Gastric suction in healthy newborn infants. Effects on circulation and developing feeding behaviour

Gastric emptying of newborn infants is a procedure performed to prevent aspiration of gastric contents. The present investigation was conducted to study the effects of gastric suction on circulatory and behavioural parameters in 21 healthy newborn children (11 cases, 10 controls). A small elevation in mean arterial blood pressure was observed during gastric suction. The incidence of retching was also increased. In all children spontaneous sucking and rooting movements, as well as state of sleep and wakefulness were recorded. In the control group spontaneous sucking and rooting movements started occur 15 min after birth and reached a maximum at 45 and 60 min, respectively. The first hand to mouth movement was observed after a mean of 34 min and the infants found the nipple and started to suckle at about 55 min. This sequence of prefeeding behaviour was disrupted in children who had undergone gastric suction. The physiological side-effects induced by gastric suction are minor, but it seemed to be unpleasant for the child and no clear advantages are gained by the procedure.     

Effects of maternal pethidine on infants' developing breast feeding behaviour

The aim of this quasi-experimental study was to examine the effects of maternal pethidine during labour on the developing breast feeding behaviour in infants in the first 2 h after birth compared with infants not exposed to pethidine. Forty-four healthy infants were observed immediately after birth. They were placed skin-to-skin on their mothers' chests. The development of mouth and sucking movements as well as rooting behaviour and state of sleep/wakefulness were noted. The observer was blind as to the pain relief the mother had received during labour. Of the 44 mothers 18 had received pethidine. The main findings were that infants exposed to pethidine had delayed and depressed sucking and rooting behaviour. In addition, a smaller proportion of infants exposed to pethidine started to suckle the breast. Rooting movements which are expected to be vigorous at 30 min after birth were affected both by administration of pethidine and a longer second stage of labour. It is suggested that the differences found in sucking behaviour may be a central effect of pethidine. Depression of rooting movements in the pethidine group may be caused by exhaustion due to a longer second stage of labour and administration of pethidine. It is recommended that pethidine-exposed mother-infant couples stay together after birth long enough to enable the infant to make the choice to attach or not to attach to the nipple without the forceful helping hand of the health staff.     

Analysis of feeding behavior with direct linear transformation

AIM: The sucking pattern of term infants is composed of a rhythmic alteration of expression and suction movements. The aim is to evaluate if direct linear transformation (DLT) method could be used for the assessment of infant feeding. SUBJECT AND METHODS: A total of 10 gnormalh infants and two infants with neurological disorders were studied using DLT procedures and expression/suction pressure recordings. Feeding pattern of seven gnormalh infants were evaluated simultaneously recording DLT and pressures. The other infants were tested non-simultaneously. We placed markers on the lateral angle of the eye, tip of the jaw, and throat. The faces of infants while sucking were recorded in profile. The jaw and throat movements were calculated using the DLT procedure. Regression analysis was implemented to investigate the relationship between suction and expression pressures and eye-jaw and eye-throat movement. All regression analyses investigated univariate relationships and adjusted for other covariates. RESULTS: Ten gnormalh infants demonstrated higher suction pressure than expression pressure, and their throat movements were larger than jaw movements. Two infants with neurological problems did not generate suction pressure and demonstrated larger movements in their jaw than throat. The simultaneous measurement (n=7) showed a significant correlation, not only between eye-jaw distance and the expression pressure, but also between eye-throat distance and suction pressure. The change in the eye-jaw distance was smaller than the changes in the eye-throat distance in gnormalh infants (p<0.001). CONCLUSIONS: The DLT method can be used to evaluate feeding performance without any special device.     

The analysis of sucking behaviour in newborn infants.

A special video camera devised by the author and a fiberscope were used to film the neonatal sucking response of 50 low-risk full-term newborn infants on the 5th day after birth. Analysis of the sucking behaviour showed that the sucking movements consist mainly of a peristaltic tongue movement and two kinds of negative pressure; that the peristaltic tongue movements are synchronized with the jaw movements; that infants actively adapt to a varying environment; and that the sucking movements change to minimize the energy required.     

The development of preterm infants' breastfeeding behavior.

