Sucking Bursts Research Articles

Exploration of the Association Between Sucking Measures and Ability to Attain Independent Oral Feeds Among Infants Who Are Born Preterm.

Infants who are born preterm often experience difficulty transitioning from full tube to independent oral feeds, which often prolongs their hospital stay. No clinical measures associated with attainment of independent oral feeds are currently available. To identify specific nutritive sucking measures associated with time to attainment of independent oral feeds among infants who are born preterm. An observational cohort pilot study was undertaken. A Level 2 to Level 3 neonatal intensive care unit. Fourteen infants (7 male, 7 female) born at or less than 34 wk gestation were enrolled. The monitored suck measures included average suck strength (millimeters of mercury), average sucking burst duration (seconds), average suck count (number of sucks), and average pause duration (seconds). Time to independent oral feeds (days) and baseline characteristics were also monitored. The nutritive sucking measures were recorded once, during the first 5 min of an oral feed, when infants were taking an average of three to four oral feeds per day using a nipple monitoring device. An inverse relation was found among average suck burst duration (p = .04), gestational age (p = .03), and days to attainment of independent oral feeds. Study results suggest that average sucking burst duration, during the first 5 min of an oral feed, is associated with time to attain independent oral feeds. Plain-Language Summary: Sucking burst duration is a simple measure that may be used clinically to identify early on infants who may have trouble transitioning from full tube to independent oral feedings. The results of this study suggest that a suck burst duration in the first 5 min of an oral feeding is inversely associated with the length of time to achieve independent oral feeding. The results highlight the importance of considering an infant's nutritive sucking ability when evaluating their potential to achieve independent oral feedings.

Menerjemahkan Instrumen Preterm Infant Breastfeeding Behavior Scale ke Bahasa Indonesia: Studi Pilot

Background:The availability of instruments to observe the behavior of premature infants while breastfeeding in Indonesia is important, considering the number of premature babies in Indonesia is high Indonesia Objective: This study aims to translate and cross-cultural adaptation of the Preterm Infant Breeding Behavior Scale (PIBBS) into Indonesian. Methods: The research design uses instrument translation, including testing the reliability of the instrument. The study was conducted by observing 10 breastfeeding sessions on a convenience sample of three late preterm infants (34-<37 weeks' gestation) and mothers in the Perinatology Room of RSUD Goeteng Taroenadibrata. Observations were made by the researcher and the baby's mother. The research instrument used a demographic sheet, and PIBBS. The inter-rater reliability test was carried out using the percentage agreement on observations and the Intraclass Correlation Coefficient (ICC). Research Results: The study found the percentage agreement on the observation of premature babies' behavior while breastfeeding was 80-100%. Intraclass Correlation Coefficients (ICC) observations of nipple seeking behavior, areola coverage, attachment and attachment to the breast, nipple sucking, longest sucking burst, and swallowing behavior were >0.90, 1.00, 1.00, 1.00, >0.90, and 1.00. Conclusion: The Indonesian version of the PIBBS instrument has a very good reliability value. This instrument is appropriate and can be used to observe the behavior of premature babies while breastfeeding in Indonesia

Neonatal manual specialization in language and music conditions: Consistency with the hemispheric specialization adult model

The main purpose of this study was to test in neonates the influence of the sound environment, i.e., language versus music, on asymmetric hand movement activity in the presence of a target object. Based on hemispheric specialization, our hypothesis was that infants would use their right hand more in the speech context (left hemisphere) and their left hand more in the music context (right hemisphere). The study involved 19 full-term 3-day-old neonates. An object was presented successively in the two sound environments in counterbalance order for 120 s each. Left and right movements and mouth activity were scored during the target object presentation. Results show that neonates moved their left hand twice as much as their right hand in the music condition than in the language condition, and they moved their right hand a longer time in the language condition than in the music condition. The average number of sucking bursts was significantly higher in the language condition than in the music condition. We discuss the results in terms of manual specialization in relation to the development of hemispheric specialization.

