Sucking In Preterm Infants Research Articles

Quantitative non-nutritive sucking measurement as a predictor of oral feeding readiness in newborns.

The purpose of this study is to examine the relationship between the parameters of a silver nanowire-based flexible pressure sensor developed to measure the non-nutritive sucking (NNS) performance and predict the nutritive sucking status in preterm infants. Preterm infants who were referred for feeding difficulty during the transition period from tubal feeding to oral feeding were enrolled in our study. A flexible pressure sensor was used to measure the non-nutritive sucking parameters of neonates. The evaluator stimulated the infants' lips and tongue with a pacifier integrated with a sucking pressure sensor, to check whether non-nutritive sucking had occurred. When the sucking reflex was induced, it was measured. The infants' sucking characteristics were subdivided into classifications according to the NOMAS criteria and full oral feeding (FOF) status. Quantitative NNS measurement according to the feeding state was compared between groups. When comparing the quantitative NNS measurement by feeding characteristics, the average sucking pressure was significantly higher in infants in the FOF capable group than those in the incomplete FOF group. In addition, the maximum and average sucking pressure was significantly higher in infants with a normal sucking pattern compared to those with a disorganized sucking pattern. The average NNS pressure was divided over the range of 0-3 kPa and the same weight was assigned to each item. When the optimal cut-off value for the sensitivity and specificity of the average NNS pressure to estimate the FOF was set, a pressure of 1.5 kPa yielded the highest sensitivity (84.62%) and specificity (67.65%) on the receiver operating characteristic (ROC) curve. The area under the curve (AUC) was 0.786, and this result was statistically significant. This study presents a quantitative parameter for non-nutritive sucking in preterm infants with the use of a flexible pressure sensor. Results show possible quantitative indicators that can aid in predicting when preterm infants can transition to oral feeding and their prognosis. This will serve as a basis for future research on determining the feeding transition period of newborns with health conditions that affect oral feeding.

A comparison of objective and subjective measurements of non-nutritive sucking in preterm infants

Background Of preterm infants born before 32 weeks of gestation, 40-70% have atypical and immature feeding skills, which could delay initiation of oral feeding. A formal objective measurement of non-nutritive sucking may increase the accuracy of determining the right time to initiate oral feeding, however, most hospital perinatology care units do not own a suction pressure measurement device to objectively measure non-nutritive sucking parameters.
 Objective To compare objective and subjective non-nutritive sucking (NNS) based on sucking pressure, number of suctions per burst, and time between bursts.
 Methods One hundred twenty preterm infants born at 28-34 weeks’ gestation were evaluated for objective and subjective NNS. Data were collected from August to November 2021 at five hospitals in Jakarta. Objective NNS was measured by a suction pressure measurement device, while subjective NNS was clinically examined. Number of suctions per burst, sucking pressure, and time between bursts were analysed by Spearman’s correlation test.
 Results A positive and significant correlation between objective and subjective NNS was found in all parameters (P<0.001). The highest correlation was found in time between bursts (r=0.74; P<0.001), followed by number of suctions per burst (r=0.60; P<0.001), and sucking pressure (r=0.58; P<0.001).
 Conclusion The correlation between objective and subjective NNS examination was moderate in preterm infants. Therefore, an objective NNS measurement is still required for optimizing the examination.

A comparison of objective and subjective measurements of non-nutritive sucking in preterm infants

