Feeding Performance Of Preterm Infants Research Articles

Effect of oral stimulation in improving feeding performance of pre-term infants in NICU: A systematic review

Aim: The Aim of this systematic review is to evaluate the effectiveness of oral stimulation techniques in improving feeding performance among pre-term infants in neonatal intensive care units (NICUs). Method: We conducted a comprehensive literature search of electronic databases, including PubMed, CINAHL, and Cochrane Library, from 2010-2021. Studies were included if they investigated the effect of oral stimulation on feeding performance outcomes such as time to full enteral feeding, weight gain, and length of hospital stay. Two reviewers independently assessed the quality of the studies using the Cochrane risk-of-bias tool and extracted data using a standardized data extraction form, and data were synthesized using a narrative approach due to heterogeneity in study design and outcome measures. Result: Our search identified 10 studies that met the inclusion criteria, consisting of randomized controlled trials, quasi-experimental studies, and case series. Eight studies reported significant improvements in feeding performance outcomes with the use of oral stimulation interventions compared to standard care or placebo. The remaining two studies reported mixed findings or no significant differences between groups. Overall, the quality of evidence was low to moderate due to methodological limitations and inconsistency in outcome reporting. Our findings suggest that oral stimulation techniques such as non-nutritive sucking, pacifier-activated device, and oral motor exercises are effective in improving feeding performance among pre-term infants in NICUs. These techniques were associated with reduced time to achieve full oral feeds, shortened hospital stay, and improved weight gain compared to control groups. Conclusion: The results of this systematic review suggest that oral stimulation may be an effective intervention for improving feeding performance in pre-term infants in NICUs. However, further research is needed to establish the optimal timing, frequency, and duration of oral stimulation interventions, as well as their long-term effects on growth and development. Future studies should also address methodological limitations, such as small sample sizes and lack of blinding, to improve the quality of evidence in this field. Significance of the study: Oral feeding is a difficult job for premature infants those who are admitted to NICU. Because of poor muscle tone, underdeveloped oral motor skills and reduced suck-swallow-breathe synchronization, they are unable to commence feeds from the bottle and breast immediately after birth, unlike full-term infants. As long as oral feeding is not developed, a number of non-oral feeding methods are employed which feeding methods can cause severe side effects 1. The primary barrier to oral feeding in infants with gestational age less than 34 weeks is the lack of coordination in sucking, swallowing, and breathing. Oral feeding in these infants can cause apnoea, decreased pulse oximetry, transient bradycardia, and aspiration. Therefore, in neonates those who do not reach the gestational age of 34 weeks for them bottle or breastfeeding are not considered, and developmental transition from gavage to oral feeding in a 28-week-old infant may take 6 weeks or longer. Several studies have shown that oral motor intervention on infants less than 34 weeks results in decreased transition time from gavage to oral feeding 2.

Effects of Swaddling During Bottle Feeding in Preterm Infants.

Preterm infants have immature oral feeding skills, affecting length of hospital stay and long-term feeding outcomes. Swaddling has positive effects on pain and stress responses, state regulation, and physiological stability in preterm infants in the neonatal intensive care unit (NICU). Swaddling during bottle feeding may support preterm infant behavioral organization and oral feeding skills. Swaddling is used inconsistently during feeding in the NICU and has not been critically examined for effects on bottle feeding performance in preterm infants. To examine the effects of swaddling on bottle feeding quality and efficiency in preterm infants. A convenience sample of 30 infants born before 34 weeks of gestation was selected in an urban level IV NICU. Using an experimental, randomized crossover design, each infant was swaddled for one feeding and unswaddled for one feeding. Feeding efficiency was measured by rate and volume consumed. Feeding quality was examined by the Early Feeding Skills Assessment and frequency of physiological changes. Data were analyzed using dependent t tests and Wilcoxon signed rank test. When swaddled, participants demonstrated significantly better scores on all related subtests of the Early Feeding Skills Assessment ( P ≤ .001). Infants demonstrated no difference in frequency of bradycardia or oxygen desaturations greater than 4 seconds. No significant differences were found in feeding efficiency outcomes. Swaddling can be used in the NICU to improve bottle feeding quality in preterm infants. Future investigation is needed on long-term effects of swaddling during bottle feeding on feeding performance, weight gain, and length of stay.