Changes in non-nutritive suck between 3 and 12 months

BackgroundNon-nutritive suck (NNS) is one piece of the complex oral feeding process, yet there is paucity on how it develops throughout the first year of life. AimsTo determine changes in infant NNS between 3 and 12 months of age. Study designTwenty-six full-term infants (65% male) completed this study. All infants were offered our custom research pacifier to attain a quantitative analysis of their suck pattern. Based on quantitative analyses of NNS cycle count, the best 2 min of infants' suck were selected and analyzed. Outcome measuresNNS duration, amplitude, cycles/burst, frequency, cycles, and bursts. ResultsNNS duration, bursts, cycles/burst and cycles significantly decreased from 3 to 12 months, yet amplitude significantly increased over the same time period. Additionally, no significant differences were evident for NNS frequency. Three-month-old infants produced a median of 4.50 suck bursts per minute that contained 9.60 cycles/burst, resulting in a burst duration of 4.74 s. The median NNS frequency was 2.09 Hz, with an average amplitude of 14.05 cmH20. Twelve-month-old infants produced a median of 2.50 suck bursts that contained 3.75 cycles/burst, resulting in a burst duration of 1.67 s. The median NNS frequency was 2.11 Hz with an amplitude of 19.75 cmH20. ConclusionFull-term infants significantly change their NNS duration, amplitude, burst number, cycles/burst and cycle number with no significant changes present in NNS frequency between 3 and 12 months. Knowledge of NNS emergence and maturation during the first year of life is imperative for proper NNS assessment so that healthcare professionals can identify delays.

Changes in infant non-nutritive sucking throughout a suck sample at 3-months of age.

The goal of this study was to compare how infants' non-nutritive suck (NNS) changes throughout a suck sample. Fifty-four full-term infants (57% male) completed this study at, on average, 3.03 (SD .31) months of age. These infants sucked on our custom research pacifier for approximately five minutes. Infants produced, on average, 14.50 suck bursts during the sample. NNS data was pooled across subjects and breakpoint analyses were completed to determine if there were changes in their NNS patterning. Breakpoints were evident for NNS cycles per burst at burst numbers 18 and 34, and for amplitude (cmH20) at burst numbers 18 and 29. No breakpoints were present for NNS frequency. Infants exhibit changes in their suck physiology across burst number. When assessing suck, developmental specialists should observe more than one suck burst to attain a more valid and appropriate scope of the infant's suck ability.

Quantitative assessment of nutritive sucking patterns in preterm infants

ObjectiveTo assess patterns of nutritive sucking in very preterm infants ≤32 weeks of gestation. Study designVery preterm infants who attained independent oral feeding were prospectively assessed with an instrumented feeding bottle that measures nutritive sucking. The primary outcome measure was nutritive sucking performance at independent oral feeding. ResultWe assessed nutritive sucking patterns in 33 very preterm infants. We recorded 63 feeding sessions. The median number of sucks was 784 (IQR: 550–1053), the median sucking rate was 36/min (IQR: 27–55), and the median number of sucking bursts during the first 5 min of oral feeding was 14 (IQR: 12–16). Maximum sucking strength correlated with the number of sucks (r = 0.62; p < 0.01). No safety concerns were identified during the study. ConclusionThe quantitative analysis of nutritive sucking patterns with a newly developed instrumented bottle in stable, very preterm infants is safe and feasible. More research is needed to develop and refine the instrument further.

Breastfeeding skills of full-term newborns and associated factors in a low-and-middle-income setting.

Normative information on the breastfeeding of term newborns may guide clinicians in early identification of breastfeeding difficulties and oro-pharyngeal dysphagia (OPD), and may support optimal breastfeeding practices. To describe breastfeeding skills of term newborn infants in a South African hospital, a lower-middle-income setting, and investigate associations between infants' feeding and other factors. One breastfeeding session of each of the 71 healthy newborn full-term infants (mean chronological age=1.9 days; mean gestation=39.1 weeks) was evaluated using the Preterm Infant Breastfeeding Behavior Scale (PIBBS), suitable for use with term newborns. All participants were exclusively breastfed. Thirteen participants (18%) were HIV-exposed. There was no significant difference in the findings of the PIBBS between HIV-exposed and unexposed participants. Most newborns had obvious rooting, latched deeply onto the nipple and some of the areola, had repeated long sucking bursts (mean length=16.82 sucks/burst), and swallowed repeatedly. Most participants were in either the drowsy or quiet-alert state, which are optimal behavioural states for breastfeeding. One to two-hourly on-demand feeds was significantly associated with mothers who had normal births and did not use galactogogues to promote lactation. Results may be used for early identification of OPD in newborns. The findings may be useful to primary care clinicians.

