Oral Feeding In Preterm Infants Research Articles

Incoordinated sucking pattern is associated with longer transition time to full oral feeding in premature infants

Several treatments have been proposed in order to shorten the time to the attainment of full oral feeding (FOF) for pre-term infants, but there are only a few evaluation methods useful in estimating predictors of this period. We investigated whether specific items within the disorganized sucking patterns described by the neonatal oral-motor assessment scale (NOMAS) could estimate the time to FOF in preterm infants with sucking difficulty. Video recordings of at least 2 minutes of oral feeding were analyzed by two assessors, and the premature infants observed to exhibit disorganized sucking patterns ( n = 109) were divided into three clusters (clusters 2, 3, and 4), and further divided into incoordination positive (cluster 4) and incoordination negative groups (clusters 2, 3). Premature infants in the incoordination positive group showed a median transition time of 22 days (range: 4–121 days) which was longer than that in the incoordination negative group (arrhythmic and/or unable to sustain sucking pattern, median 6 days; range: 1–25 days). Univariate analysis revealed that the presence of incoordination among disorganized sucking patterns (NOMAS cluster 4 vs. clusters 2, 3), birth weight, TPN duration, NIPPV duration, the presence of moderate to severe BPD, pulmonary hypertension, sepsis, SGA, and NEC, are associated with the transition time to FOF. When selecting premature infants to be treated with swallowing therapy, it is reasonable to perform treatment with the incoordination positive group described in the NOMAS, that is, premature infants with stress signals to shorten the time to attain full oral feeding.

Sniffin' Away the Feeding Tube: The Influence of Olfactory Stimulation on Oral Food Intake in Newborns and Premature Infants.

Because of their immaturity, many premature infants are fed via nasogastric tube. One objective of the neonatal care is to feed infants orally early. The olfactory function of premature infants is developed before birth and odorants have a significant impact on nutrition in infants. The aim of the study was to test whether odor stimulation has a positive effect on the transition from gavage to oral feeding in infants. Participants were premature infants with gestational age of more than 27 weeks, with full or partial gavage feeding, stable vital parameters and without invasive ventilation. Before each feeding procedure an odorant was presented in front of the infant's nose. Infants were randomized into 1 of 3 groups and received either rose odor (not food-associated), vanilla odor (food-associated), or placebo (no odor). The primary outcome of the study was defined as the time until complete oral nutrition. About 150 children born at a postnatal age of 9.5 ± 7.8 days were included in this study. The duration until complete oral nutrition was reached after 11.8 ± 7.7 (vanilla), 12.2 ± 7.7 (rose), and 12.9 ± 8.8 (control) days. A nearly linear relation between odor presentation frequency and effect size was detectable. For infants that received the intervention for more than 66.7% of the time the length of gavage feeding (8 ± 5.4) and hospitalization (11 ± 6.5) was significantly lower in the vanilla group when compared with control (15 ± 7.3 and 21 ± 13.7, respectively). Odor stimulation with vanilla has an impact on oral feeding in premature infants, however the odor has to be presented on regular basis.

Stress Signals During Sucking Activity Are Associated With Longer Transition Time to Full Oral Feeding in Premature Infants.

