Oral Feeding Readiness Research Articles

Preterm Bebeklerde Oral Beslenmeye Hazır Oluşluğun Değerlendirilmesi

Preterm bebekler; fizyolojik ve nörolojik açıdan immatür olma, oral-motor reflekslerin zayıf olması, emme, yutma ve solunum arasında koordinasyon sağlayamama, beslenme sırasında fleksiyon postürünü koruyamama, kısa süreli uyanık kalabilme, beslenme sırasında fizyolojik değerleri normal düzeyde sürdürememe gibi özelliklerinden dolayı yaşamın ilk günlerinde orogastrik sonda ile enteral beslenmektedir. Ancak; orogastrik sonda ile beslenmenin uzun süre devam etmesi, oral beslenmenin gecikmesine ve oral beslenme için gerekli olan motor becerilerin kazanılamamasına neden olmaktadır. Bu nedenle preterm bebekler hazır olduklarında oral beslenmeye geçirilmelidir. Preterm bebeklerin oral beslenmeye hazır oluşluğunun değerlendirilmesi güvenli bir oral beslenmenin yapılabilmesi için son derece önemlidir. Günümüzde, preterm bebeklerde oral beslenmeye hazır oluşluğun ne zaman başlayacağı ve orogastrik sonda ile beslenmeden biberonla oral beslenmeye ne zaman geçilmesi gerektiğine ilişkin evrensel olarak kanıtlanmış bir kriter listesi ya da rehber bulunmamaktadır. Oral beslenmeye geçiş kararı hemşire tarafından objektif kriterler göz önüne alınarak verilmelidir. Bu çalışmada, preterm bebeklerde oral beslenme, oral beslenmeye hazır oluşluğu etkileyen faktörler ve yenidoğan hemşirelerinin preterm bebeklerin oral beslenmeye hazır oluşluğunu nasıl değerlendirecekleri konuları güncel literatür bilgileri ışığında ele alınmıştır.

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

PO06 – Cross cultural validation of the preterm oral feeding readiness assessment scale (POFRAS)

PO06 – Cross cultural validation of the preterm oral feeding readiness assessment scale (POFRAS)

Relação entre prontidão para início da alimentação oral e desempenho alimentar em recém-nascidos pré-termo

RESUMO Objetivo Verificar se a presença de prontidão para iniciar a alimentação oral, obtida por meio do Preterm Oral Feeding Readiness Scale (POFRAS) se relaciona com o desempenho alimentar na primeira oferta oral de leite, com o tempo de transição da sonda para a via oral plena e o tempo de internação hospitalar. Métodos Estudo longitudinal, que envolveu 65 recém-nascidos pré-termo. Foi realizada a avaliação da prontidão para início da alimentação oral, por meio do POFRAS, constituindo-se dois grupos: com e sem prontidão para iniciar a alimentação por via oral, em dois estratos de idade gestacional ao nascer: de 28 a 33 semanas e de 34 a 36 semanas. Em cada estrato, os grupos foram comparados entre si, quanto ao desempenho alimentar na primeira oferta oral de leite (por meio das variáveis proficiência, taxa de transferência e desempenho alimentar oral) e quanto ao tempo de transição da sonda para a via oral plena e o tempo de internação hospitalar. O teste t-Student ou o teste de Wilcoxon foram utilizados para comparar as variáveis contínuas e o teste exato de Fisher, para as variáveis categóricas. Resultados A prontidão para iniciar a alimentação por via oral se relacionou com melhores resultados de proficiência e taxa de transferência na primeira alimentação, contribuindo para a transição mais rápida da sonda para a via oral plena, nas crianças nascidas com idade gestacional entre 28 a 33 semanas. Conclusão a avaliação por meio do POFRAS permite estabelecer um prognóstico da alimentação oral em recém-nascidos pré-termo, menores de 34 semanas. No entanto, não exclui a necessidade de avaliação da biomecânica da deglutição.

Sensorized pacifier to quantify the rhythmicity of non-nutritive sucking: A preliminary study on newborns.

