Identification of a Pivotal Period in the Oral Feeding Progression of Preterm Infants

2018 ◽  
Vol 36 (05) ◽  
pp. 530-536 ◽  
Author(s):  
Sandra Fucile ◽  
Sarah Phillips ◽  
Kelly Bishop ◽  
Meagan Jackson ◽  
Taylor Yuzdepski ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Motor Skills ◽  
Tube Feeding ◽  
Time Frame ◽  
Oral Feeding ◽  
High Risk Population ◽  
Feeding Difficulties ◽  
Oral Motor ◽  
Enteral Tube Feeding ◽  
Degree Of Maturity

Objective Preterm infants are at risk of encountering oral feeding difficulties which impede on the transition to independent oral feeds. The objective of this study was to identify a pivotal period where regressions are most likely to occur during their oral feeding progression. Study Design This is a retrospective study on 101 infants born <35 weeks' gestation. The sample was separated into two groups, infants who experienced a regression during their oral feeding progression and those who did not. A pivotal period was defined as a time frame where setbacks (a decrease in oral feed attempts by one) are most likely to occur at the start (1–2 oral feed attempts per day), middle (3–5 oral feed attempts per day), or end (6–8 oral feed attempts per day) of the oral feeding progression. Result Eighty-two percent of infants experienced setbacks; 45% of all setbacks occurred at the middle time frame (p = 0.03). Infants' degree of maturity and enteral tube feeding intolerances were associated with increased occurrence of setbacks (p = 0.04). Conclusion The midpoint in the oral feeding progression is a pivotal period where setbacks are most likely to occur. This time frame can be used by clinicians to evaluate oral-motor skills for earlier provision of interventions to reduce the occurrence of oral feeding difficulties in this high-risk population.

Developing a Quality Improvement Feeding Program for NICU Patients

NeoReviews ◽  
2022 ◽  
Vol 23 (1) ◽  
pp. e23-e35
Author(s):  
Erika K. Osborn ◽  
Sudarshan R. Jadcherla
Keyword(s):  
Quality Improvement ◽  
Clinical Outcomes ◽  
Preterm Infants ◽  
Tube Feeding ◽  
Practice Variation ◽  
Oral Feeding ◽  
Evidence Based ◽  
Feeding Difficulties ◽  
Feeding Program ◽  
Hospital Stays

Practices in NICUs vary widely, particularly when clinical decisions involve complex tasks and multiple disciplines, which occurs with feeding preterm infants. Neonatal feeding difficulties in preterm infants often lead to prolonged tube feeding and therefore lengthened hospital stays. Education and compliance with evidence-based protocols and guidelines are needed on the initiation of feedings and feeding advancement to transform enteral and oral feeding practices and thus reduce practice variation and improve clinical outcomes.

Pharyngo-esophageal motility reflex mechanisms in the human neonate: Importance of integrative cross-systems physiology

2021 ◽  
Author(s):  
Zakia Sultana ◽  
Kathryn A. Hasenstab ◽  
Sudarshan R Jadcherla
Keyword(s):  
Esophageal Motility ◽  
Tube Feeding ◽  
Oral Feeding ◽  
Primary Role ◽  
Critical Function ◽  
Feeding Difficulties ◽  
Survival And Development ◽  
Human Neonate ◽  
Systems Physiology

Swallowing is a critical function for survival and development in human neonates, and requires cross-system coordination between neurologic, airway, and digestive motility systems. Development of pharyngo-esophageal motility is influenced by intra- and extra-uterine development, pregnancy complications, and neonatal comorbidities. Primary role of these motility reflex mechanisms is to maintain aerodigestive homeostasis under basal and adaptive biologic conditions including oral feeding, gastroesophageal reflux, and sleep. Failure may result in feeding difficulties, airway compromise, dysphagia, aspiration syndromes, and chronic eating difficulties requiring prolonged tube feeding. We review the integration of cross-systems physiology to describe the basis for physiologic and pathophysiologic neonatal aerodigestive functions.

Effect of Oral Motor Intervention on Oral Feeding in Preterm Infants: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-11
Author(s):  
Danna Chen ◽  
Zhen Yang ◽  
Chujie Chen ◽  
Pu Wang
Keyword(s):  
Weight Gain ◽  
Hospital Stay ◽  
Preterm Infants ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Oral Feeding ◽  
Transition Time ◽  
Cochrane Library ◽  
Oral Motor ◽  
Feeding Efficiency

Objective This review article aimed to explore the effect of oral motor intervention on oral feeding in preterm infants through a meta-analysis. Method Eligible studies were retrieved from four databases (PubMed, Embase, Cochrane Library, and Web of Science) up to July 2020 and screened based on established selection criteria. Thereafter, relevant data were extracted and heterogeneity tests were conducted to select appropriate effect models according to the chi-square test and I 2 statistics. Assessment of risk of bias was performed among the included studies. Finally, a meta-analysis was carried out to evaluate the effect of oral motor intervention in preterm infants according to four clinical indicators: transition time for oral feeding, length of hospital stay, feeding efficiency, and weight gain. Results Eighteen randomized controlled trials with 848 participants were selected to evaluate the effect of oral motor intervention on preterm infants. The meta-analysis results revealed that oral motor intervention could effectively reduce the transition time to full oral feeds and the length of hospital stay as well as increase feeding efficiency and weight gain. Conclusions Oral motor intervention was an effective way to improve oral feeding in preterm infants. It is worthy to be used widely in hospitals to improve the clinical outcomes of preterm infants and reduce the economic burdens of families and society. Future studies should seek to identify detailed intervention processes and intervention durations for clinical application.

