Oral Feeding Performance Research Articles

Elastic sac to support oral feeding performance of preterm infants: Crossover randomized controlled study.

Swaddling is recommended for preterm infants during feeding. Swaddling preterm infants with elastic cotton materials allows infants to easily stretch and move their extremities. This study aimed to assess the effect of bottlefeeding in a novel "elastic sac" on physiological parameters and feeding performance of preterm infants. A randomized controlled, crossover trial was conducted with total of 26 preterm infants at 26-36+6 weeks of gestation. Infants randomly assigned to group 1 (n = 13) were bottlefed in an elastic sac (researcher-designed single-piece pouch made of soft, elastic cotton) for the first feeding and in normal clothes for the next feeding. Infants randomly assigned to group 2 (n = 13) were fed first in normal clothes and then in the elastic sac. The physiological parameters and feeding performance of the infants were assessed during each feeding. Preterm infants fed in the elastic sac had lower heart rate and higher oxygen saturation during and after feeding than infants fed in normal clothes (P < 0.05). Although all values were within clinically normal ranges, the findings suggest that feeding preterm infants in the elastic sac had a favorable effect on physiological parameters compared with feeding in normal clothes. There was no significant difference in the infants' feeding performance (P > 0.05). A semielevated right lateral position and flexed body posture are recommended while feeding preterm infants, which can be easily maintained using the elastic sac. Feeding preterm infants in an elastic sac may support physiologic stability during oral feeding.

Investigation of the relationship between oral motor feeding development and gross motor development between preterm and term infants at 10- to 12-month postnatal age

BackgroundImmature central nervous system, extended stay in the neonatal intensive care unit, and sensory experience deficiency may contribute to oral and gross motor delay in preterm infants. Current study aimed to investigate oral and motor development in preterm infants.MethodsTwenty-nine preterm infants and 28 term infants were evaluated within the scope of the study. Oral motor feeding development was assessed with the Schedule for Oral Motor Assessment, and motor development was evaluated with the Alberta Infant Motor Scale. All analyses were performed using SPSS 22. The study was approved by the Gazi University Clinical Researches Ethics Committee (no: 25901600–23).ResultsThere was a correlation between the Schedule for Oral Motor Assessment categories (solid, semisolid, cracker, puree, bottle, and cup) and the Alberta Infant Motor Scale score (p < 0.05). There was a significant difference between groups in the Schedule for Oral Motor Assessment’s solid, semisolid, cracker, and puree categories and total score (p < 0.05). There was a significant difference between groups regarding the Alberta Infant Motor Scale score (p < 0.05).ConclusionPreterm infants come behind their term peers in motor and oral motor feeding performance. These two areas of development can influence each other. For this reason, oral motor feeding problems should be emphasized as well as motor problems in physiotherapy rehabilitation evaluations.

Item-Level Psychometrics of the Neonatal Eating Outcome Assessment in Orally Feeding Infants.

The Neonatal Eating Outcome Assessment determines feeding performance based on the infant's postmenstrual age (PMA). To examine item-level measurement properties of this assessment's rating scale. In this retrospective study, Rasch analysis was completed on clinical data from the Neonatal Eating Outcome Assessment for 100 infants (52 preterm and 48 full-term) using Winsteps version 3.93.1. Instead of PMA-based scores, ordered letters converted to numerical scores were analyzed. Analysis demonstrated that Section I (Pre-Feeding Skills) represents a separate construct from Sections II and III (Oral Feeding and End of Feeding, respectively). Sections II and III were adequately unidimensional to complete Rasch analysis. These sections fit the Rasch model overall, but rating scale category underuse was common, which may be attributed to sample characteristics. This analysis supports using validated ordered letter scoring of Sections II and III to measure oral feeding performance in preterm and full-term newborns.