Several treatments have been proposed to shorten the time to the attainment of full oral feeding (FOF) for premature infants, but there are only a few evaluation methods useful in estimating predictors of this period. We investigated whether specific items within the disorganized sucking patterns described by the Neonatal Oral-Motor Assessment Scale (NOMAS) could estimate the time to FOF in preterm infants with feeding difficulty. Preterm infants diagnosed with a disorganized sucking pattern in the NOMAS evaluation before 50 weeks of postmenstrual age were included. Video recordings of at least 2 min of oral feeding were further analyzed retrospectively by two assessors and the premature infants who exhibited disorganized sucking patterns (n = 109) were divided into three clusters (clusters 2–4). The observational items compatible with disorganization in the original NOMAS were divided into three groups: cluster 2 (disorganized: arrhythmical), cluster 3 (disorganized: arrhythmical + unable to sustain), and cluster 4 (disorganized: arrhythmical + incoordination ± unable to sustain) and further divided into incoordination-positive (cluster 4) and incoordination-negative groups (clusters 2 and 3). Premature infants in the incoordination-positive group (cluster 4, which means stress signals) showed a median transition time of 22 days (range: 4–121 days) which was longer than that in the incoordination-negative group (median 6 days; range: 1–25 days). Univariate linear regression analysis revealed that the presence of incoordination among disorganized sucking patterns (NOMAS cluster 4 vs. clusters 2 and 3), birth weight, total parenteral nutrition (TPN) duration, non-invasive positive pressure ventilation duration, the presence of moderate to severe bronchopulmonary dysplasia, pulmonary hypertension, sepsis, small for gestational age (SGA), and necrotizing enterocolitis are associated with the transition time to FOF. In a multivariate linear regression analysis, the variables revealed to be associated with the transition time were TPN duration, SGA, and the presence of stress signals (incoordination-positive group) among disorganized sucking patterns. When selecting premature infants to be treated with swallowing therapy, it is reasonable to pay more attention to the incoordination-positive group described in the NOMAS, that is, premature infants with stress signals to shorten the time to attain FOF.

Evidence-Based Interventions Supporting Oral Feeding in Preterm Infants

Preterm bebeklerin oral beslenmesi, oral-motor, norolojik, kardiyorespiratuar ve gastrointestinal sistemlerin etkilesiminden olusan, karmasik ve dinamik bir surectir. Preterm bebeklerin oral beslenmesi sirasinda fizyolojik yonden stabil olmasini saglayan bu sistemlerin birbirleri ile olan etkilesimleri bebegin “bireysel organizasyonu” olarak adlandirilir. Bireysel organizasyon saglanamadiginda, beslenme ve solunumun koordinasyonu bozulur, solunumun olumsuz etkilenmesi bebegin fizyolojik degerlerinde de degisim ve duzensizlige neden olur. Bu duruma bagli olarak beslenme sirasinda bebekte erken donemde fizyolojik stres ve yorgunluk belirtileri ortaya cikar. Bebegin beslenme yeteneginin yetersiz olmasi hastaneden taburculugu geciktirmekte, bu durum bebegin yenidogan yogun bakim unitesinin olumsuz cevresel kosullarindan etkilenmesi ve enfeksiyon etkenlerine daha fazla maruz kalmasina neden olmaktadir. Ayrica yetersiz beslenme bebegin uzun vadede buyume ve gelismesinin gecikmesine neden olmaktadir. Preterm bebeklerin beslenme problemleri goz onunde bulundurularak basarili ve guvenli bir oral beslenme deneyiminin olusmasini saglamak amaci ile yenidogan hemsiresi bakiminda terapotik girisimlere yer vermelidir. Bu derlemede preterm bebeklerde oral beslenmeyi destekleyici kanita dayali girisimler literatur bilgileri isiginda tartisilacaktir.

Comparison of the finger‐feeding versus cup feeding methods in the transition from gastric to oral feeding in preterm infants

ObjectivesTo assess the finger‐feeding technique when compared with the cup feeding method during the early stage of preterm infant feeding transition regarding milk loss, milk ingestion period, and complications. MethodsExperimental, randomized, prospective study including 53 preterm infants with gestation age<37 weeks, clinically stable, and with a score of >28 points in the Oral Feeding Readiness Assessment Scale. The preterm babies were randomized to be included in the control group, which underwent the feeding transition using a cup or in the experimental group, which used the finger‐feeding technique. The analysis of data was performed using Student's t‐test to evaluate differences between mean values of the appointed variables, and Fischer's test for categorical variables; the asymmetric variables were assessed by the Kruskal–Wallis ANOVA test. ResultsWhen compared with the control group, the experimental group showed lower milk loss, longer milk ingestion time, and a lower frequency of complications during feeding. The significance level was set at 5%, with a confidence interval of 90%. ConclusionThe finger‐feeding technique was shown to be a better feeding transition method regarding efficacy when compared with cup feeding method, due to lower milk loss and fewer complication episodes.