Effects of oral stimulation with breast milk in preterm infants oral feeding: a randomized clinical trial

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Qiong Le ◽  
Sheng-hua Zheng ◽  
Lan Zhang ◽  
Li-fen Wu ◽  
Feng-juan Zhou ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Breast Milk ◽  
Premature Infant ◽  
Preterm Infants ◽  
Oral Feeding ◽  
Transition Time ◽  
Control Group ◽  
Oral Motor ◽  
Oral Stimulation ◽  
Nutritive Sucking

Abstract Objectives This study was performed to evaluate the effect of oral stimulation with breast milk for preterm infants. Methods A total of 68 subjects form neonatal intensive care unit were randomly assigned into control group (n=20), premature infant oral motor intervention (PIOMI) group (n=25) and premature infant oral motor intervention with breast milk (BM-PIOMI) group (n=23). Results BM-PIOMI group had significant shorter initiation of oral feeding (IOF) time compared to PIOMI group (2.95 days, 95% CI [0.42–5.48]) or control group (9.79 days, 95% CI [7.07–12.51]). BM-PIOMI group had significant sooner transition time from IOF to full oral feeding (FOF) compared to control group (6.68 days, 95% CI [2.2–11.16]), but not to PIOMI group (2.09 days, 95% CI [−2.07 to 6.25]). Length of hospital stay (LOS) did not show statistical different between three groups (control 38.85 ± 14.40 vs. PIOMI 38.48 ± 11.76 vs. BM-PIOMI 38.04 ± 12.2). Growth mixture model identified improvement in non-nutritive sucking (NNS) score in BM-PIOMI group compared to control and PIOMI group (0.8293, p<0.0001, and 0.8296, p<0.0001, respectively). Conclusions Oral stimulation with breast milk can better promotes the oral feeding process of premature infants than the simple oral stimulation, by shorten IOF time and improve early NNS score, but does not shorten transition time from IOF to FOF and LOS. Trial registration The trial identification number is ChiCTR1800019134 (Chinese Clinical Trial Registry http://www.who.int/ictrp/network/chictr2/en/)

Feeding and Swallowing Issues in Infants With Craniofacial Anomalies

2016 ◽  
Vol 1 (5) ◽  
pp. 13-26 ◽  
Author(s):  
Claire Kane Miller ◽  
Lauren L. Madhoun
Keyword(s):  
Clinical Signs ◽  
Oral Feeding ◽  
Deletion Syndrome ◽  
Feeding Strategies ◽  
Primary Role ◽  
Craniofacial Anomalies ◽  
Airway Protection ◽  
Feeding Difficulties ◽  
Oral Motor ◽  
Swallowing Dysfunction

The problems with feeding and swallowing that occur as a result of clefts and craniofacial anomalies range in severity. The extent of clefting, as well as other structural, airway, and neurologic issues, are factors that contribute to potential difficulty with oral feeding mechanics and with the integrity of airway protection during swallowing. Oral motor dysfunction in conjunction with obstruction in the upper airway secondary to anatomic or physiologic anomalies has the potential to cause serious disruption to the necessary coordination of respiration and swallowing. Timely identification of problems is necessary to address threats to nutritional status and/or respiratory health. The pediatric speech-language pathologist has a primary role in the clinical assessment of oral motor/feeding skills, and in the recognition of clinical signs and symptoms of swallowing dysfunction that may warrant referral for instrumental assessment of swallowing function and airway protection. The objective of this article is to summarize the potential feeding difficulties and feeding strategy options for patients with Craniofacial Microsomia, 22q11.2 Deletion Syndrome, Treacher Collins Syndrome, and Pierre Robin Sequence. Awareness of the factors that impact upon the success of feeding and the efficacy of compensatory feeding strategies is key to best practice and successful patient outcomes.