Non-nutritive sucking (NNS) is one of the most significant spontaneous actions of infants. The suction/expression rhythmicity of NNS remains unknown. We developed a sensorized pacifier for an objective measurement of NNS. Two miniaturized digital pressure sensors are embedded into a commercial pacifier and they acquired suction and expression pressures simultaneously. Experimental tests with nine newborns confirmed that our device is suitable for the measurement of the natural NNS behavior and for the extrapolation of parameters related to the suction/expression rhythmicity. Preliminary results encourage future studies to evaluate the possibility to use these parameters as indicators of oral feeding readiness of premature infants.

Oral feeding readiness assessment in premature infants.

Oral feeding readiness is a complex concept. More evidence is needed on how to approach beginning oral feedings in premature hospitalized infants. This article provides a review of literature related to oral feeding readiness in the premature infant and strategies for promoting safe and efficient progression to full oral intake. Oral feeding readiness assessment tools, clinical pathways, and feeding advancement protocols have been developed to assist with oral feeding initiation and progression. Recognition and support of oral feeding readiness may decrease length of hospital stay and have a positive impact on reducing healthcare costs. Supporting effective cue-based oral feeding through use of rigorous assessment or evidence-based care guidelines can also optimize the hospital experience for infants and caregivers, which, in turn, can promote attachment and parent satisfaction.

Oral Feeding Readiness Assessment in Premature Infants

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Preterm newborn readiness for oral feeding: systematic review and meta-analysis.

To identify and systematize the main studies on the transition from enteral to oral feeding in preterm infants. Articles that describe the transition from oral to enteral feeding in preterm infants were located in MEDLINE, LILACS, and SciELO databases. Original studies, with available abstract, published in the last 10 years were included. Analysis of the methodology and the main results of the studies, and meta-analysis of the effects of sensory-motor-oral stimulation at the time of transition to full oral feeding and duration of hospitalization were conducted. Twenty-nine national and international publications were considered. Most studies were clinical trials (44.8%) and did not use rating scales to start the transition process (82.7%). In the meta-analysis, positive effect of stimulation of the sensory-motor-oral system was observed with respect to the transition time to oral diet (p=0.0000), but not in relation to the length of hospital stay (p=0.09). However, heterogeneity between studies was found both in the analysis of the transition time to full oral feeding (I2=93.98) and in the length of hospital stay (I2=82.30). The transition to oral feeding is an important moment, and various physical and clinical characteristics of preterm infants have been used to describe this process. Despite the impossibility of generalizing the results due to the heterogeneity of the studies, we have noted the importance of strategies for stimulation of sensory-motor-oral system to decrease the period of transition to full oral feeding system.

Computational Gene Expression Modeling Identifies Salivary Biomarker Analysis that Predict Oral Feeding Readiness in the Newborn

To combine mathematical modeling of salivary gene expression microarray data and systems biology annotation with reverse-transcription quantitative polymerase chain reaction amplification to identify (phase I) and validate (phase II) salivary biomarker analysis for the prediction of oral feeding readiness in preterm infants. Comparative whole-transcriptome microarray analysis from 12 preterm newborns pre- and postoral feeding success was used for computational modeling and systems biology analysis to identify potential salivary transcripts associated with oral feeding success (phase I). Selected gene expression biomarkers (15 from computational modeling; 6 evidence-based; and 3 reference) were evaluated by reverse-transcription quantitative polymerase chain reaction amplification on 400 salivary samples from successful (n = 200) and unsuccessful (n = 200) oral feeders (phase II). Genes, alone and in combination, were evaluated by a multivariate analysis controlling for sex and postconceptional age (PCA) to determine the probability that newborns achieved successful oral feeding. Advancing PCA (P < .001) and female sex (P = .05) positively predicted an infant's ability to feed orally. A combination of 5 genes, neuropeptide Y2 receptor (hunger signaling), adneosine-monophosphate-activated protein kinase (energy homeostasis), plexin A1 (olfactory neurogenesis), nephronophthisis 4 (visual behavior), and wingless-type MMTV integration site family, member 3 (facial development), in addition to PCA and sex, demonstrated good accuracy for determining feeding success (area under the receiver operator characteristic curve = 0.78). We have identified objective and biologically relevant salivary biomarkers that noninvasively assess a newborn's developing brain, sensory, and facial development as they relate to oral feeding success. Understanding the mechanisms that underlie the development of oral feeding readiness through translational and computational methods may improve clinical decision making while decreasing morbidities and health care costs.

