for better risk-benefit analysis. The methodology and quality of the studies differed too much to allow for quantitative analysis; however, there does not appear to be compelling evidence that more stimulatory interventions are superior to less stimulatory interventions – a key consideration when working with preterm infants.