Quantitative Assessment of Nutritive Sucking Patterns in Preterm Infants (P11-095-19)

ObjectivesMastery of oral feeding independent of supplementary feeding tubes is crucial for safe discharge of very preterm infants (≤ 32 weeks of gestation). Qualitative assessments of suck-swallow-breathe coordination can be subjective and result in prolonged hospitalizations and delay discharges. Quantitative assessment of sucking activity during feeding (i.e., nutritive sucking) could improve determination of readiness for progression to independent oral feeding and facilitate discharge planning. To quantitively assess nutritive sucking patterns using an instrumented feeding bottle. MethodsPreterm infants ≤ 32 weeks of gestation who attained independent oral feeding were prospectively evaluated after written informed consent was obtained. Infants with congenital anomalies and infants with major comorbidities were excluded. Nutritive sucking was assessed for a minimum of one feeding session in each participant by instrumenting a commercially available feeding bottle with a detachable pressure sensor configured to detect changes in the bottle enclosure. Speech pathologists administered the feeding using a standardized technique with infants under continuous cardiorespiratory monitoring. Type of feed, volume, and schedule was maintained consistently in accordance with each participant’s defined regimen during his/her hospitalization. ResultsWe analyzed 63 feeding sessions from 33 preterm infants. Mean birthweight of study participants was 1160 g (SD: 455) and median gestational age was 28 weeks (IQR: 27 – 31). Nutritive sucking patterns were assessed at term equivalent age (median corrected gestational age: 37 weeks; IQR: 35 – 39). During each feeding session, the median suck count was 784 (IQR: 550 – 1053), the median sucking rate was 0.6/s (IQR: 0.5 -0.9), the median number of brief feeding interruptions was 10 (IQR: 6–15), and the median value of sucking bursts was 52 (41-65) [Image]. Maximum suck strength strongly correlated with suck count (r = 0.68). A positive association between suck count and sucking bursts was found in unadjusted regression models (R2 = 0.35; P < 0.0001) and models adjusted for gestational age at birth, birthweight, feeding volume, transient events during feeding, and postnatal age (R2 = 0.50; P < 0.0001). ConclusionsIn stable very preterm infants, nutritive sucking patterns can be quantified by instrumentation of commercially available feeding bottles. Further analyses of sucking burst patterns may improve determination of readiness for progression to independent oral feeding in preterm infants. Funding SourcesNone. Supporting Tables, Images and/or Graphs▪

Nonnutritive Sucking at the Mother's Breast Facilitates Oral Feeding Skills in Premature Infants: A Pilot Study.

Premature infants have difficulties in transitioning from gavage to breastfeeding. Targeted interventions to support breastfeeding in premature infants in the neonatal intensive care unit are scarce. This pilot study evaluates the effectiveness of nonnutritive sucking at the mother's breast in premature infants to facilitate breastfeeding performance and exclusive breastfeeding. The study design constituted a single-blinded randomized control trial, with 9 participants randomly allocated into experimental (n = 4) and control (n = 5) groups. The intervention, nonnutritive sucking at the mother's breast thrice a day for 5 minutes, till nutritive breastfeeding was started, was done in addition to standard care, which was nonnutritive sucking on a finger during gavage feeds. The control group received only standard care. Nonnutritive sucking was assessed using "Stages of Nonnutritive Sucking Scale," and breastfeeding performance was assessed using the "Preterm Infant Breastfeeding Behavior Scale" by a blinded assessor unaware of the infants' allocation. Five infants in the control arm and 4 in the intervention arm completed the study. The infants in the intervention group showed faster transition to mature stages of nonnutritive sucking (P = .05) and had longer sucking bursts during breastfeeding (P = .06) than those in the control group. There was no difference in the rates of exclusive breastfeeding at 6 months in the intervention and control groups. Early initiation of nonnutritive sucking at the mother's breast in very preterm infants is a safe and effective intervention to facilitate maturation of oral feeding and breastfeeding behavior. Nonnutritive sucking at the mother's breast can be explored as an intervention, with a larger sample, to facilitate exclusive breastfeeding and to establish intervention fidelity.