Background Of preterm infants born before 32 weeks of gestation, 40-70% have atypical and immature feeding skills, which could delay initiation of oral feeding. A formal objective measurement of non-nutritive sucking may increase the accuracy of determining the right time to initiate oral feeding, however, most hospital perinatology care units do not own a suction pressure measurement device to objectively measure non-nutritive sucking parameters.
 Objective To compare objective and subjective non-nutritive sucking (NNS) based on sucking pressure, number of suctions per burst, and time between bursts.
 Methods One hundred twenty preterm infants born at 28-34 weeks’ gestation were evaluated for objective and subjective NNS. Data were collected from August to November 2021 at five hospitals in Jakarta. Objective NNS was measured by a suction pressure measurement device, while subjective NNS was clinically examined. Number of suctions per burst, sucking pressure, and time between bursts were analysed by Spearman’s correlation test.
 Results A positive and significant correlation between objective and subjective NNS was found in all parameters (P<0.001). The highest correlation was found in time between bursts (r=0.74; P<0.001), followed by number of suctions per burst (r=0.60; P<0.001), and sucking pressure (r=0.58; P<0.001).
 Conclusion The correlation between objective and subjective NNS examination was moderate in preterm infants. Therefore, an objective NNS measurement is still required for optimizing the examination.

Effect of an early oral stimulation program on oral feeding in preterm neonates

ObjectiveTo evaluate the effect of prefeeding oral stimulation program on feeding performance, weight gain, and length of hospital stay of preterm infants in neonatal ICUs.BackgroundPrevious research has declared that poor oral-motor developments in premature infants are common. So, most of the preterm infants require individualized therapy. Early intervention of oral-motor management on feeding pattern improves the outcome.Patients and methodsTo reach the goal of this research, a case–control study was conducted. A total of 50 preterm infants were divided into two groups: (a) interventional group (25 preterm infants), which received prefeeding oral stimulation program by stimulation of the oral and perioral structures for 5 min for 10 days and was started immediately after delivery, and (b) control group (25 preterm infants), which did not receive stimulation. Postmenstrual age, total intake volume, body weight, the transition time from initiation of oral feeding to full oral feeding, and feeding efficiency were calculated.ResultsWe found that the mean oral feeding duration was significantly lower among intervention group compared with control group (P = 0.04). The percentage of weight change was significantly higher among intervention group compared with control group (P = 0.03).ConclusionOur study reveals that early sensory oral-motor stimulation with nonnutritive sucking in preterm infants may be effective to expedite oral feeding and hospital discharge. A touch therapy program may confer a statistically significant weight gain for premature babies at much shorter intervals, which leads to a shorter hospital stay.

Do orally-directed behaviors mediate the relationship between behavioral state and nutritive sucking in preterm infants?

Studies show that 40% to 70% of premature infants exhibit both immature and atypical feeding ability. To establish thresholds of performance and develop efficacious treatments for initiating and advancing oral feedings, we must first identify the nutritive sucking performance measures impacted by preterm birth.To compare objective measures of neonatal nutritive sucking between full term and preterm infants at hospital discharge.This was a prospective observational study including full term (FT; N = 32) and preterm (PT; N = 44) infants. Nutritive sucking performance at discharge was assessed. The outcome measures of interest were means and coefficients of variability of nutritive sucking peak amplitude, frequency, duration, and smoothness, and feeding-related length of stay.There was a significant difference in sucking performance between groups; FT infants demonstrated significantly lower mean suck frequency, with longer suck duration and greater suck smoothness as compared to PT. PT infants had significantly less variability in suck amplitude and frequency as compared to FT, while FT infants had significantly less variability in suck smoothness as compared to PT. Post hoc regression analyses found suck frequency alone accounted for 28% of the variance in feeding length of stay for PT; suck smoothness alone accounted for 34% of the variance in feeding length of stay for FT.Suck frequency may be an important intervention target for PT infants having difficulty transitioning to oral feeding. Suck smoothness may be a sensitive marker for identifying infants at high risk for feeding challenges.

Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants.