Effect of Prefeeding Oromotor Stimulation on Oral Feeding Performance of Preterm Neonates during Hospitalization and at Corrected One Month of Age at a Tertiary Neonatal Care Unit of India: A Randomized Controlled Trial

Aim To evaluate the effect of prefeeding oromotor stimulation on preterm infants’ feeding performance during hospitalization and in early infancy. Methods Twenty nine preterm neonates born between 26 and 32 weeks of gestation were randomized to receive either 5 minutes of prefeeding oromotor stimulation or routine care. Results Improvement in mean (SD) scores of feeding performance measured by various standardized scales were higher in the study group ( p &lt;.001). There were a higher number of preterms of the intervention group on mothers’ milk at discharge and at corrected one month of age. They achieved independent oral feeding at significantly lower body weight ( p &lt;.001) and had a shorter duration of hospitalization ( p &lt;.05). No significant difference was found in the weight gain rate of preterm infants during hospitalization and at corrected one month of age. Conclusion Prefeeding oromotor stimulation improves feeding performance and shortens hospital stay in preterm neonates and improves the breastfeeding rate at their corrected one month of age.

Effectiveness of multistimulation approach on feeding habits of low-birth-weight babies-A randomized control trial.

IntroductionLow- birth- weight neonates face oral feeding difficulties due to hemodynamic instability, immaturity of central nervous systems, and incomplete development of oral functions. Use of several interventions might help in improvement of the feeding ability of neonates. The objective of the study was to evaluate the effect of the multistimulation approach in low-birth-weight babies on the oral feeding performance, oral intake volume, weight gain and transition time from tube to total oral intake.MethodsA Randomized, parallel-group, multiple arm trial study was conducted, and a total of 44 low birth weight babies were randomized into three parallel groups with a 2:1:1 ratio. Babies who are Hemodynamically stable were included in the trial. In two Intervention groups, one received an oral stimulation program, another intervention group received tactile stimulation, and the control group received routine newborn procedures for the same duration of time. Oral feeding performance was determined by Oral Feeding Skills (OFS) on a daily basis for five days after providing ten days of intervention. Neonates were monitored until hospital discharge.ResultsInfants in the stimulation groups had significantly better oral feeding performance than infants in the control group in terms of mean proficiency, transfer rate and overall transfer of feeding volume. There was a substantial increase in mean feeding score, daily weight, oral intake volume, and early transition time in both intervention groups compared to control. There was no significant difference in feeding behaviours between the oromotor and multistimulation groups, but the multistimulation group gained more weight compared to the oromotor group.ConclusionsInfants exposed to the stimulation programme had better feeding skills and a shorter transition period from tube feeding to oral feeding; however, the babies who received multistimulation gained greater weight than babies who received only oromotor stimulation. The study recommends multi stimulation in the form of oromotor, and tactile stimulation can be used as an effective NICU procedure for maintaining an infant's ability to take feeds orally before being discharged from the hospital.

The Impact of Infant and Maternal Factors on Oral Feeding Performance in Premature Infants

Aims: To identify infant and maternal factors associated with attainment of full oral feeding (FOF) in premature infants. Method: A retrospective study was performed on 89 premature infants (<34 weeks gestational age) from a tertiary care neonatal intensive care unit (NICU). Infant and maternal factors were concurrently assessed. Infant factors included gestational age, birthweight, continuous positive airway pressure assistance, mechanical ventilation support, and presence of neonatal morbidities including bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and intraventricular hemorrhages (IVH). Maternal factors included maternal age, first born, twin birth, and presence of mental health conditions including anxiety, stress, or depression. Results: A total of 89 premature infants were included in the sample. A stepwise linear regression model revealed that infants who received mechanical ventilator support and presence of maternal mental health conditions were significantly associated with time to attain FOF. Conclusions: Results suggest that oral feeding performance is influenced not only by infant’s medical severity denoted by need for ventilator assistance, but also by presence of maternal anxiety, stress, and/or depression.

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.

Sleep-Wake States and Feeding Progression in Preterm Infants.