Extensive scientific data are available on the development of sucking in term infants, but corresponding knowledge about preterm infants has been lacking. The aim was to describe the development of preterm infants' behavior at the breast, according to postmenstrual and postnatal age. Mothers co-operated as data collectors using the Preterm Infant Breastfeeding Behavior Scale for observations. Seventy-one singletons (born after 26.7-35.9 gestational weeks) were studied prospectively. Mothers received regular advice about breastfeeding and guidance about interaction and appropriate stimulation. Breastfeeding was initiated at a postmenstrual age (PMA) of 27.9-35.9 weeks. Mothers provided 4321 records of infants' behavior, 70% of the total breastfeeding sessions during the infants' hospital stay. Irrespective of PMA, the infants responded by rooting and sucking on the first contact with the breast. Efficient rooting, areolar grasp and latching on were observed at 28 weeks, and repeated bursts of > or = 10 sucks and maximum bursts of > or = 30 sucks at 32 weeks. Nutritive sucking appeared from 30.6 weeks. Sixty-seven infants were breastfed at discharge. Fifty-seven of them established full breastfeeding at a mean PMA of 36.0 weeks (33.4-40.0 weeks). Their early sucking behavior is interpreted as the result of learning, enhanced by contingent stimuli. We therefore suggest that guidelines for initiation of breastfeeding in preterm infants should be based on cardiorespiratory stability, irrespective of current maturity, age or weight.     

The position of the tongue during rooting reflexes elicited in newborn infants before the first suckle

A common breast-feeding problem is when the infant "places its tongue in its palate" and has difficulties in attaching to its mother's nipple. The aim of this study was to document the position of the tongue in the mouth cavity during rooting reflexes elicited in newborn infants before the first suckle. Eleven healthy, full-term infants were videotaped 101 ± 31 min after birth during an evoked distinct rooting reflex before the first suckle. The videotaped rooting reflex was analyzed in detail concerning the degree of turning of the head, mouth opening and position of the tongue, in pictures that were "frozen" at specific intervals. "Licking movements" preceded and followed the rooting reflex in the alert infants. In 10 of the 11 infants the tongue was placed in the bottom of the mouth cavity during a distinct rooting reflex ( p = < 0.05). It is suggested that forcing the infant to the breast might abolish the rooting reflex and disturb placement of the tongue. A healthy infant should have the opportunity of showing hunger and optimal reflexes, and attach to its mother's nipple by itself.     

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 transfered/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.     

Effect of suckling on the peripheral sensitivity of full-term newborn infants

BACKGROUND: Sucking may reduce the manifestations of pain in newborn infants. OBJECTIVE: To examine the effect of suckling on the threshold for peripheral somatosensory responses. Subjects and methods: Graded Von Frey filaments were applied to the heel to initiate peripheral somatosensory responses (withdrawal reflex and gross body movements) in term infants. RESULTS: Dummy sucking increases the somatosensory threshold, but breast feeding had a more marked effect, increasing the threshold of the flexion withdrawal reflex (p相似文献   

Patterns of breath intervals during non-nutritive sucking in full-term and ‘at risk’ preterm infants with normal neurological examinations

The interaction between respiration and non-nutritive sucking rhythms was investigated in 12 sleeping, normal, full-term, newborn infants and in 14 preterm infants who were examined repeatedly at 34, 40 and 46 wk of conceptional age. Full-term infants showed a shortening of breath intervals in the middle of sucking bursts and a lengthening of the breath interval spanning the end of sucking bursts. The differences were more marked in females than males.A rhythm interaction between sucking and respiration was also observed in preterm infants as young as 34 wk of conceptional age. Clinical neurological examinations did not discriminate between pretern infants above and below a median score for optimal obstetric conditions, but the interaction between breathing and sucking rhythms made such a discrimination, most clearly in females. Preterm infants with lower optimal obstetric scores showed less change of breath durations during sucking than preterms with higher scores. It was concluded that interaction of concurrent motor rhythms may be a sensitive index of central nervous system integrity in newborn infants, even when there are no clinical neurological signs of nervous system dysfunction.     

Does the choice of bottle nipple affect the oral feeding performance of very‐low‐birthweight (VLBW) infants?