Effect of Left and Right Semi-Elevated Side-Lying Positions on Feeding Performance of Preterm Infants

ObjectiveTo determine the effect of right and left semi-elevated side-lying positions on the feeding performance and skills of bottle-fed preterm infants. DesignA single-group, crossover experimental study. SettingsLevel 3 NICU of a training and research hospital in Istanbul. ParticipantsA total of 60 preterm infants born at 24 to 36 6/7 weeks gestation. MethodsWe collected data using an infant information form, feeding observation form, and the Turkish version of the Early Feeding Skills Assessment (EFS-Turkish). For each infant, we collected data for two feeds: one in the right and one in the left semi-elevated side-lying position. ResultsWe found no difference between the right and left semi-elevated side-lying positions in the volume or percentage of food taken (p = .582 and p = .625, respectively), feeding duration (p = .901), or feeding efficiency (p = .423). We observed no significant differences between feedings in the left and right semi-elevated side-lying positions in mean EFS-Turkish total score (p = .251) or subscale scores (p > .05). ConclusionNeonatal nurses can feed preterm infants in both directions of the semi-elevated side-lying position when following evidence-based feeding guidelines.

Nonnutritive Sucking Before Oral Feeding of Preterm Infants in Turkey: A Randomized Controlled Study

BackgroundThe use of a pacifier is recommended to support sucking reflex during transition from gavage feeding to oral feeding and ensure readiness for feeding. PurposeA randomized controlled experimental design was used to determine the effect of a pacifier given before feeding on physiological characteristics and feeding performance in preterm infants initially fed orally. Design and methodsThe data were obtained from preterm infants (N = 72) born before 31st gestational week, who were admitted to Newborn Intensive Care Unit of a training and research hospital affiliated with Ministry of Health between January 2017–July 2018 and met the case selection criteria. Heart rates, oxygen saturation levels and feeding performances of preterm infants in both groups before, during, and after feeding were compared. ResultsHeart rates of preterm infants in the experimental group were statistically significantly lower (Experimental: 139.64 ± 10.16; Control: 149.31 ± 8.40; p < 0.01) and their oxygen saturation levels were higher (Experimental: 97.22 ± 2.22; Control: 96.33 ± 1.93; p < 0.05). Feeding efficiency rates (Experimental: 1.94 ± 1.19; Control: 0.69 ± 0.34; p < 0.01) and the percentage of food intake (Experimental: 89.5 ± 23.93; Control: 70.86 ± 27.41; p < 0.01) of newborns in the experimental group were statistically significantly higher and their feeding duration was shorter (Experimental: 10.58 ± 8.29; Control: 16.14 ± 8.31; p < 0.01). ConclusionsIt was determined that a pacifier given before feeding is effective on regulating physiological parameters and supporting feeding performance in preterm infants. Practice implicationsThe use of a pacifier in the first transition to oral feeding in preterm infants supports their sucking reflex, calms them down, and ensures the readiness for feeding.

Oral Feeding in Preterm Infants: A Conceptual Model for Health Care Practitioners

Oral feeding competence is a critical milestone needed for proper growth and development in preterm infants. Commonly, the oral feeding process is conceptualized as an infant's ability to coordinate suck–swallow–breathe. However, oral feeding is a highly complex multisystem process. In this article, an oral feeding model is presented that takes into consideration the intrinsic and extrinsic factors that influence oral feeding performances. The intrinsic neurophysiologic factors include the musculoskeletal, gastrointestinal, respiratory, cardiovascular, behavioral, and neurologic systems. The extrinsic environmental factors include the physical surroundings, NICU policies, parental attributes, health care practitioners, and feeding equipment. The objectives of this article are to (1) describe the intrinsic and extrinsic factors affecting oral feeding performance of preterm infants in the NICU, (2) introduce a conceptual model of oral feeding that displays the relationship between these factors, and (3) provide a reference guide for health care practitioners to refer to when evaluating an infant's oral feeding performance.