Previous studies demonstrated a short-term relationship between infant sleep-wake states and oral feeding performance, with state being an indication of infants' neurobehavioral readiness for feeding. However, the relationship between sleep-wake states and feeding skills has not been evaluated longitudinally during hospitalization. The purpose of this study was to examine preterm infants' sleep-wake state developmental trajectories and their associations with feeding progression during hospitalization. This descriptive and exploratory study was a secondary analysis using data from a longitudinal two-group, randomized controlled trial evaluating the effects of early and late cycled light on health and developmental outcomes among extremely preterm infants who were born ≤28 weeks of gestational age. Sleep-wake states were assessed for two 2-hour interfeeding periods per day (day and night hours), 30 weeks postmenstrual age, and every 3 weeks until discharge. Occurrences of active sleep, quiet sleep, and waking were recorded every 10 seconds. Feeding progression was assessed based on an infant's postmenstrual age at five milestones: first enteral feeding, full enteral feeding, first oral feeding, half oral feeding, and full oral feeding. Trajectory analyses were used to describe developmental changes in sleep-wake states, feeding progression patterns, and associations between feeding progression and sleep-wake trajectories. Active sleep decreased while waking, and quiet sleep increased during hospitalization. Two distinct feeding groups were identified: typical and delayed feeding progression. In infants with delayed feeding progression, rates of active and quiet sleep development during the day were delayed compared to those with typical feeding progression. We also found that infants with delayed feeding progression were more likely to be awake more often during the night compared to infants with typical feeding progression. Findings suggest that delays in sleep-wake state development may be associated with delays in feeding progression during hospitalization. Infants with delayed feeding skill development may require more environmental protection to further support their sleep development.

Olfactory stimulation may promote oral feeding in immature newborn: a randomized controlled trial.

Premature newborns have an increased mortality and morbidity due to respiratory immaturity and inefficient oral feeding performance. Transient assistance with feeding tubes until oral performance improves is required with consequent hospital admission. Based on a controlled and randomized study, we tested whether olfactory stimulation compared to odorless stimulation could accelerate the switch from feeding tube to satisfactory oral feeding. Fifty newborns were included and randomly assigned to either odorless or olfactory stimulation with anise or cinnamon. The main outcome measurement was the duration of the hospital stay. The odor-stimulated group could be discharged from hospital on average 3.4days earlier than the control group (p = 0.12). When including only more mature newborns into the analysis (n = 39), the difference was statistically significant (p < 0.05). This trend emphasizes that olfaction may have its place in early feeding stimulation.

Effect of Oral Stimulation and Non-Nutritive Sucking Program on Feeding Readiness of Preterm Infants

Postpartum The aim of this study was to assess the effect of oral stimulation and non nutritive sucking program on: The feeding readiness (sucking and feeding ability) of preterm infants, the behavioral states of preterm infants, and the feeding-related physiological changes of preterm infants. A quasi experimental (intervention) study design was utilized to achieve the aim of this study. The study was conducted at NICU in Benha University Hospital, and NICUs at Benha Specialized Pediatric Hospital affiliated to Ministry of Health. Sample consists of 52 preterm infant. The tools of data collection were a structured interviewing questionnaire sheet for the preterm infant, and preterm infant oral feeding readiness assessment scale. The results revealed that, there were statistical significant differences between pre and post application of oral stimulation and non-nutritive sucking program for preterm infants regarding their readiness to oral feeding. It was concluded from the study that applying oral stimulation and non-nutritive sucking program had a positive effect on enhancing sucking and feeding readiness of preterm infants, in addition, improving the oral feeding performance. The study recommended that emphasizing the importance of applying oral stimulation and non-nutritive sucking program, on feeding readiness and transition to gavage and oral feeding, which is effective and safe non invasive intervention in all NICUs as a standard of care for all preterm infants.

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

Premature: growth and its relation to oral skills.