Evaluation of swallowing in infants with congenital heart defect.

Introduction Surgical repair of congenital heart disease in the first years of life compromises the coordination of the suction, breathing, and swallowing functions. Objective To describe the alterations in swallowing found in infants with congenital heart defect during their hospitalization. Methods Prospective, cross-sectional study in a reference hospital for heart disease. The sample consisted of 19 postsurgical patients who underwent an evaluation of swallowing. The infants included were younger than 7 months and had a diagnosis of congenital heart defect and suspected swallowing difficulties. Results Of the 19 infants with congenital heart defect, the median age was 3.2 months. A significant association was found between suction rhythm and dysphagia (p = 0.036) and between oral-motor oral feeding readiness and dysphagia (p = 0.014). Conclusions The data suggest that dysphagia often occurs after surgery in infants with congenital heart defect. Infants with congenital heart defect had very similar behavior to preterm infants in terms of oral feeding readiness.

Efeitos da estimulação da sucção não nutritiva com dedo enluvado na transição alimentar em recém-nascido prematuro de muito baixo peso

Objetivos analisar os efeitos da estimulação da sucção não nutritiva com a técnica do dedo enluvado, sobre o início e a transição alimentar da via gástrica para a via oral em prematuros de muito baixo peso. Métodos estudo aleatório, prospectivo, longitudinal, experimental e controlado, que incluiu 40 prematuros internados na UTI Neonatal do Hospital de Clínicas, com idade gestacional £ 32 semanas e peso de nascimento £ 1500g, clinicamente estáveis. Os prematuros foram distribuídos aleatoriamente, por meio de sorteio, em 2 grupos: grupo controle, sem SNN e grupo experimental, com SNN com dedo enluvado, 3 vezes ao dia, 3 dias na semana. Foram avaliados critérios quanto ao escore da avaliação da prontidão para início da alimentação oral, intercorrências durante a sucção nutritiva (SN) e o tempo de transição alimentar. Resultados quando comparado o grupo experimental em relação ao grupo controle observou-se um escore significantemente maior na avaliação da prontidão para início da alimentação via oral, uma menor frequência de sinais de estresse durante a sucção nutritiva e um menor tempo de transição alimentar da via gástrica para via oral. Conclusão a estimulação da sucção não nutritiva com a técnica do dedo enluvado melhorou a prontidão do prematuro para início da alimentação via oral, diminuiu a frequência dos sinais de estresse durante a alimentação via oral e reduziu o tempo de transição alimentar no grupo experimental quando comparado ao grupo controle.

Effect of oral stimulation on oral feeding ability of preterm infants

Objective To study the effect of Sandra Fucile oral stimulation on oral feeding readiness and ability of preterm infants. Methods Sixty-five premature infants were selected in the study.All of the premature infants were recruited randomly in convenience between Jul.and Dec.2012.For a randomized control principle, SPSS 13.0 was performed to achieve complete random design.Objects were divided into control group(receiving routine nursing) and intervention group(on the basis of routine nursing, receiving 15 minutes oral stimulation, 1 time/day, for 10 days). Chinese version of Preterm Infant Oral Feeding Readiness Assessment scale(PIOFRA scale-CV) was used when intervention began, and 7 days, 10 days, 14 days after the start of the intervention. Results PIOFRA-CV scale score was statistically different at different time in both groups(F=169.062, P 0.05). Conclusions Saudra Fucile oral stimulation method can significantly promote the development of premature oral feeding ability on the 10 day after the intervention, and will not increase vomiting, gastroesophageal reflux, and infection.It is suitable for clinical application. Key words: Chinese version of Preterm Infant Oral Feeding Readiness Assessment Scale; Oral stimulation; Preterm infant