Readiness for oral feeding and oral motor function in preterm infants

ABSTRACT Objective: this study aimed at investigating the Schedule Oral Motor Assessment (SOMA) tool to be used with preterm infants and to compare its results with the Preterm Oral Feeding Readiness Assessment Scale (POFRAS) to start oral feeding. Methods: a cross-sectional and quantitative study, consisting in a sample of 45 healthy and clinically stable preterm infants, assessed at their first oral feeding with two tools: the Schedule Oral Motor Assessment and Preterm Oral Feeding Readiness Assessment Scale. Stata 10.0 software was used for data analysis. Results: 10 preterm infants with readiness for oral feeding showed normal oral motor function, and 16, presented with oral motor dysfunction, did not show readiness for feeding (p &lt;0.05). The time of transition for full oral feeding was 13.5 (± 8.1) days for preterm infants with better results in both assessment tools, and 17.7 (± 10.9) days for those who did not show readiness for oral feeding and had oral motor dysfunction to initiate oral feeding, resulting in a given clinical relevance, even showing no significance (p&gt; 0.05). Conclusion: these results suggest that the Schedule Oral Motor Assessment can be an adjunctive method for evaluation of the oral motor function at the first oral feeding in preterm infants.

Comparison of the finger-feeding versus cup feeding methods in the transition from gastric to oral feeding in preterm infants

ObjectivesTo assess the finger-feeding technique when compared with the cup feeding method during the early stage of preterm infant feeding transition regarding milk loss, milk ingestion period, and complications. MethodsExperimental, randomized, prospective study including 53 preterm infants with gestation age<37 weeks, clinically stable, and with a score of >28 points in the Oral Feeding Readiness Assessment Scale. The preterm babies were randomized to be included in the control group, which underwent the feeding transition using a cup or in the experimental group, which used the finger-feeding technique. The analysis of data was performed using Student's t-test to evaluate differences between mean values of the appointed variables, and Fischer's test for categorical variables; the asymmetric variables were assessed by the Kruskal–Wallis ANOVA test. ResultsWhen compared with the control group, the experimental group showed lower milk loss, longer milk ingestion time, and a lower frequency of complications during feeding. The significance level was set at 5%, with a confidence interval of 90%. ConclusionThe finger-feeding technique was shown to be a better feeding transition method regarding efficacy when compared with cup feeding method, due to lower milk loss and fewer complication episodes.

Somatosensory Modulation of Salivary Gene Expression and Oral Feeding in Preterm Infants: Randomized Controlled Trial.