To evaluate the influence of oral motor skills of premature infants on their oral feeding performance and growth, during neonatal hospitalization. Fifty-one newborns hospitalized in the neonatal intensive care unit of a hospital in Southern Brazil, between July 2012 and March 2013, were evaluated. The evaluation of oral feeding skills, according to Lau and Smith, was applied after prescription for starting oral feeding. The oral feeding performance was analyzed using the following variables: days taken to start independent oral feeding and hospital discharge. Growth was measured by weight, length, and head circumference, using the curves of Fenton, at birth, first and independent oral feeding, and hospital discharge. At birth, 71% preterm infants were proper for gestational age, most of them were males (53%), with average of 33.6 (±1.5) weeks of gestational age. The gestational age in the assessment did not influence the oral feeding performance of the premature infant and did not differ between levels. Time of transition from tube feeding to oral feeding and hospital stay was shorter when the oral skills were higher. At birth, there was a tendency of low weight and low oral feeding performance. Level IV premature infants in the release of oral feeding presented higher weights. The level of oral skills of the premature infant interfered positively on time of feeding transition from tube to independent oral feeding and hospital stay. Growth, represented by weight gain, was not affected by the level of oral skill.

A self-paced oral feeding system that enhances preterm infants' oral feeding skills

AimVery low birth weight (VLBW) infants have difficulty transitioning to independent oral feeding, be they breast- or bottle-feeding. We developed a ‘self-paced’ feeding system that eliminates the natural presence of the positive hydrostatic pressure and internal vacuum build-up within a bottle during feeding. Such system enhanced these infants' oral feeding performance as monitored by overall transfer (OT; % ml taken/ml prescribed), rate of transfer (RT; ml/min over an entire feeding). This study hypothesizes that the improvements observed in these infants resulted from their ability to use more mature oral feeding skills (OFS). Methods‘Feeders and growers’ born between 26 and 29 weeks gestation were assigned to a control or experimental group fed with a standard or self-paced bottle, respectively. They were monitored when taking 1–2 and 6–8 oral feedings/day. OFS was monitored using our recently published non-invasive assessment scale that identifies 4 maturity levels based on infants' RT and proficiency (PRO; % ml taken during the first 5 min of a feeding/total ml prescribed) during bottle feeding. ResultsInfants oral feeding outcomes, i.e., OT, RT, PRO, and OFS maturity levels were enhanced in infants fed with the self-paced vs. standard bottle (p ≤ 0.007). ConclusionThe improved oral feeding performance of VLBW infants correlated with enhanced OFS. This study is a first to recognize that VLBW infants' true OFS are more mature than recognized. We speculate that the physical properties inherent to standard bottles that are eliminated with the self-paced system interfere with the display of their true oral feeding potential thereby hindering their overall oral feeding performance.

Influência do estado comportamental nos padrões de sucção de recém-nascidos pré-termo

Objetivo Verificar a influência do estado comportamental na sucção não nutritiva, na sucção nutritiva e na performance alimentar de recém-nascidos pré-termo, no momento da liberação da via oral. Métodos Participaram 32 recém-nascidos pré-termo, clinicamente estáveis, internados em uma unidade de terapia intensiva neonatal. Foram realizadas, por um fonoaudiólogo, as avaliações do estado comportamental, padrão postural, reflexos orais, características dos órgãos fonoarticulatórios, sucção não nutritiva e nutritiva, número de suções por bloco de sucção, taxa de transferência e desempenho alimentar, após a liberação médica para início da alimentação por via oral. Resultados Não foi possível verificar associação do estado comportamental com a sucção não nutritiva. Na sucção nutritiva, verificou-se influência do estado comportamental sobre o número de sucções nos três primeiros blocos, ou seja, o estado de alerta, ao iniciar a mamada, possibilitou aos recém-nascidos apresentarem maior número de sucções, quando comparados aos recém-nascidos em estado de sono. Isto se refletiu na performance alimentar, por meio da maior taxa de transferência e melhor desempenho, embora não tenha sido observada significância estatística quanto a esses aspectos. Conclusão Os achados mostram que o estado comportamental não influenciou os aspectos de sucção não nutritiva, considerados, entretanto, na sucção nutritiva. O estado de alerta apresentou associação com maior número de sucções por bloco, em relação ao estado de sono.