Contributing to Content Validity of the Infant-Driven Feeding Scales© through Delphi surveys

The Infant-Driven Feeding Scales© (IDFS) assess a preterm infant’s readiness for oral feeding, evaluate the infant’s quality of feeding, provide a guide for intervention, and provide a standardized format for documentation (Ludwig and Waitzman, 2007). Since its inception, the IDFS have evolved over time with changes in language and clarity founded on clinical experience, best-practice information from the literature, and knowledge of existing infant feeding assessments. This paper presents additional evidence to support the content validity of the IDFS by reporting opinions collected from neonatal feeding experts by way of the Delphi Technique. Updates to the IDFS are presented.

Assessment of swallowing in preterm newborns fed by bottle and cup

To compare the swallowing performance of premature infants using a cup and a bottle during the first offer of food by mouth. This study was carried out with preterm newborns who presented low weight at birth and no neurological illnesses, genetic syndromes or congenital malformations. The newborns were assessed by videofluoroscopy while using a cup and a bottle, when they reached a post-conceptual age of ≥34 weeks, weight ≥ 1,500 g and showed signs of readiness for oral feeding. All children were fed exclusively by gavage during the period prior to the study. This study included 20 preterm newborns, with average birth weight of 1,356 g and gestational age of 31.3 weeks. The majority of the bottle-fed newborns (68%) presented strong and rhythmic suction and 63% showed good sucking/swallowing/breathing coordination. The same percentage of newborns fed by cup (68%) could not perform the sipping movement and only 32% could suck a minimal amount of liquid contrast. There were no signs of laryngeal penetration and tracheal aspiration in both procedures. At the first oral feeding, preterm newborns showed better swallowing performance with a bottle in comparison to using a cup.

State of the Science

Oral feeding readiness has been described by researchers in the neonatal intensive care unit, and research has continued on this topic for many years. The purpose of this narrative review is to identify research and practice guidelines related to oral feeding readiness in preterm infants that have occurred during the last decade. The introduction and mastery of oral feeding is a major developmental task for the preterm infant that is often a prerequisite for discharge from the neonatal intensive care unit. Having a better understanding of the evidence supporting the development of this skill will help the practicing nurse choose appropriate interventions and the researcher to develop trajectories of research that continue to increase our knowledge in this important practice area.

Demanda para intervenção fonoaudiológica em uma unidade neonatal de um hospital-escola

OBJETIVO: caracterizar a demanda e intervenção fonoaudiológicas realizadas em recém-nascidos e lactentes que apresentaram alterações no processo de alimentação por via oral, na Unidade Neonatal de um hospital-escola de caráter público. MÉTODOS: trata-se de um estudo retrospectivo, descritivo e de corte transversal. Foi realizada a coleta de dados por meio de consulta a todos os prontuários fonoaudiológicos de recém-nascidos e lactentes internados no período entre março de 2008 e fevereiro de 2010, que receberam ao menos uma avaliação/intervenção fonoaudiológica. RESULTADOS: foram atendidos nesse período 205 recém-nascidos e lactentes internados. Destes sujeitos, 104 atenderam aos critérios de inclusão na pesquisa. A população predominante foi do sexo masculino, composta de recém-nascidos pré-termo, adequados para idade gestacional, baixo peso ao nascimento, em média com 36 semanas de idade gestacional, com diagnósticos mais frequentes de distúrbio respiratório, síndrome ictérica e/ou distúrbio cardiovascular. Dentre os motivos de encaminhamento para avaliação fonoaudiológica predominaram: alteração no comportamento motor oral, avaliação da prontidão para alimentação por via oral e dificuldades no uso do copo. As avaliações foram solicitadas, em sua maioria, por médicos residentes quando os recém-nascidos estavam, em média, com 28 dias de vida. Verificou-se ampliação dos critérios de encaminhamento da equipe para avaliação fonoaudiológica, quando comparados aos critérios descritos na literatura. CONCLUSÕES: esse trabalho permitiu caracterizar a população, a demanda e a intervenção fonoaudiológicas em uma unidade neonatal. Verificou-se que a maioria dos recém-nascidos e lactentes ainda recebe alimentação por via oral sem avaliação fonoaudiológica prévia, o que pode gerar situações de risco para uma alimentação segura e eficiente.