BackgroundDespite numerous medical advances in the care of at-risk preterm neonates, oral feeding still represents one of the first and most advanced neurological challenges facing this delicate population. Objective, quantitative, and noninvasive assessment tools, as well as neurotherapeutic strategies, are greatly needed in order to improve feeding and developmental outcomes. Pulsed pneumatic orocutaneous stimulation has been shown to improve nonnutritive sucking (NNS) skills in preterm infants who exhibit delayed or disordered nipple feeding behaviors. Separately, the study of the salivary transcriptome in neonates has helped identify biomarkers directly linked to successful neonatal oral feeding behavior. The combination of noninvasive treatment strategies and transcriptomic analysis represents an integrative approach to oral feeding in which rapid technological advances and personalized transcriptomics can safely and noninvasively be brought to the bedside to inform medical care decisions and improve care and outcomes.ObjectiveThe study aimed to conduct a multicenter randomized control trial (RCT) to combine molecular and behavioral methods in an experimental conceptualization approach to map the effects of PULSED somatosensory stimulation on salivary gene expression in the context of the acquisition of oral feeding habits in high-risk human neonates. The aims of this study represent the first attempt to combine noninvasive treatment strategies and transcriptomic assessments of high-risk extremely preterm infants (EPI) to (1) improve oral feeding behavior and skills, (2) further our understanding of the gene ontology of biologically diverse pathways related to oral feeding, (3) use gene expression data to personalize neonatal care and individualize treatment strategies and timing interventions, and (4) improve long-term developmental outcomes.MethodsA total of 180 extremely preterm infants from three neonatal intensive care units (NICUs) will be randomized to receive either PULSED or SHAM (non-pulsing) orocutaneous intervention simultaneous with tube feedings 3 times per day for 4 weeks, beginning at 30 weeks postconceptional age. Infants will also be assessed 3 times per week for NNS performance, and multiple saliva samples will be obtained each week for transcriptomic analysis, until infants have achieved full oral feeding status. At 18 months corrected age (CA), infants will undergo neurodevelopmental follow-up testing, the results of which will be correlated with feeding outcomes in the neo-and post-natal period and with gene expression data and intervention status.ResultsThe ongoing National Institutes of Health funded randomized controlled trial R01HD086088 is actively recruiting participants. The expected completion date of the study is 2021.ConclusionsDifferential salivary gene expression profiles in response to orosensory entrainment intervention are expected to lead to the development of individualized interventions for the diagnosis and management of oral feeding in preterm infants.Trial RegistrationClinicalTrials.gov NCT02696343; https://clinicaltrials.gov/ct2/show/NCT02696343 (Archived by WebCite at http://www.webcitation.org/6r5NbJ9Ym)

Clinicians guide for cue-based transition to oral feeding in preterm infants: An easy-to-use clinical guide.

Rationale, aims and objectivesThis article aims to provide evidence to guide multidisciplinary clinical practitioners towards successful initiation and long‐term maintenance of oral feeding in preterm infants, directed by the individual infant maturity.MethodA comprehensive review of primary research, explorative work, existing guidelines, and evidence‐based opinions regarding the transition to oral feeding in preterm infants was studied to compile this document.ResultsCurrent clinical hospital practices are described and challenged and the principles of cue‐based feeding are explored. “Traditional” feeding regimes use criteria, such as the infant's weight, gestational age and being free of illness, and even caregiver intuition to initiate or delay oral feeding. However, these criteria could compromise the infant and increase anxiety levels and frustration for parents and caregivers. Cue‐based feeding, opposed to volume‐driven feeding, lead to improved feeding success, including increased weight gain, shorter hospital stay, fewer adverse events, without increasing staff workload while simultaneously improving parents' skills regarding infant feeding. Although research is available on cue‐based feeding, an easy‐to‐use clinical guide for practitioners could not be found. A cue‐based infant feeding regime, for clinical decision making on providing opportunities to support feeding success in preterm infants, is provided in this article as a framework for clinical reasoning.ConclusionsCue‐based feeding of preterm infants requires care providers who are trained in and sensitive to infant cues, to ensure optimal feeding success. An easy‐to‐use clinical guideline is presented for implementation by multidisciplinary team members. This evidence‐based guideline aims to improve feeding outcomes for the newborn infant and to facilitate the tasks of nurses and caregivers.

Every three-hour versus every six-hour oral feeding in preterm infants: a randomised clinical trial

目的 比较每3小时和每6小时经口喂养两种喂养程序，确定那种程序可以使早产儿更快的过渡到全经口喂养。 方法 孕周≤33周出生的婴儿，如果允许喂养，随机分为每3小时喂养或者每6小时喂养。主要结果为完全到经口喂养的时间；次要结果包括呼吸和呼吸暂停比例、生长以及住院时间。 结果 55例婴儿纳入研究。两组比较主要结果和次要结果均无差异。 结论 如果允许喂养，与每3小时一次喂养程序比较，早产儿喂养采用每6小时一次的程序不会改变过渡到完全经口喂养的时间，也不会影响呼吸增快、呼吸暂停或者住院时间。每6小时喂养程序可以减少每日经口喂养的工作量。