Effects of two different feeding positions on physiological characteristics and feeding performance of preterm infants: A randomized controlled trial.

The aim of this randomized controlled study was to determine the effect of semielevated side-lying (ESL) and semielevated supine (ESU) positions, which are used to bottle-feed preterm infants, on their physiological characteristics and feeding performance. The sample consisted of preterm infants who were born in the 31st gestational week and below, and met the inclusion criteria. A randomization was provided in the sample group with a total of 80 infants including 38 infants in the ESL (experimental) group and 42 infants in the ESU (control) group. Both groups were compared in terms of their SpO2 values, heart rates, and feeding performances before, during, and after the feeding. The data were obtained by using a form for infant descriptive characteristics, feeding follow-up form, a Masimo Radical-7 pulse oximeter device, and a video camera. It was determined that the infants in the ESL group had statistically significantly higher SpO2 values (ESL: 96.77±2.51; ESU: 93.48±5.63) and lower heart rates (ESL: 155.87±11.18; ESU: 164.35±6.00) during the feeding compared to the infants in the ESU group (p<.05). Besides, oxygen saturation levels of the infants in the ESU group decreased more (p<.01) and their heart rates increased more (p<.05) during the feeding than those obtained before the feeding compared to the infants in the ESL group. The ESL position has a more positive effect on oxygen saturation and heart rate of infants and it is more effective in providing a physiological stabilization during the feeding, compared to the ESU position. According to these results, the ESL position can be recommended for preterm feeding.

GW28-e0572 Influence of Music and Oral Movement’s Intervention Therapy on Feeding Performance in Preterm Infants with Feeding and Swallowing Disorders

GW28-e0572 Influence of Music and Oral Movement’s Intervention Therapy on Feeding Performance in Preterm Infants with Feeding and Swallowing Disorders

Feeding Performance in Preterm Infants and Full Term Infants at 40 Weeks Postmenstrual Age

Introduction: Feeding problems are commonly reported among preterm infants. As premature infants are born before adequate maturation, inadequate feeding capabilities are common among preterm infants. Feeding is an innate behaviour in a new born. Swallowing is evident in a foetus by 16th week of gestation (Tuchman, 1994). By 40th week of gestation, neural processes are expected to mature completely. Feeding is an innate behaviour in a new born. Swallowing is evident in a foetus by 16th week of gestation. By 40th week of gestation, neural processes are expected to mature completely. Since the premature infants are born before adequate maturation of the systems, it is not unusual for them to have inadequate feeding capabilities.Material and Methods: This study aimed to compare feeding performance in preterm (between 30 and 34 weeks GA) and full term infants at 40 weeks Post menstrual age. Seventy infants and their mothers served as participants. A close ended questionnaire documented the oral reflexes, oro-motor skills, oro-sensory skills and feeding history in infants.Results: Results were tabulated under feeding history, (viz; history of use of nasogastric feeding, duration of feeding, episodes of coughing/ choking and vomiting, fussing during feeding, noisy breathing) and oral skills. Significant difference in feeding behaviour was observed between the term and preterm infants at 40 weeks post menstrual age. Conclusion: Hence the need for Speech Language Pathologist to evaluate feeding behaviour at 40 weeks post menstrual age becomes necessary.

Effect of nonnutritive sucking and oral stimulation on feeding performance in preterm infants: a randomized controlled trial.