Direct swallowing training and oral sensorimotor stimulation in preterm infants: a randomised controlled trial

2021 ◽  
pp. fetalneonatal-2021-321945
Author(s):  
Ju Sun Heo ◽  
Ee-Kyung Kim ◽  
Sae Yun Kim ◽  
In Gyu Song ◽  
Young Mi Yoon ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Controlled Trial ◽  
Tube Feeding ◽  
Tertiary Hospital ◽  
Oral Feeding ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Randomised Controlled

ObjectiveTo evaluate the effects of direct swallowing training (DST) alone and combined with oral sensorimotor stimulation (OSMS) on oral feeding ability in very preterm infants.DesignBlinded, parallel group, randomised controlled trial (1:1:1).SettingNeonatal intensive care unit of a South Korean tertiary hospital.ParticipantsPreterm infants born at <32 weeks of gestation who achieved full tube feeding.InterventionsTwo sessions per day were provided according to the randomly assigned groups (control: two times per day sham intervention; DST: DST and sham interventions, each once a day; DST+OSMS: DST and OSMS interventions, each once a day).Primary outcomeTime from start to independent oral feeding (IOF).ResultsAnalyses were conducted in 186 participants based on modified intention-to-treat (63 control; 63 DST; 60 DST+OSMS). The mean time from start to IOF differed significantly between the control, DST and DST+OSMS groups (21.1, 17.2 and 14.8 days, respectively, p=0.02). Compared with non-intervention, DST+OSMS significantly shortened the time from start to IOF (effect size: −0.49; 95% CI: −0.86 to –0.14; p=0.02), whereas DST did not. The proportion of feeding volume taken during the initial 5 min, an index of infants’ actual feeding ability when fatigue is minimal, increased earlier in the DST+OSMS than in the DST.ConclusionsIn very preterm infants, DST+OSMS led to the accelerated attainment of IOF compared with non-intervention, whereas DST alone did not. The effect of DST+OSMS on oral feeding ability appeared earlier than that of DST alone.Trial registration numberClinicalTrials.gov Registry (NCT02508571).

Feeding Difficulties in Preterm Infants

2011 ◽  
Vol 3 (6) ◽  
pp. 324-331 ◽  
Author(s):  
Pamela Dodrill
Keyword(s):  
Risk Factor ◽  
Preterm Infants ◽  
Oral Feeding ◽  
Early Feeding ◽  
Feeding Difficulties ◽  
Milk Flow ◽  
Feeding Skills ◽  
Clinical Questions ◽  
Feeding Difficulty ◽  
Therapy Interventions

Preterm infants often display difficulty establishing oral feeding in the weeks following birth. This article aims to provide an overview of the literature investigating the development of feeding skills in preterm infants, as well as of interventions aimed at assisting preterm infants to develop their feeding skills. Available research suggests that preterm infants born at a lower gestational age and/or with a greater degree of morbidity are most at risk of early feeding difficulties. Respiratory disease was identified as a particular risk factor. Mechanisms for feeding difficulty identified in the literature include immature or dysfunctional sucking skills and poor suck–swallow–breath coordination. Available evidence provides some support for therapy interventions aimed at improving feeding skills, as well as the use of restricted milk flow to assist with maintaining appropriate ventilation during feeds. Further research is needed to confirm these findings, as well as to answer remaining clinical questions.

scholarly journals Readiness for oral feeding and oral motor function in preterm infants

Revista CEFAC ◽  
2017 ◽  
Vol 19 (4) ◽  
pp. 503-509 ◽  
Author(s):  
Raquel Coube de Carvalho Yamamoto ◽  
Leila Sauer Prade ◽  
Geovana de Paula Bolzan ◽  
Angela Regina Maciel Weinmann ◽  
Márcia Keske-Soares
Keyword(s):  
Preterm Infants ◽  
Motor Function ◽  
Oral Feeding ◽  
Motor Dysfunction ◽  
Assessment Tools ◽  
Assessment Scale ◽  
Readiness Assessment ◽  
Motor Assessment ◽  
Oral Motor ◽  
Oral Motor Function

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

scholarly journals Simulation-Based Training Improves Student Assessment of Oral Feeding Skills in Preterm Infants

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Courtney Broadfoot ◽  
Julie Estis
Keyword(s):  
Health Care ◽  
Preterm Infants ◽  
Student Assessment ◽  
Oral Feeding ◽  
Feeding Difficulties ◽  
Entry Level ◽  
Undergraduate Nursing ◽  
Clinical Recommendation ◽  
Simulation Based ◽  
Feeding Skills

Advancements in medical technology have contributed to increased rates of preterm birth. Prematurity places infants at high risk for feeding difficulties, however. Early identification and assessment of preterm infant dysphagia is critical to maximize nutrition and hydration, feeding safety, and growth and development. The purpose of this study was to assess the ability of a simulation-based training toolto increase non-health care and entry-level clinical student sensitivity to signs of feeding distress in preterm infants. Data were collected from 60 students (20 masters-level Speech-Language Pathology, 20 undergraduate nursing, 20 undergraduate non-health care) in a pre-test/post-test design. All participants completed a brief simulation training protocol, and accuracy percentages were calculated based on their ability to determine the following: physiological and behavioral signs of feeding distress, oral feeding skill level (OFS), and clinical recommendation for further feeding evaluation. Our results revealed that this simulation-based training improved the identification of behavioral (p < 0.001) and physiological (p < 0.001) signs of feeding distress, OFS level (p < 0.001), and ability to make appropriate clinical recommendations (p < 0.001).This study has identified a successful method to effectively train entry-level clinical and non-clinical students to screen feeding skills in preterm infants. This training approach has the potential to improve identification of feeding distress and to recognize the need for a dysphagia evaluation to optimize clinical outcomes in this fragile population.

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