Social visual stimuli increase infants suck response: A preliminary study.

This study investigated whether visual stimuli (FACES vs. CARS) combined with the presence of maternal scent can influence suck patterning in healthy infants. Fifteen healthy full-term infants (six months and younger) were exposed to their mother’s scent during a visual preference paradigm consisting of FACES vs. CARS stimuli while sucking on a custom research pacifier. Infants looked significantly longer to the FACES compared to CARS, p = .041. Repeated Measures ANOVA revealed a significant main effect for non-nutritive suck (NNS) bursts and visual stimuli (p = .001) with the largest differences evident between FACES and when the infant looked away from the visual stimuli (p = 0.008) as well as between FACES and CARS (p = 0.026). These preliminary findings suggest that infants have more suck attempts when looking at FACES in the presence of maternal scent thereby indicating potent links between visual preference and suck behavior.

Characterisation of sucking dynamics of breastfeeding preterm infants: a cross sectional study

BackgroundFull breastfeeding is the ultimate aim for preterm infants to ensure they receive the full benefits of human milk however, preterm infants face a number of challenges associated with their immaturity and associated morbidities. In order to facilitate oral feeding, it is essential to have a sound knowledge of the sucking dynamics of the breastfed infant. The aim of this study was to measure and describe the sucking dynamics of the preterm breastfeeding infant.MethodsA prospective cross sectional observational study was carried out at King Edward Memorial Hospital, Perth. 38 mothers and their preterm infants (birth gestation age: 23.6–33.3 weeks; corrected gestation age 32.7 to 39.9 weeks) were recruited. Intra-oral vacuum levels, tongue movement and milk intake for a single breastfeed was measured. Statistical analysis employed linear regression and linear mixed effects models.ResultsSynchronised ultrasound and intra-oral vacuum measurements show that the preterm infant generates vacuum by lowering their tongue in a parallel fashion, without distortion of the nipple/nipple shield. Baseline (B), mean (M) and (P) peak suck burst vacuums weakened over the course of a feed (B: p = 0.015; M: p = 0.018; P: p = 0.044) and mean and peak vacuums were weaker if the mother fed with a nipple shield (M: p = 0.012; P: p = 0.021). Infant milk intakes were higher when infants sucked for longer (p = 0.002), sucked for a greater proportion of the feed (p = 0.002), or had a greater sucking efficiency (p < 0.001).ConclusionsBreastfeeding preterm infants generated intra-oral vacuum in the same manner as term infants. Nipple shields were associated with weaker intra-oral vacuums. However, vacuum strengths were not associated with milk intake rather time spent actively sucking was related to milk volumes. Further research is required to elucidate factors that influence preterm infant milk intake during breastfeeding.

Breastfeeding Characteristics of Late-Preterm Infants in a Kangaroo Mother Care Unit.