Background: There is a continuous debate regarding the best bottle nipple to be used to enhance the bottle-feeding performance of a preterm infant. Aim: To verify that feeding performance can be improved by using the bottle nipple with the physical characteristics that enhance infants' sucking skills. Methods: Ten “healthy” VLBW infants (941±273 g) were recruited. Feeding performance was monitored at two time periods, when taking 1-2 and 6-8 oral feedings/d. At each time and within 24 h, performance was monitored using three different bottle nipples offered in a randomized order. Rate of milk transfer (ml/min) was the primary outcome measure. The sucking skills monitored comprised stage of sucking, suction amplitude, and duration of the generated negative intraoral suction pressure. Results: At both times, infants demonstrated a similar rate of milk transfer among all three nipples. However, the stage of sucking, suction amplitude, and duration of the generated suction were significantly different between nipples at 1-2, but not 6-8 oral feedings/d.

Conclusion: We did not identify a particular bottle nipple that enhanced bottle feeding in healthy VLBW infants. Based on the notion that afferent sensory feedback may allow infants to adapt to changing conditions, we speculate that infants can modify their sucking skills in order to maintain a rate of milk transfer that is appropriate with the level of suck-swallow-breathe coordination achieved at a particular time. Therefore, it is proposed that caretakers should be more concerned over monitoring the coordination of suck-swallow-breathe than over the selection of bottle nipples.     

The Effect of Non-Nutritive Sucking on Plasma Insulin, Gastrin, and Somatostatin Levels in Infants

ABSTRACT. The aim of the present investigation was to study the effect of non-nutritive sucking on plasma levels of insulin, gastrin, and somatostatin in infants. These hormones were measured with radioimmunoassay in plasma collected from fullterm and preterm infants sucking a pacifier. In fullterm infants, sucking caused a significant increase of insulin levels from 13 ± 10 μU/ml to 40 ± 36 μU/ml and 21 ± 17 μU/ml after 45 sec and 5 min respectively, from when the infants started sucking. A similar pattern was seen in preterm infants. In contrast, gastrin and somatostatin levels were not significantly affected. We suggest that sucking causes an activation of the vagal nerve, which results in the release of insulin. We also suggest that in infants, oral feeding is superior to bolus feeding, since in the latter case no vagal activation and consequently no release of hormones with anabolic properties occurs.     

The effect of non-nutritive sucking on plasma insulin, gastrin, and somatostatin levels in infants

The aim of the present investigation was to study the effect of non-nutritive sucking on plasma levels of insulin, gastrin, and somatostatin in infants. These hormones were measured with radioimmunoassay in plasma collected from fullterm and preterm infants sucking a pacifier. In fullterm infants, sucking caused a significant increase of insulin levels from 13 +/- 10 microU/ml to 40 +/- 36 microU/ml and 21 +/- 17 microU/ml after 45 sec and 5 min respectively, from when the infants started sucking. A similar pattern was seen in preterm infants. In contrast, gastrin and somatostatin levels were not significantly affected. We suggest that sucking causes an activation of the vagal nerve, which results in the release of insulin. We also suggest that in infants, oral feeding is superior to bolus feeding, since in the latter case no vagal activation and consequently no release of hormones with anabolic properties occurs.     

Effects of routinely given pethidine during labour on infants' developing breastfeeding behaviour. Effects of dose-delivery time interval and various concentrations of pethidine/norpethidine in cord plasma

A standard dose of 100 mg of pethidine was given im to 13 healthy primiparae during labour. The aim of the study was to investigate whether developing breastfeeding behaviour in the newborn infant was associated with the dose-delivery time interval (DDI) or with the plasma concentration of pethidine and norpethidine in mixed cord blood at birth. The DDI was found to be unevenly distributed with no pethidine exposures in the time interval 5.4-8h. The material was therefore divided into a "short DDI" group (1.1–5.3h) and a "long DDI" group (8.1–9.9h). The infants in the "short DDI" group had a depressed sucking behaviour in 15–45 min of observation and a delayed initiation of lip and mouth movements when compared with the infants in the "long DDI" group. Six of the thirteen infants did not suck their mothers' breasts during the observation period. These infants had higher median plasma concentrations of pethidine at birth than the seven infants who did start sucking. No differences were found between the plasma levels of norpethidine and the behaviour. It was concluded that 100mg of pethidine im as an analgesic given under routine conditions may have unfavourable effects on infants' developing breastfeeding behaviour if the DDI is short.     