Non-nutritive sucking (NNS) is used during gavage feeding and in the transition from gavage to breast/bottle feeding in preterm infants to improve the development of sucking behavior and the digestion of enteral feedings. To assess the effects of non-nutritive sucking on physiologic stability and nutrition in preterm infants. We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 1), MEDLINE via PubMed (1966 to 25 February 2016), Embase (1980 to 25 February 2016), and CINAHL (1982 to 25 February 2016). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials. Randomised controlled trials and quasi-randomised trials that compared non-nutritive sucking versus no provision of non-nutritive sucking in preterm infants. We excluded cross-over trials. Two review authors assessed trial eligibility and risk of bias and undertook data extraction independently. We analysed the treatment effects in the individual trials and reported mean differences (MD) for continuous data, with 95% confidence intervals (CIs). We used a fixed-effect model in meta-analyses. We did not perform subgroup analyses because of the small number of studies related to the relevant outcomes. We used the GRADE approach to assess the quality of evidence. We identified 12 eligible trials enrolling a total of 746 preterm infants. Meta-analysis, though limited by data quality, demonstrated a significant effect of NNS on transition from gavage to full oral feeding (MD -5.51 days, 95% CI -8.20 to -2.82; N = 87), transition from start of oral feeding to full oral feeding (MD -2.15 days, 95% CI -3.12 to -1.17; N = 100), and the length of hospital stay (MD -4.59 days, 95% CI -8.07 to -1.11; N = 501). Meta-analysis revealed no significant effect of NNS on weight gain. One study found that the NNS group had a significantly shorter intestinal transit time during gavage feeding compared to the control group (MD -10.50 h, 95% CI -13.74 to -7.26; N = 30). Other individual studies demonstrated no clear positive effect of NNS on age of infant at full oral feeds, days from birth to full breastfeeding, rates and proportion of infants fully breastfeeding at discharge, episodes of bradycardia, or episodes of oxygen desaturation. None of the studies reported any negative outcomes. These trials were generally small and contained various methodological weaknesses including lack of blinding of intervention and outcome assessors and variability on outcome measures. The quality of the evidence on outcomes assessed according to GRADE was low to very low. Meta-analysis demonstrated a significant effect of NNS on the transition from gavage to full oral feeding, transition from start of oral feeding to full oral feeding, and length of hospital stay. None of the trials reported any adverse effects. Well-designed, adequately powered studies using reliable methods of randomisation, concealment of treatment allocation and blinding of the intervention and outcome assessors are needed. In order to facilitate meta-analysis of these data, future research should involve outcome measures consistent with those used in previous studies.

Preference for infant-directed speech in preterm infants

The current study explores the effects of exposure to maternal voice on infant sucking in preterm infants. Twenty-four preterm infants averaging 35 weeks gestational age were divided randomly into two groups. A contingency between high-amplitude sucking and presentation of maternal voice was instituted for one group while the other group served as a yoked control. No significant differences were observed in sucking of the two groups, but the degree of pitch modulation of the maternal voice predicted an increase in the rate of infant sucking.

Effects of oral stimulus frequency spectra on the development of non-nutritive suck in preterm infants with respiratory distress syndrome or chronic lung disease, and preterm infants of diabetic mothers

The precocial nature of orofacial sensorimotor control underscores the biological importance of establishing or orythmic activity in human infants. The purpose of this study was to assess the effects of comparable doses of three forms of orosensory experience, including a low-velocity spectrally reduced orocutaneous stimulus (NT1), a high-velocity broad spectrum orocutaneous stimulus (NT2), and a SHAM stimulus consisting of a blind pacifier. Each orosensory experience condition was paired with gavage feedings 3×/day for 10 days in the neonatal intensive care unit (NICU). Four groups of preterm infants (N = 214), including those with respiratory distress syndrome (RDS), chronic lung disease (CLD), infants of diabetic mothers (IDM), and healthy controls (HI) were randomized to the type of orosensory condition. Mixed modeling, adjusted for gender, gestational age, post-menstrual age, and birth weight, demonstrated the most significant gains in non-nutritive suck (NNS) development among CLD infants who were treated with the NT2 stimulus, with smaller gains realized among RDS and IDM infants. The broader spectrum of the NT2 stimulus maps closely to known response properties of mechanoreceptors in lip, tongue, and oral mucosa and is more effective in promoting NNS development among preterm infants with impaired oromotor function compared to the low-velocity, spectrally reduced NT1 orosensory stimulus.