To evaluate the effectiveness of nonnutritive sucking (NNS) and oral stimulation (OS), either applied alone or in combination, to reduce the transition time from tube feeding to independent oral feeding. Randomized controlled trial. A 40-bed neonatal ICU in a university hospital in the People's Republic of China. A total of 120 preterm infants were admitted to the neonatal ICU from December 2012 to July 2013. Oral motor interventions. One hundred twelve preterm infants were assigned to three intervention groups (NNS, OS, and combined NNS + OS) and one control group. Primary outcome was the number of days needed from introduction of oral feeding to autonomous oral feeding (transition time). Secondary outcome measures were the rate of milk transfer (mL/min), proficiency (intake first 5 min/volume ordered), volume transfer (volume transferred during entire feeding/volume prescribed), weight, and hospital length of stay. Transition time was reduced in the three intervention groups compared with the control group (p < 0.001). The milk transfer rate in the three intervention groups was greater than in the control group (F3,363 = 15.37; p < 0.001). Proficiency in the NNS and OS groups did not exceed that in the control group while the proficiency in the NNS + OS group was greater than that in the control group at the stage when the infants initiated the oral feeding (p = 0.035). Among all groups, no significant difference was found on weight gain and length of stay. The combined NNS + OS intervention reduced the transition time from introduction to independent oral feeding and enhanced the milk transfer rate. The combined intervention seems to have a beneficial effect on oral feeding proficiency in preterm infants.

Interventions to Improve Oral Feeding Performance of Preterm Infants

This review presents a summary of our current understanding of the development of preterm infant oral feeding skills, the feeding issues they are facing, and evidence-based approaches that facilitate their transition from tube to oral feeding.The field of infant oral feeding research is understudied as the recognition of its importance truly came about with the increased preterm population and the realization that a large number of these infants are not safe and competent oral feeders. It is understandable that this research has taken a “back seat” to the more immediate concerns of saving these babies’ lives. However, the time has now come when these infants make up a large proportion of patients referred to feeding specialists for unresolved oral feeding problems during their stay in neonatal intensive care units (NICUs) as well as post-discharge. Unfortunately, due to the limited research so far conducted in this domain, available therapies are limited and lack evidence-based support. Fortunately, this growing medical concern is stimulating deeper research interests and funding.It is hoped that the information provided will assist the development of systematic differential diagnostic approaches to address infant oral feeding issues.

Interventions to improve the oral feeding performance of preterm infants

Preterm infants have difficulty oral feeding. We hypothesized that a specific sucking and swallowing exercises vs. no intervention accelerate the attainment of independent oral feeding through a faster maturation of infants' oral feeding skills (OFS). Very low birthweight infants were randomized to a control, sucking and swallowing groups. Sucking consisted of active sucking on a pacifier, and swallowing of placing a milk bolus (0.05-0.2 mL) on the tongue where the bolus rests prior to entering the pharynx. Primary outcome was days from start to independent oral feeding (SOF-IOF). Secondary outcomes included overall transfer (OT, % volume taken/volume prescribed), proficiency (PRO, % volume taken at 5 min/volume prescribed), rate of transfer (RT, mL/min) over the entire feeding and infants' OFS levels. OFS levels were defined by PRO and RT. Days from SOF to IOF vs controls (21 ± 2) were similar for the sucking group (19 ± 2) and shorter for the swallowing group (15 ± 2; p = 0.019). Only the latter infants demonstrated more mature OFS levels than controls. The swallowing exercise is an efficacious intervention in facilitating the attainment of independent oral feeding, but not the sucking exercise. We speculate that the swallowing benefit resulted from an accelerated maturation of infants' OFS levels.

A New Bottle Design Decreases Hypoxemic Episodes during Feeding in Preterm Infants

Oxygen saturation is lower during bottle feeding than during breastfeeding in preterm infants. Our objective was to compare two different bottle systems in healthy preterm infants before discharge in terms of SpO2 and oral feeding efficiency (rate of milk intake). Infants without supplement oxygen needs were evaluated twice on the same day during two consecutive feeds, by the same nurse. Infants served as their own controls for comparison of two systems of bottles, the order of which was randomized. The new bottle's nipple design mimics mom's breast in shape and feel, and the bottle vents to air when the child sucks on the nipple. The other system was the hospital's standard plastic bottle with silicone nipple. The rate of milk intake was calculated as the total volume transferred minus volume lost divided by time of feeding, mL/min. Thirty-four infants (BW: 1, 163 ± 479.1 g) were studied at 35.4 ± 1.3 weeks after-conception. SpO2 was significantly higher in infants fed with the new bottle design. Milk intake rate was significantly higher with the new bottle than with the standard bottle design. The new bottle design improves oral feeding performance in preterm infants near to discharge when compared to that of a standard bottle.