Nonlinear methods of analysis to examine respiratory waveform variability during oral feeding in preterm infants

In a novel exploratory study, nonlinear methods of analysis for respiratory patterns were used to examine respiratory waveform variability during oral feeding in preterm infants. Twelve healthy preterm infants were studied using a within-subject cross over design to compare semi-upright and the elevated sidelying position during bottle feeding. Outcome measures were physiologic indicators of cardiopulmonary status: heart rate, respiratory rate, oxygen saturation and respiratory pattern variability. Preliminary results suggest that analysis of respiratory waveform variability is feasible and may be a more sensitive measure of cardiopulmonary physiology than means for heart rate, respiratory rate and percent haemoglobin oxygen saturation. Nonlinear methods of analysis of the respiratory data provide a distinct perspective on the adaptability of infants' breathing patterns while feeding. The clinical application of monitoring respiratory waveforms using nonlinear methods may be helpful in identifying readiness to initiate and advance feeds orally in preterm infants.

Relationship between oxygen saturation, gestational age, and level of oral feeding skills in preterm infants.

To correlate the peripheral oxygen saturation with gestational age and the level of oral feeding skills in the introduction of oral feeding in preterm infants. This is a cross-sectional, quantitative study whose sample was composed of 169 clinically stable preterm infants. Peripheral oxygen saturation was assessed before and after introduction of oral feeding. The preterm infants were stratified into three groups based on their gestational age at birth: 26-29, 30-33, and 34-36 weeks. The preterm infants were classified into four levels according to their oral feeding skill and resistance. No differences in oxygen saturation were observed between the strata of gestational age and between the levels of oral feeding skill. Differences were observed in the groups of preterm infants aged 30-33 weeks (p=0.04) and 34-36 weeks (p=0.02) and on the level I of oral feeding skills (p=0.04) when oxygen saturation was compared at pre- and post-first oral feeding. Significant correlations (p<0.001) were found between gestational age and the levels of oral feeding skills (r=0.38); in Group A, between gestational age and oxygen saturation before the first oral feeding (r=0.83); in Group B, between the level of oral feeding skill and oxygen saturation before the first oral feeding (r=0.26) and between level of oral feeding skill and gestational age (r=0.26). Correlation was found for peripheral oxygen saturation when compared with gestational age and with the level of oral feeding skills.

Desempenho da alimentação oral em recém-nascidos prematuros estimulados pela técnica treino de deglutição

RESUMO Introdução A prematuridade pode afetar o desenvolvimento adequado do recém-nascido. Objetivo Avaliar o desempenho para a alimentação via oral em recém-nascidos prematuros, estimulados pela técnica treino de deglutição. Métodos A pesquisa ocorreu em uma unidade de terapia intensiva neonatal, no período de março a agosto de 2015. Trata-se de um estudo Quase Experimento de Série Temporal com 14 recém-nascidos pré-termo (RNPT), com idade gestacional corrigida entre 30-36 semanas. Foi aplicado o protocolo de avaliação da prontidão do prematuro para início da alimentação oral (pré e pós-treino de deglutição). O treino de deglutição ocorreu uma vez ao dia e, em média, durante seis dias consecutivos. Resultados Verificou-se melhora pós-estimulação, comparando-se os dados do protocolo pré-intervenção e pós-intervenção. Quanto aos níveis de habilidades de alimentação por via oral, 50% dos prematuros foram classificados como nível 4. A alimentação via oral foi iniciada, em média, 1 dia após o término do treino de deglutição; a sonda alimentar foi retirada em, aproximadamente, 7 dias após o início da via oral. Houve associação inversa limítrofe entre melhora no escore de prontidão e tempo de transição da via alternativa para a via oral total e associação inversa entre melhora no escore de prontidão e idade gestacional corrigida. Conclusão A intervenção com treino de deglutição possibilitou melhora na habilidade de alimentação em 50% da amostra, com início da alimentação via oral e obtenção da alimentação exclusiva via oral em um curto período de tempo, com prontidão para via oral em idades gestacionais precoces.