Cochrane Review: Non‐nutritive sucking for promoting physiologic stability and nutrition in preterm infants

AbstractBackgroundNon‐nutritive sucking is used during gavage feeding and in the transition from gavage to breast/bottle feeding in preterm infants to promote the development of sucking behaviour and improve digestion of enteral feedings.ObjectivesTo determine whether non‐nutritive sucking (NNS) in preterm infants influences: a) weight gain, b) energy intake, c) heart rate, d) oxygen saturation, e) length of hospital stay, f) intestinal transit time, g) age at full oral feeds, or h) any other clinically relevant outcomes.Search strategyMEDLINE and CINAHL databases back to 1976 and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2005) were searched. Updated search in March 2010 included MEDLINE (search via PubMed), CINAHL, EMBASE and CENTRAL (The Cochrane Library).Selection criteriaAll trials utilizing experimental or quasi‐experimental designs in which non‐nutritive sucking in preterm infants was compared to no provision of non‐nutritive sucking were eligible for the review.Data collection and analysisData were extracted independently by the two authors. No subgroup analyses were performed because of the small number of studies related to the relevant outcomes.Main resultsThis review consisted of 21 studies, 15 of which were randomized controlled trials. NNS was found to decrease significantly the length of hospital stay in preterm infants. The review did not reveal a consistent benefit of NNS with respect to other major clinical variables (weight gain, energy intake, heart rate, oxygen saturation, intestinal transit time, age at full oral feeds and behavioral state). The review identified other positive clinical outcomes of NNS: transition from tube to bottle feeds and better bottle feeding performance. No negative outcomes were reported in any of the studies.Authors' conclusionsThis review found a significant decrease in length of stay in preterm infants receiving a NNS intervention. The review did not reveal a consistent benefit of NNS with respect to other major clinical variables (weight gain, energy intake, heart rate, oxygen saturation, intestinal transit time, age at full oral feeds and behavioral state).The review identified other positive clinical outcomes of NNS: transition from tube to bottle feeds and better bottle feeding performance. No negative outcomes were reported in any of the studies. There were also a number of limitations of the presently available evidence related to the design of the studies, outcome variability, and lack of long‐term data. Based on the available evidence, NNS in preterm infants would appear to have some clinical benefit. It does not appear to have any short‐term negative effects.Plain Language SummaryNon‐nutritive sucking for promoting physiologic stability and nutrition in preterm infantsAn infant born prematurely may be fed through a tube into the stomach, so is often given a pacifier to suck on to improve nutrition. An infant needs coordinated sucking, swallowing and breathing to feed. The ability to suck and to swallow is present by 28 weeks gestation, but infants are not fully coordinated until 32 to 34 weeks. This means that preterm infants less than 32 weeks gestation are usually not able to feed effectively from the breast or a bottle. They are fed by a small tube that is placed up the nose into the stomach (gavage feeding). Sucking on a pacifier (non‐nutritive sucking) during gavage feeding may encourage the development of sucking behaviour and improve digestion of the feeding. Non‐nutritive sucking may also have a calming effect on infants, although it does have the potential to interfere with breastfeeding. The authors searched the medical literature and found 21 studies, 15 were randomized controlled trials and six were non‐randomized. The total number of infants in each study ranged from 10 to 59. Weight gain was similar with and without use of a pacifier. Preterm infants with pacifiers did not stay in hospital as long as those without and hospital costs were less (two studies). These infants showed less defensive behaviors during tube feedings, spent less time in fussy and active states during and after tube feedings, and settled more quickly into sleep. Their transition to full enteral (by tube or mouth) or bottle feeds (three studies) and bottle feeding performance, in general, (one study) were easier. No negative outcomes were reported.