Factors Affecting Early Feeding Performance in Preterm Infants below 32 Weeks Gestation

To identify the influence of various physiological and behavioral factors on feeding performance of preterm infants in the transition to full oral feeding. We retrospectively reviewed data from a feeding assessment conducted on 24 preterm infants born at 25-31 weeks without severe brain complications. Prolonged oxygen use and low current weight are two adverse factors for feeding efficiency (volume of milk ingested orally per minute in the initial 5 min of feeding) and proficiency (percentage of prescribed volume ingested orally over the entire feeding). Young post-menstrual age, low baseline oxygen saturation and high feeding efficiency were risk factors for oxygen desaturation during the initial feeding. Proper feeding strategies are needed for preterm infants with those disadvantageous factors to improve their early feeding performance.

Effectiveness of Cheek and Jaw Support to Improve Feeding Performance of Preterm Infants

We examined the effects of cheek and jaw support on the feeding ability of inefficient feeders born prematurely. Twenty preterm infants served as their own controls. Each infant received either intervention (feeding with oral support) or control (feeding without oral support) for 2 consecutive feedings per day on 2 consecutive days. Infants displayed a greater intake rate during the intervention feedings, both during the first 5 min (p = .046) and throughout the entire feeding (p = .023). The percentage of leakage during the first 5-min feeding was smaller in the intervention condition than in the control condition (p = .040). No significant differences were found between the two conditions in the sucking, physiological, and alertness variables. Findings confirm oral support as a safe and effective strategy to improve the feeding performance of preterm infants who are poor feeders.

Effects of prefeeding oral stimulation on feeding performance of preterm infants

To investigate the effects of a prefeeding oral stimulation program on the feeding performance of preterm infants. A crossover design was used. Nineteen preterm infants who were in the transitional time to full oral feeding served as their own controls. A 5-min oral stimulation program was applied to infants prior to feeding in two of 4 feedings on two consecutive days. Feeding, behavioral state, and physiological parameters of infants in the intervention and control feeding conditions were compared using SPSS software. There were two significant findings: (1) Compared to the control condition, infants in the intervention condition achieved a greater intake rate in the initial 5 min of the feeding (P = 0.021). (2) After receiving oral stimulation, a higher percentage of infants moved to the drowsy or quiet alert state from sleep or restlessness before feeding, both on Day 1 (P= 0.016) as well as Day 2 (P = 0.016). No significant differences were found in other feeding parameters, feeding-induced physiological changes (peripheral oxygen saturation levels and pulse rate) and behavioral states between two feeding conditions. Oral stimulation had a modulating effect on the prefeeding behavioral states and short-lived beneficial effects on the feeding efficiency of preterm infants.

Effects of oral stimulation and oral support on non‐nutritive sucking and feeding performance in preterm infants

This study compared the effects of oral stimulation with those of oral support on non-nutritive sucking and feeding parameters in preterm infants. Preterm infants (23 males, 20 females) born between 29 and less than 34 weeks' gestational age (GA; mean GA 31.2wks [standard error of mean{SEM} 0.39]; mean birth-weight 1580g [SEM 120]) were allocated to one of three experimental groups: (Stimulation+support [five males, four females]; Stimulation [four males, seven females]; and Support [seven males, five females]) or a control group. Non-nutritive sucking pressure and sucking activity were quantified in the gavage and transition periods. Oral support minimizes fluid loss, stabilizes the jaw, and organizes deglutition. The time of transition, the quantity of milk ingested per day, and the number of bottle feeds per day were recorded. Variables were analyzed by repeated-measures analysis of variance, with birth-weight as covariate (ANCOVA). Transition time was reduced (p<0.0001) for the Stimulation+support and Support groups. ANCOVA computed during gavage showed increased non-nutritive sucking pressure and sucking activity (p<0.001) for the Stimulation and Stimulation+support groups. ANCOVA computed during transition revealed increases in non-nutritive sucking pressure and daily bottle feeds (p<0.001) for the three experimental groups and in daily milk ingested (p=0.002) for the Stimulation+support and Support groups. We demonstrated that oral support is the result of both the action of chin and cheek support, and the aid to deglutition. An analysis of the organization of sucking patterns should be undertaken to provide better understanding of the mechanisms involved in oral support.