To describe the breastfeeding characteristics of late-preterm infants (LPIs) in a kangaroo mother care (KMC) unit. In a 20-bed KMC unit, the breastfeeding of 73 purposively-selected LPIs' (mean gestational age: 34.8 weeks) was observed once-off, using the Preterm Infant Breastfeeding Behavior Scale. Participants' mean age was 9.5 days, mean number of days in the unit was 3.1 days, and mean number of days breastfeeding was 7.5 on observation. Only 13.7% of participants were directly breastfeeding without supplementary naso- or orogastric feeding/cup-feeding and 86.3% received supplementary cup-feeding of expressed breast milk. Most participants did not exhibit obvious rooting (83.5%) and although most latched-on (97.3%), those who did, latched shallowly (93%). The mean longest sucking burst was 18.8 (standard deviation: 10.5) and approximately half the participants swallowed repeatedly (53.4%). The mean breastfeeding session duration was 17.8 minutes, but most participants breastfed for less than 10 minutes (76.7%). No statistically significant differences in breastfeeding characteristics were detected between participants of different chronological ages. A general trend toward more mature behaviors in participants' breastfeeding for more days was present for many breastfeeding characteristics. More infants exhibited the most mature behavior for each breastfeeding characteristic when the environment was quiet, rather than noisy and disturbing, except for depth of latching (quiet: 0%, disturbance: 15.2%). LPIs in this sample presented with subtle breastfeeding difficulties, highlighting their need for breastfeeding support. Further research is required to examine the effect of KMC on breastfeeding in LPIs.

Longitudinal Changes in Suck-Swallow-Breathe, Oxygen Saturation, and Heart Rate Patterns in Term Breastfeeding Infants

Despite the differences in breastfeeding and bottle-feeding, our understanding of how suck-swallow-breathe (SSwB), oxygenation, and heart rate patterns change as the infant ages is based predominantly on bottle-feeding studies. Therefore, this study aimed to measure how SSwB, oxygenation, and heart rate patterns changed during the first 4 months of lactation in term breastfeeding infants. Infants less than 1 month postpartum (n = 15) were monitored early in lactation and again later in lactation (2-4 months postpartum). Simultaneous recordings of vacuum, tongue movement, respiration, swallowing, oxygen saturation, and heart rate were made during both nutritive sucking and non-nutritive sucking during breastfeeding. Infants transferred a similar amount of milk (P = .15) over a shorter duration later in lactation (P = .04). Compared to early lactation, suck bursts became longer (P < .001), pauses became shorter (P < .001), vacuum levels decreased (all P < .05), oxygen saturation increased (P < .001), and heart rate decreased (P < .001) later in lactation. This study confirmed that term infants become more efficient at breastfeeding as they age, primarily by extending their suck bursts and pausing less. Although infants demonstrated satisfactory SSwB coordination during early lactation, they showed a level of adaption or conditioning at later lactation by applying weaker vacuum levels and demonstrating improved cardiorespiratory responses.

Short-Term Effects of Pacifier Texture on NNS in Neurotypical Infants

The dense representation of trigeminal mechanosensitive afferents in the lip vermilion, anterior tongue, intraoral mucosa, and temporomandibular joint allows the infant's orofacial system to encode a wide range of somatosensory experiences during the critical period associated with feed development. Our understanding of how this complex sensorium processes texture is very limited in adults, and the putative role of texture encoding in the infant is unknown. The purpose of this study was to examine the short-term effects of a novel textured pacifier experience in healthy term infants (N = 28). Nonnutritive suck (NNS) compression pressure waveforms were digitized in real time using a variety of custom-molded textured pacifiers varying in spatial array density of touch domes. MANCOVA, adjusted for postmenstrual age at test and sex, revealed that infants exhibited an increase in NNS burst attempts at the expense of a degraded suck burst structure with the textured pacifiers, suggesting that the suck central pattern generator (sCPG) is significantly disrupted and reorganized by this novel orocutaneous experience. The current findings provide new insight into oromotor control as a function of the oral somatosensory environment in neurotypically developing infants.

Perioral movements and sucking pattern during bottle feeding with a novel, experimental teat are similar to breastfeeding

To measure intraoral pressure and perioral movement in infants during breastfeeding (BF) and feeding with experimental teat (ET). The teat has a wide base, firm shaft and a valve at the base, such that milk flows only when the baby provides a hold pressure. Twenty healthy term infants, between 1 and 8 months old, were enrolled in the study. Feeding sessions (BF and ET) were recorded using a digital video camera. During both BF and ET feeding sessions, recordings during feeding were taken of jaw and throat movements (n=20) as well as intraoral pressure (n=18). The efficiency of milk transfer and the angle of the mouth were also measured. There was no significant difference in either the jaw or throat movements between BF and ET. The sucking burst pattern, the efficiency (ml min(-1)), and the angle of the mouth did not differ between both feeding methods. The intraoral negative pressure observed during ET was significantly smaller than that observed during BF. There were no significant differences in perioral movements. Although the value was smaller, a hold pressure was observed during ET. From these results, the novel, ET may decrease BF problems related to bottle use.