Características da sucção nutritiva na liberação da via oral em recém-nascidos pré-termo de diferentes idades gestacionais

OBJETIVO: Analisar as características da sucção nutritiva na liberação da via oral em recém-nascidos pré-termo (RNPT) de diferentes idades gestacionais. MÉTODOS: A amostra constou de 32 RNPT, avaliados no momento da liberação para alimentação por via oral, dividida em dois grupos: Grupo 1 (G1) com idade gestacional inferior a 34 semanas; e Grupo 2 (G2) com idade gestacional igual ou superior a 34 semanas. O desempenho da sucção nutritiva foi avaliado observando-se presença ou ausência de blocos de sucção, número e tempo das sucções nos três primeiros blocos apresentados, e presença ou ausência de coordenação entre sucção/deglutição/respiração (S/D/R). Nenhum RNPT recebeu estimulação fonoaudiológica prévia. RESULTADOS: O G2 apresentou, na maioria dos RNPT, presença de coordenação entre S/D/R, além de melhor desempenho em relação ao número e ao tempo de sucção nos blocos de sucção quando comparado ao G1. Na correlação do número versus tempo de sucção por bloco, o G1 apresentou resultados aproximados aos do G2. Considerando-se a classificação quanto ao desenvolvimento intra-útero adequado para a idade gestacional, os RNPT do G1 apresentaram desempenho semelhante aos do G2, no primeiro e segundo blocos, observando-se queda, no G1, apenas no terceiro bloco. CONCLUSÃO: O melhor desempenho no padrão de sucção nutritiva foi apresentado pelo G2, sugerindo que a idade gestacional corrigida dos RNPT interfere diretamente nos resultados obtidos na avaliação da sucção nutritiva. Assim sendo, esta também é uma variável a ser considerada para liberação da alimentação por via oral.

Respiratory distress syndrome degrades the fine structure of the non-nutritive suck in preterm infants

Aims and objectivesSuck development is a challenging hurdle for preterm infants who endure an extensive oxygen history due to respiratory distress syndrome (RDS). The fine structure of the non-nutritive suck (NNS) was studied in preterm infants according to RDS severity. Design and methodsRecordings of NNS were completed cribside in the neonatal intensive care unit (NICU) in 55 preterm infants distributed among one healthy control group and two RDS infant groups. NNS pressure amplitude (cm H2O) and within-burst suck cycle period (ms) were the dependent measures extracted from digitized records of pacifier nipple compression pressure. Results and conclusionsRDS preterm infants demonstrated significant differences in NNS suck pressure amplitude compared to healthy preterm infants. Periods of oxygen supplementation restrict orofacial movement and limit orosensory experiences necessary for suck development and neural maturation. RDS infants may be excellent candidates for patterned oral stimulation programs designed to advance the maturation of sucking skills.

Predictors of nutritive sucking in preterm infants

The purposes of this analysis were to determine how select characteristics of nutritive sucking (number of sucks, sucks/burst, and sucks/minute) change over time and to examine the effect of select factors (morbidity, maturity, prefeeding behavior state, and feeding experience) on those changes. A longitudinal, non-experimental study was conducted in a Level 3 neonatal intensive care unit using a convenience sample of 88 preterm infants. Statistical analyses were performed using a repeated-measures mixed-model in SAS. Sucking activity (number of sucks, sucks/burst, and sucks/minute) was predicted by morbidity, maturity, feeding experience and prefeeding behavior state. Experience at oral feeding had the greatest effect on changes in the number of sucks, suck/burst and sucks/minute. Experience at feeding may result in more rapid maturation of sucking characteristics.

Non-nutritive sucking for promoting physiologic stability and nutrition in preterm infants.