A randomized study of the efficacy of sensory-motor-oral stimulation and non-nutritive sucking in very low birthweight infant

To assess if sensory-motor-oral stimulation and non-nutritive sucking gavage feeding enhances the oral feeding performance of preterm infants born between 26 and 32 weeks of gestational age. Study design: Very low birthweight infants ( n = 98) were randomized into a experimental and control group. Preterm infants in the experimental group received sensory-motor-oral stimulation and non-nutritive sucking and infants in the control group received a sham stimulation program. Both were administered from when they reached enteral diet (100 kcal/kg/day) until the beginning of oral diet. Primary outcome was length of hospital stay. Results: Independent oral feeding was attained significantly earlier in the experimental group than the control group, 38 ± 16 days of life (mean ± S.D.) versus 47 ± 17 days of life, respectively ( P < 0.001) There was significant difference in length of hospital stay between the two groups (41.9 ± 17 (mean ± S.D.) versus 52.3 ± 19 days ( P < 0.01)). Conclusion: Sensory-motor-oral stimulation, together with early non-nutritive sucking (as soon as the newborn reaches full diet and is clinically stable) in very low birthweight preterm infants, as long as they are clinically stable, in this study, earlier initiation of oral feeding and earlier hospital discharge.

Prediction of Feeding Performance in Preterm Infants

A nonexperimental study with a sample of 95 preterm infants was used to develop a model of feeding performance outcomes (proficiency, percent of prescribed volume consumed, and efficiency) using feeding readiness indicators (morbidity, maturity, behavior state at feeding start, and feeding experience). All readiness indicators were related to each other. In particular, there was a strong relationship between maturity and feeding experience. Morbidity only had an effect on efficiency; the most ill infants were less efficient feeders. Behavior state affects all feeding outcomes in a linear fashion; more awake and alert infants had better feeding performance outcomes. The effect of experience and maturity on the outcomes is more complex because of the relationship between the two. Experience has a greater effect as the infant matures, and as the infant matures, the amount of experience increases. Successful feeding requires maturity as well as experience.

Oral stimulation accelerates the transition from tube to oral feeding in preterm infants

Objective: To assess whether an oral stimulation program, before the introduction of oral feeding, enhances the oral feeding performance of preterm infants born between 26 and 29 weeks' gestational age. Study design: Preterm infants (n = 32) were randomized into an experimental and control group. Infants in the experimental group received an oral stimulation program consisting of stimulation of the oral structures for 15 minutes. Infants in the control group received a sham stimulation program. Both were administered once per day for 10 consecutive days, 48 hours after discontinuation of nasal continuous positive air pressure. Results: Independent oral feeding was attained significantly earlier in the experimental group than the control group, 11 ± 4 days (mean ± SD) versus 18 ± 7 days, respectively (P =.005). Overall intake and rate of milk transfer were significantly greater over time in the experimental group than the control group (P =.0002 and.046, respectively). There was no difference in length of hospital stay between the 2 groups. Conclusion: An early oral stimulation program accelerates the transition to full oral feedings in preterm infants. This was associated with greater overall intake and rate of milk transfer observed in the experimental group when compared with the control group. (J Pediatr 2002;141:230-6)

Effects of Nonnutritive Sucking On Behavioral Organization And Feeding Performance in Preterm Infants

The purpose of this study was to examine the effects of nonnutritive sucking (NNS) on behavioral organization and feeding performance in preterm infants. Thirteen preterm infants were observed at four bottle-feedings, two of which involved treatment with prefeeding NNS. NNS had a positive effect on oxygen saturation and behavior state, as well as on the initiation and duration of the first nutritive suck burst.