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.

Oral Feeding Competences of Healthy Preterm Infants: A Review

Background. With increasing sophistication and technology, survival rates hugely improved among preterm infants admitted to the neonatal intensive care unit. Nutrition and feeding remain a challenge and preterm infants are at high risk of encountering oral feeding difficulties. Objective. To determine what facts may impact on oral feeding readiness and competence and which kind of interventions should enhance oral feeding performance in preterm infants. Search Strategy. MEDILINE database was explored and articles relevant to this topic were collected starting from 2009 up to 2011. Main Results. Increasingly robust alertness prior to and during feeding does positively impact the infant's feeding Skills. The review found that oral and non-oral sensorimotor interventions, provided singly or in combination, shortened the transition time to independent oral feeding in preterm infants and that preterm infants who received a combined oral and sensorimotor intervention demonstrated more advanced nutritive sucking, suck-swallow and swallow-respiration coordination than those who received an oral or sensorimotor intervention singly.

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.

A Novel Approach to Assess Oral Feeding Skills of Preterm Infants

Background: There is no well-defined means to identify the level of oral feeding skills (OFS) in preterm infants. Objective: To determine whether OFS as reflected by the combination of proficiency (PRO, %ml taken during the first 5 min/ml prescribed) and rate of milk transfer (RT, ml/min) correlates with gestational age (GA), oral feeding performance (OT, %ml taken during a feeding/ml prescribed) and days from start to independent oral feeding (SOF-IOF). Our working premises are that PRO is reflective of infants’ actual feeding skills when fatigue is minimal and RT, monitored over an entire feeding session, reflects their overall skills when fatigue comes into play. Methods: Infants (26–36 weeks GA) with prematurity as their principal diagnosis were recruited and monitored at their first oral feeding. GA was divided into 3 strata, 26–29, 30–33, and 34–36 weeks GA. OFS was divided into 4 levels delineated by PRO (≧ or <30%) and RT (≧ or <1.5 ml/min). ANOVA with post-hoc Bonferroni and multiple regression analyses were used. Results: OFS levels were correlated with GA. OT, PRO, and days from SOF-IOF were associated with OFS and GA, whereas RT was only correlated with OFS levels. Conclusions: OFS is a novel objective indicator of infants’ feeding ability that takes into account infants’ skills and endurance. As a clinical tool, it can help caretakers monitor infants’ skills as they transition to oral feeding and identify oral feeding issues arising from immature skills and/or poor endurance.

The preterm piglet – a model in the study of oesophageal development in preterm neonates

Preterm infants have difficulty in attaining independent oral feeding. This can ensue from inadequate sucking, swallowing and/or respiration. In impeding bolus transport, immature oesophageal motility may also be a cause. As studies on the development of oesophageal motility are invasive in preterm infants, the preterm piglet was investigated as a potential research model. Oesophageal motility (EM) of term (n = 6) and preterm (n = 15) piglets were monitored by manometry for 10 min immediately following bottle feeding on days 1-2 and 3-4 of life. Piglets' oral feeding performance and EM were similar to those of their human counterparts. Term piglets readily completed their feeding, whereas their preterm counterparts did not. They also presented with greater peristaltic activity and propagating velocity. Peristaltic activity remained unchanged over time in preterm piglets, but an increase in synchronous and decrease in incomplete motor activity were noted. Preterm piglets that developed symptoms analogous to necrotizing enterocolitis (NEC) demonstrated uncharacteristic oesophageal activity. Immature EM may cause oral feeding difficulties. NEC-like symptoms may adversely affect EM. The piglet is a valid research model for studying human infant oral feeding and oesophageal development.