Non-nutritive sucking is used during gavage feeding and in the transition from gavage to breast/bottle feeding in preterm infants. The rationale for this intervention is that non-nutritive sucking facilitates the development of sucking behaviour and improves digestion of enteral feedings. Non-nutritive sucking has been considered to be a benign intervention, although it has the potential to have a negative effect on breastfeeding or on the incidence of later oral aversion. To determine whether non-nutritive sucking (NNS) in preterm infants influences: a) weight gain, b) energy intake, c) heart rate, d) oxygen saturation, e) length of hospital stay, f) intestinal transit time, g) age at full oral feeds, or h) any other clinically relevant outcomes. MEDLINE and CINAHL databases back to 1976 and the Cochrane Controlled Trials register were searched. Reference lists/bibliographies of relevant articles and reviews were also searched. A comprehensive list of relevant articles was sent to two major authors in this area. They were asked if they knew of any other published or unpublished studies relevant to the area that had not been included in the original list. The searches of MEDLINE, CINAHL and CCTR were updated to December 2000. All trials utilizing experimental or quasi-experimental designs in which non-nutritive sucking in preterm infants was compared to no provision of non-nutritive sucking. Measured clinically relevant outcomes. Reports were in English or a language for which a translator was available. Computerized searches were conducted by both reviewers. All potentially relevant titles and abstracts identified by either reviewer were extracted. All retrieved articles were assessed for relevance independently by each reviewer, based on a pre-determined set of criteria. The reference lists/bibliographies of each article were reviewed independently for additional relevant titles and were also retrieved and assessed for relevance. Articles that met all relevance criteria were then assessed for methodologic quality based on a predetermined set of criteria. Those articles judged to have the appropriate quality by both reviewers were included in the analysis. Data were extracted independently by the two authors. No subgroup analyses were performed because of the small number of studies related to the relevant outcomes. This review consisted of 20 studies, 14 of which were randomized controlled trials. NNS was found to decrease significantly the length of hospital stay in preterm infants. The review did not reveal a consistent benefit of NNS with respect to other major clinical variables (weight gain, energy intake, heart rate, oxygen saturation, intestinal transit time, and age at full oral feeds). The review identified other positive clinical outcomes of NNS: transition from tube to bottle feeds, better bottle feeding performance and behavior. No negative outcomes were reported in any of the studies. This review found a significant decrease in length of stay in preterm infants receiving a NNS intervention. The review did not reveal a consistent benefit of NNS with respect to other major clinical variables (weight gain, energy intake, heart rate, oxygen saturation, intestinal transit time, and age at full oral feeds). The review identified other positive clinical outcomes of NNS: transition from tube to bottle feeds, better bottle feeding performance and behavior. No negative outcomes were reported in any of the studies. There were also a number of limitations of the presently available evidence related to the design of the studies, outcome variability, and lack of long-term data. Based on the available evidence, NNS in preterm infants would appear to have some clinical benefit. It does not appear to have any short-term negative effects. In view of the fact that there are no long-term data, further investigations are recommended. In order to facilitate meta-analysis of these data, future research in this area should involve outcome measures consistent with those used in previous studies. In addition, published reports should include all relevant data.

Mechanically evoked perioral reflexes in premature and term human infants

Neurophysiological assessment of the preterm human neonatal oromotor system has been limited due to their fragile medical state, and methodological limitations. A new, noninvasive technology known as the actifier was developed and used to evoke perioral motor unit activity during non-nutritive suck in preterm infants. A significant ontologic trend for the early component of the perioral reflex (R1) was discovered in the context of spontaneous, centrally-patterned oromotor behavior.