Nonlinear methods of analysis to examine respiratory waveform variability during oral feeding in preterm infants

Nonlinear methods of analysis to examine respiratory waveform variability during oral feeding in preterm infants

Cardiorespiratory parameters and their relation with gestational age and level of oral feeding skills in preterm infants.

To correlate cardiorespiratory parameters with gestational age and level of oral feeding skills in the first oral feeding in preterm infants. Study participants were 37 clinically stable preterm infants. Cardiorespiratory rate was assessed before and after introduction of oral feeding. The newborns were divided into three strata according to gestational age at birth. Oral skill was classified into four levels: I - low oral skill and low resistance to feeding; II - low oral skill and high resistance to feeding; III - high oral skill and low resistance to feeding; IV - high oral skill and high resistance to feeding. No difference was observed in heart and respiratory rate between the strata of gestational age at birth and between the levels of oral skill. Comparison between pre- and post-cardiorespiratory rates within each level of oral skill and stratum of gestational age showed difference between heart rate in the strata of gestational ages of 30 to 33 weeks and of 34 to 36 weeks, as well as between oral skill of levels I, II, and IV. With regard to the comparison between pre- and post- respiratory rates, difference was found in the oral skill of level I. Differences were observed between pre- and post-prandial cardiorespiratory rates regarding the first oral feeding, as well as between strata of gestational age at birth and levels of oral feeding skills.

Acquired palatal groove and delayed oral feeding in preterm infants.

Acquired palatal groove has been reported in the 1970s and 1980s, but its current incidence in Japanese newborns is unclear. The aims of this study were to determine the incidence of palatal groove in preterm infants and to evaluate whether this condition affects oral feeding ability. We conducted a prospective observational study among very low-birthweight infants born at Takatsuki General Hospital, Osaka, between March and October in 2010. The shape of the hard palate was classified into three types: normal, narrow high-arched palate, and palatal groove. Among the 37 enrolled infants, 14 (38%) had palatal groove. In particular, among the 29 infants with birthweight <1000 g, palatal groove was observed in 48% of these patients, and only 10% were normal. Infants with palatal groove were ventilated for considerably more days with oral endotracheal tube than those without palate groove, even after adjustment for gestational age, birthweight, and duration of oral duodenal tube placement (OR, 1.11). Establishment of oral feeding and disappearance of choking on milk were considerably delayed in infants with palatal groove. Transient oral feeding difficulty requiring thickened-feed intervention was observed only in infants with palatal groove; on multi-regression analysis this difficulty seemed to be induced by the palatal groove. Palatal groove formation induced by oral endotracheal intubation occurs with a high frequency in preterm infants, and this is likely to affect oral feeding ability.

Omega-3 Fatty Acids and Maternal and Child Health: An Updated Systematic Review.