The Development of Oral Feeding Skills in Infants

The Development of Oral Feeding Skills in Infants

Quantification of Intraoral Pressures During Nutritive Sucking: Methods with Normal Infants

We report quantitative measurements of ten parameters of nutritive sucking behavior in 91 normal full-term infants obtained using a novel device (an Orometer) and a data collection/analytical system (Suck Editor). The sucking parameters assessed include the number of sucks, mean pressure amplitude of sucks, mean frequency of sucks per second, mean suck interval in seconds, sucking amplitude variability, suck interval variability, number of suck bursts, mean number of sucks per suck burst, mean suck burst duration, and mean interburst gap duration. For analyses, test sessions were divided into 4×2-min segments. In single-study tests, 36 of 60 possible comparisons of ten parameters over six pairs of 2-min time intervals showed a p value of 0.05 or less. In 15 paired tests in the same infants at different ages, 33 of 50 possible comparisons of ten parameters over five time intervals showed p values of 0.05 or less. Quantification of nutritive sucking is feasible, showing statistically valid results for ten parameters that change during a feed and with age. These findings suggest that further research, based on our approach, may show clinical value in feeding assessment, diagnosis, and clinical management.

Maturational changes in the feeding behaviour of infants – a comparison between breast‐feeding and bottle‐feeding

To obtain a better understanding of the changes in feeding behaviour from 1 to 6 months of age. By comparing breast- and bottle-feeding, we intended to clarify the difference in longitudinal sucking performance. Sucking variables were consecutively measured for 16 breast-fed and eight bottle-fed infants at 1, 3 and 6 months of age. For breast-feeding, number of sucks per burst (17.8 +/- 8.8, 23.8 +/- 8.3 and 32.4 +/- 15.3 times), sucking burst duration (11.2 +/- 6.1, 14.7 +/- 8.0 and 17.9 +/- 8.8 sec) and number of sucking bursts per feed (33.9 +/- 13.9, 28.0 +/- 18.2 and 18.6 +/- 12.8 times) at 1, 3 and 6 months of age respectively showed significant differences between 1 and 6 months of age (p < 0.05). The sucking pressure and total number of sucks per feed did not differ among different ages. Bottle-feeding resulted in longer sucking bursts and more sucks per burst compared with breast-feeding in each month (p < 0.05). The increase in the amount of ingested milk with maturation resulted from an increase in bolus volume per minute as well as the higher number of sucks continuously for both breast- and bottle-fed infants.

Prospective study of non-nutritive sucking and feeding skills in premature infants

ObjectiveThe aim of the present work was to assess the value of non-nutritive sucking (NNS) measures as predictors of oral feeding performance in comparison to other putative predictors of feeding...

Utilization of surface electromyography during the feeding of term and preterm infants: a literature review

To evaluate studies that have used surface electromyography (sEMG) during feeding for term and preterm infants. Studies published between 1996 and 2009 were identified through databases (MEDLINE, EMBASE, CINAHL, LILACS, and SciELO) and divided into groups: term infants, preterm infants, and other situations with infants aged from 0 to 12 months. Five studies were found for suckling in term infants, two evaluating muscular activity during feeding in preterm infants, and one dealing with other situations. Some studies revealed striking differences in activity of the masseter muscle between breastfed and bottle-fed term infants (action diminished in bottle-fed infants). For preterm infants, authors evaluated sucking and sucking bursts and pointed out an effective means of evaluating muscle behaviour during feeding. There is evidence of a similarity in activity between cup feeding and breastfeeding. Studies found in this literature review show the importance of using sEMG as a method of feeding assessment for term and preterm infants. For term infants, the masseter muscle presented greater muscular activity during breastfeeding and reduced activity during bottle-feeding. It was not possible to make comparisons between studies of preterm infants because of differences in methodological design.