Characterization of the developmental stages of sucking in preterm infants during bottle feeding

It is acknowledged that the difficulty many preterm infants have in feeding orally results from their immature sucking skills. However, little is known regarding the development of sucking in these infants. The aim of this study was to demonstrate that the bottle-feeding performance of preterm infants is positively correlated with the developmental stage of their sucking. Infants' oral-motor skills were followed longitudinally using a special nipple/bottle system which monitored the suction and expression/compression component of sucking. The maturational process was rated into five primary stages based on the presence/absence of suction and the rhythmicity of the two components of sucking, suction and expression/compression. This five-point scale was used to characterize the developmental stage of sucking of each infant. Outcomes of feeding performance consisted of overall transfer (percent total volume transferred/volume to be taken) and rate of transfer (ml/min). Assessments were conducted when infants were taking 1-2, 3-5 and 6-8 oral feedings per day. Significant positive correlations were observed between the five stages of sucking and postmenstrual age, the defined feeding outcomes, and the number of daily oral feedings. Overall transfer and rate of transfer were enhanced when infants reached the more mature stages of sucking. We have demonstrated that oral feeding performance improves as infants' sucking skills mature. In addition, we propose that the present five-point sucking scale may be used to assess the developmental stages of sucking of preterm infants. Such knowledge would facilitate the management of oral feeding in these infants.

Characterization of the developmental stages of sucking in preterm infants during bottle feeding

Characterization of the developmental stages of sucking in preterm infants during bottle feeding

Effects of Sweet Taste Stimulation on Growth and Sucking in Preterm Infants

To evaluate the effect of sweet taste stimulation in augmenting the reported growth-enhancing effects of nonnutritive sucking in preterm infants who are gavage-fed. Random assignment of preterm infants to receive stimulation by one of three methods during each feeding until totally orally fed. Hospital intensive-care and infant transitional units. Eligibility criteria included body weight greater than or equal to 1,250 g, gestational age younger than 34 weeks, growth parameters appropriate for gestational age, tolerating at least 100 kcals/kg/day by gavage feeding with evidence of weight gain, and no clinical evidence of health complications. Data are presented for 42 infants who completed 14 days of treatment. Exposure to a sweet pacifier, a latex pacifier, or maternal heartbeat sounds during gavage feedings. Growth, time to total oral feeding, and sucking responses. No significant differences in sucking measures were noted among treatment groups. Differences in progression time to total oral feedings and weight gain favored the sweet-pacifier group but were not statistically significant. Oral stimulation of gavage-fed, preterm infants during a 2-week hospitalization was not sufficient to elicit a significant improvement in growth efficiency, progression to total oral feedings, or sucking maturation. Additional studies may show a beneficial effect of chemosensory stimulation in preterm infants.

Concurrent Validity of a New Instrument for Measuring Nutritive Sucking in Preterm Infants

The purpose of this study was to examine the concurrent validity of the Whitney strain gage for the measurement of nutritive sucking in preterm infants. Ten preterm infants were studied continuously during at least one entire bottle feeding per week, from admission into the study until discharge from the nursery. Sucking was measured simultaneously by an adapted nipple and the Whitney gage. The two instruments were compared on the following measures: number of sucking bursts, number of sucks per burst, and duration of bursts and pauses between bursts. Total percent agreement for the occurrence of a sucking burst was 99.3% (K = .99). Sucks per burst varied from 2 to 113, with 89.3% of the pairs of sucking bursts differing by < or = 1 suck per burst. The mean absolute difference between the two instruments for the duration of sucking bursts and pauses was .64 s and .72 s, respectively. These results demonstrate the concurrent validity of the Whitney gage for measurement of sucking events in preterm infants.

Transcutaneous Oxygen Tension During Nonnutritive Sucking in Preterm Infants

The effects of nonnutritive sucking on transcutaneous oxygen tension, heart rate, and respiratory rate were studied sequentially in 14 sleeping preterm infants breathing room air. Transcutaneous oxygen tension increased during nonnutritive sucking in infants between 32 and 35 weeks postconceptional age, but not in those between 36 and 39 weeks. This response was not associated with a change in respiratory rate or sleep state, although heart rate tended to increase. These data offer further support for the beneficial effects of nonnutritive sucking in preterm infants.