To update a prior systematic review on the effects of omega-3 fatty acids (n-3 FA) on maternal and child health and to assess the evidence for their effects on, and associations with, additional outcomes. MEDLINE®, Embase®, the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Centre for Agriculture and Biosciences (CAB) Abstracts from 2000 to August 2015; eligible studies from the original report; and relevant systematic reviews. We included randomized controlled trials (RCTs) of any defined dose of n-3 FA (or combination) compared to placebo, any other n-3 FA, or alternative dose with an outcome of interest conducted in pregnant or breastfeeding women or neonates (preterm or term). We also included prospective observational studies that analyzed the association between baseline n-3 FA intake or biomarker level and followup outcomes. Postnatal interventions began within a week of birth for term infants and within a week of beginning enteral or oral feeding for preterm infants. Standard methods were used for data abstraction and analysis, according to the Evidence-based Practice Center Methods Guide. We identified 4,275 potentially relevant titles from our searches, of which 95 RCTs and 48 observational studies met the inclusion criteria. Risk of bias was a concern with both RCTs and observational studies. Outcomes for which evidence was sufficient to draw a conclusion are summarized here with the Strength of Evidence (SoE). (Outcomes for which the evidence was insufficient to draw a conclusion are summarized in Appendix G of the report.). Most studies in this report examined the effects of fish oil (or other combinations of DHA and EPA) supplements on pregnant or breastfeeding women or the effects of infant formula fortified with DHA plus AA. As with the original report, with the exception of small increases in birth weight and length of gestation,n-3 FA supplementation or fortification has no consistent evidence of effects on peripartum maternal or infant health outcomes. No effects of n-3 FA were seen on gestational hypertension, peripartum depression, or postnatal growth. Apparent effects of n-3 FA supplementation were inconsistent across assessment methods and followup times for outcomes related to infant visual acuity, cognitive development and prevention of allergy and asthma. Future RCTs need to assess standardized preparations of n-3 and n-6 FA, using a select group of clinically important outcomes, on populations with baseline n-3 FA intakes typical of those of most western populations.

Oral stimulation for promoting oral feeding in preterm infants.

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. 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. 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. 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. 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. 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. 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.

Does parental involvement affect the development of feeding skills in preterm infants? A prospective study

BackgroundFeeding difficulties frequently occur in preterm infants, thus contributing to delayed growth and hospital discharge. AimsTo evaluate the effect of Kangaroo mother care implementation and parental involvement in infants' feeding on the timing of achievement of full oral feeding in preterm infants.Study design.Prospective, observational, single-centre study. SubjectsA total of 81 infants born at a gestational age ≤32weeks, consecutively admitted to a tertiary neonatal unit between June 2014 and May 2015.Outcome measures.The timing of the achievement of full oral feeding of preterm infants. ResultsFull oral feeding was achieved at a mean postmenstrual age of 35.5±2.1weeks. A multiple linear regression analysis showed that a low birth weight, the occurrence of bronchopulmonary dysplasia, and the need for gastrointestinal surgical procedures were associated with a higher postmenstrual age at achievement of full oral feedings. By contrast, the earlier that parents fed their infants and the earlier that Kangaroo mother care was started, the lower the postmenstrual age at the achievement of full oral feeding. ConclusionsThese findings indicate that an early start of Kangaroo mother care and early parental involvement in infants' feeding positively affect the achievement of independent oral feeding.

Application of oral feeding promotion program in the oral feeding of preterm infants

Objective To explore the effect of oral feeding promotion program, which combined utilization of preterm infant oral motor intervention (PIOMI) from abroad and the Chinese version of preterm infant oral feeding readiness assessment scale (PIOFRAS), on the performance, process and outcome of oral feeding in preterm infants. Methods A total of 62 infants born before 34 weeks of gestation were divided into control group and experimental group according to the order of admission. Both groups received the same routine care. The infants in the experimental group (n=30) received the assessment of oral feeding readiness by PIOFRAS before feeding, and were given oral massage and non-nutritive sucking for 5 minutes once a day. The intervention started from gavage feeding to total oral feeding. While the control group (n=32) received a sham intervention that nurses stood beside the warm box or the baby′s bed for 5 minutes once a day before feeding. The oral feeding performance, the corrective gestational age of initiation of oral feeding and achieving full oral feeding, daily bodyweight and length of hospital stay were recorded. Results The transitional time from the initiation of oral feeding to full oral feeding in experimental group was shorter than that in control group[(8.07±6.73) d vs (13.88±7.51)d], and the difference was statistically significant (t=3.200, P 0.05). Conclusions The oral feeding promotion program can improve the oral feeding of preterm infants. Key words: Preterm infant; Enteral nutrition; Oral motor intervention; Oral feeding