Oral Feeding Readiness in Preterm Infants

Oral feeding readiness in the neonatal intensive care unit (NICU) population of preterm infants is a complex and multifactorial concept that is encountered on a daily basis. The significance of having an understanding of the concept of oral feeding readiness within the context of prematurity is explored using the Wilsonian approach to concept analysis through the identification of characteristics and case examples of oral feeding readiness in preterm infants as directly observed in a level III NICU. Identification of these essential elements provides clarity for determining oral feeding readiness as well as leading to greater consistency in the provision of evidence-based feeding-related care for the preterm infant hospitalized in the NICU. Outcomes of this analysis demonstrated that oral feeding readiness is affected by a combination of neurodevelopmental maturity, behavioral state organization, and physiologic stability as well as being influenced by caregivers and the environment.

Assess of validity and reliability of Chinese version of Preterm Infant Oral Feeding Readiness Assessment Scale

Objective To assess the reliability and validity of Chinese version of Preterm Infant Oral Feeding Readiness Assessment Scale. Methods The original edition of Preterm Infant Oral Feeding Readiness Assessment Scale was translated from English into Chinese.The Chinese version scale was tested in 154 preterm infants for reliability and validity. Results The Cronbach's α coefficient for the scale was 0.817.The ICC between 2 examiners for the scale was 0.917(P<0.01)and the Spearman rs was 0.927(P<0.01). The structure of the scale was reasonable and the difference whether the premature could start oral bottle-feeding was statistically significant(P=0.000). Area under the receiver operating characteristic(ROC)curve was 0.858(P=0.000, 95%CI: 0.775-0.941). The sensitivity of the scale was 0.756, and the specificity was 0.800 when a cut of 30 point was set by ROC curve analysis, and the overall cross-validated kappa was 0.387(P=0.000). Therefore, 30 point was suggested as the cut point for preterm infant oral feeding readiness. Conclusions The Chinese version of Preterm Infant Oral Feeding Readiness Assessment Scale has a good reliability and validity and it is a favorable tool to assess whether the premature can start oral bottle-feeding safely. Key words: Preterm Infant Oral Feeding Readiness Assessment Scale; Reliability; Validity; Preterm infant

Clinical validation of the Preterm Oral Feeding Readiness Assessment Scale

INTRODUCTION: Health professionals have great difficulties to establish the adequate and safe time to start breast feeding in preterm infants. There is a need to develop a standardized tool to help health professionals to comprehensively evaluate preterm infant readiness to transition preterm infants´ feeding from gastric to oral, and encourage breast feeding practice in neonatal units. Aims: To clinical validate the accuracy of a Preterm Oral Feeding Readiness Assessment Scale with 60 clinically stable preterm infants. METHODS: Global accuracy, sensitivity and specificity of Preterm Oral Feeding Readiness Assessment Scale cut-offs, compared to milk intake through translactation, were estimated through ROC curves (Receiver Operating Characteristic Curves). RESULTS: The global accuracy of Preterm Oral Feeding Readiness Assessment Scale was 74.38%. The highest sensitivity and specificity were obtained for three cut-offs: 28, 29 and 30. Since higher specificity (75.68%) for the Preterm Oral Feeding Readiness Assessment Scale was found at a score cut-off=of 30 showed higher specificity (75.68%), it should be used as a cut-off score to select initiate breastfeeding the preterm newborns' oral feeding readiness. CONCLUSION: The Preterm Oral Feeding Readiness Assessment Scale is considered valid to assist health professionals to initiate preterm feeding in view of promoting safe and objective breastfeeding.