“Holding–Cuddling” and Sucrose for Pain Relief During Venepuncture in Newborn Infants: A Randomized, Controlled Trial (CÂSA)

Objectives: Oral sucrose is commonly used to provide analgesia to neonates during painful procedures, such as venepuncture. The additional benefits of reducing pain during venepuncture when oral sucrose is combined with nonpharmacological strategies have not been extensively studied. This randomized controlled trial compared the efficacy of oral sucrose with nonnutritive sucking vs. oral sucrose with nonnutritive sucking plus “holding–cuddling” for pain management during venepuncture in term infants from birth to 3 months of life.Methods: Seventy-eight infants were equally randomized to receive 24% oral sucrose with nonnutritive sucking (control group) or 24% oral sucrose with nonnutritive sucking plus “holding–cuddling” (being held in a secure, cuddling position; experimental group) before venepuncture. Behavioral response to pain was measured by the 0–10 ranking scale “acute pain for neonates (APN)” at 30 and 60 s after venepuncture.Results: Within the study sample, APN scores were ≥ 2 for 32/68 (47%) infants. “Holding–cuddling” did not significantly reduce mean APN scores at 30 and 60 s, but the rate of infants experiencing a high pain score (APN ≥ 8) at 60 s after the venepuncture was significantly lower in the experimental group compared to controls [4/34 vs. 12/34 (p = 0.04)].Conclusions: Venepuncture is a painful procedure in newborn and young infants. The implementation of behavioral strategies in association with oral sucrose may mitigate pain during this procedure.Clinical Trial Registration: This trial was registered at http://clinicaltrials.gov/ (NCT number 02803723).

Influence of non-nutritive sucking habits on anterior open bite

Aim: To evaluate the clinical behavior of sucking habits in children between 2 to 6 years old in a private (A1) and a public school (A2) in the state of Piauí. Methods: It was cross-sectional and quantitative study in 340 participants, 169 in A1 and 171 in A2. The researchers asked the children evaluated to keep their teeth occluded while analyzing whether there was no contact between the anterior teeth and no lip sealing, characterizing the anterior openbite for G1 or if there was contact between the incisors, with lip sealing, characterizing the control group (G2). Results: There was no statistically significant difference between groups regarding bottle feeding at main meals (χ2 = 3.03; p = 0.08). However, regarding the use of a pacifier, there was a statistically significant association (χ2 = 17.99; p <0.01) between pacifier use and the presence of anterior openbite. Such association was also observed between digital sucking habit and malocclusion (χ2 = 8.99; p = 0.01). Only the parents of the children with anterior openbite noticed the disharmony in the occlusion. It can be deduced that there was an awareness of parents /guardians about the disharmony generated by non-nutritive sucking habits. Conclusion: Nonnutritive sucking habits influenced the appearance of the anterior open bite in children with deciduous dentition. Nonnutritive sucking habits, such as digital sucking and pacifiers, are significantly associated with the presence of anterior open bite. Breastfeeding is important in preventing this malocclusion.

Breastfeeding Behavior in Brazilian Children with Congenital Zika Syndrome

Congenital Zika Syndrome (CZS) is a condition that has emerged only recently, bringing together multiple changes, including significant changes in the stomatognathic system, which may compromise sucking behavior and consequently the breastfeeding practice. The aim of this study was to investigate the breastfeeding behaviors in children with CZS. A longitudinal study was carried out in two reference centers in Northeastern Brazil. The nonprobabilistic sample consisted of 79 children diagnosed with physical, neurological, and behavioral alterations compatible with CZS. Information regarding the child, nutritive, and nonnutritive sucking behavior and changes related to the sucking reflex was collected. Data were presented through descriptive and inferential statistics. In the bivariate analyses, the chi-squared test was used and 5% significance level was adopted. The majority of children had severe microcephaly (59.7%). Breastfeeding was performed at birth in most of CZS children (89.9%) but only 36.6% of them presented exclusive breastfeeding in the six months of life. Bottle feeding and pacifier were used in 89.9% and 55.7%, respectively. Sucking and swallowing difficulties and occurrence of gastroesophageal reflux were observed in 27.8%, 48.0%, and 29.2% of children, respectively. Early weaning was associated with bottle feeding (p=0.005) and pacifier sucking (p=0.003). Although breastfeeding practice at birth constitutes a behavior adopted by most of mothers, adherence to this exclusive habit until the first six months of life was low since the children presenting a large number of comorbidities with direct interference in the suction reflex, sucking, and swallowing difficulty.

Early Premature Infant Oral Motor Intervention Improved Oral Feeding and Prognosis by Promoting Neurodevelopment

Objective This study aimed to explore the clinical significance of early premature infant oral motor intervention (PIOMI) in the prognosis of premature infants. Study Design Infants were randomly divided into an intervention group (n = 78) and a control group (n = 73). PIOMI was given to the intervention group 15 to 30 minutes before feeding once a day for 14 days. The whole procedure lasted 15 minutes, including oral stimulation and nonnutritive sucking. Oral feeding ability and neuromotor development were evaluated using the Preterm Infant Oral Feeding Readiness Assessment (PIOFRA) scale and Infant Neurological International Battery (Infanib) scale. Results The PIOFRA score was higher in the intervention group and increased with time, showing a group–time interaction effect. The intervention group exhibited a higher feeding efficiency, a shorter transition time from assisted oral feeding to independent oral feeding, and lower body weight at achievement of independent oral feeding. The percentages of infants with a normal score on the Infanib scale were higher in the intervention group at 3 and 6 months of age, and an abnormal ratio was lower in the intervention group at 6 months (p < 0.01). Conclusion PIOMI promoted neuromotor coordination by improving neurodevelopment, thereby improving the oral feeding ability and prognosis of preterm infants.