Neonatal Fat Digestion and Lingual Lipase

ABSTRACT. Lingual lipase (IX) activity, pH, and products of fat hydrolysis were determined in gastric aspirates from preterm infants who received formula milk feeds by a nasogastric tube. In 1-hourly ( n =9), 2-houriy ( n =8) and 3-hourly ( n =9) fed infants LL activity increased to reach its maximum value at 60, 90, and 120 min respectively after the feeds, and gastric pH levels fell from about 6.0 to <3.5. There was a reduction in triglyceride content to 50% of the initial value, measured immediately after a feed, and the products of hydrolysis were mainly di-glycerides and FFA. In a subsequent study 3-hourly fed infants ( n =8) had a tube feed followed by a bottle feed, and then a bottle feed followed by a tube feed on successive days (cross-over). The LL activity observed after a bottle feed (mean maximal value 23.8 nmol FFA/ml/h) was significantly higher than after a tube feed (19.1 nmol FFA/ml/h). It is suggested that substantial triglyceride hydrolysis takes place in the stomach due to lingual lipase, and sucking seems to enhance enzyme production.     

Neonatal fat digestion and lingual lipase

Lingual lipase (LL) activity, pH, and products of fat hydrolysis were determined in gastric aspirates from preterm infants who received formula milk feeds by a nasogastric tube. In 1-hourly (n = 9), 2-hourly (n = 8) and 3-hourly (n = 9) fed infants LL activity increased to reach its maximum value at 60, 90, and 120 min respectively after the feeds, and gastric pH levels fell from about 6.0 to less than 3.5. There was a reduction in triglyceride content to 50% of the initial value, measured immediately after a feed, and the products of hydrolysis were mainly diglycerides and FFA. In a subsequent study 3-hourly fed infants (n = 8) had a tube feed followed by a bottle feed, and then a bottle feed followed by a tube feed on successive days (cross-over). The LL activity observed after a bottle feed (mean maximal value 23.8 mumol FFA/ml/h) was significantly higher than after a tube feed (19.1 mumol FFA/ml/h). It is suggested that substantial triglyceride hydrolysis takes place in the stomach due to lingual lipase, and sucking seems to enhance enzyme production.     

The effect of phenobarbital on cerebral blood flow in newborn infants with foetal distress

The effect of phenobarbital on cerebral blood flow (CBF) was investigated by the intravenous Xenon¹³³ clearance technique in seven term newborn infants with signs of mild to moderate hypoxic ischaemic encephalopathy, all on sustained spontaneous ventilation. Phenobarbital treatment had no significant effect on CBF 60 min after loading dosage (20mg/kg i.v.). Likewise, no significant change in mean arterial blood pressure, heart rate or transcutaneous gas tensions was observed. Though slight changes in CBF of short duration cannot be excluded, conventional dosage of phenobarbital to term newborn infants with foetal distress apparently imposes no risk of cerebrovascular damage.     

Coordination of suck-swallow and swallow respiration in preterm infants

Safe oral feeding of infants necessitates the coordination of suck-swallow-breathe. Healthy full-term infants demonstrate such skills at birth. But, preterm infants are known to have difficulty in the transition from tube to oral feeding. AIM: To examine the relationship between suck and swallow and between swallow and breathe. It is hypothesized that greater milk transfer results from an increase in bolus size and/or swallowing frequency, and an improved swallow-breathe interaction. METHODS: Twelve healthy preterm (<30 wk of gestation) and 8 full-term infants were recruited. Sucking (suction and expression), swallowing, and respiration were recorded simultaneously when the preterm infants began oral feeding (i.e. taking 1-2 oral feedings/d) and at 6-8 oral feedings/d. The full-term infants were similarly monitored during their first and 2nd to 4th weeks. Rate of milk transfer (ml/min) was used as an index of oral feeding performance. Sucking and swallowing frequencies (#/min), average bolus size (ml), and suction amplitude (mmHg) were measured. RESULTS: The rate of milk transfer in the preterm infants increased over time and was correlated with average bolus size and swallowing frequency. Average bolus size was not correlated with swallowing frequency. Bolus size was correlated with suction amplitude, whereas the frequency of swallowing was correlated with sucking frequency. Preterm infants swallowed preferentially at different phases of respiration than those of their full-term counterparts. CONCLUSION: As feeding performance improved, sucking and swallowing frequency, bolus size, and suction amplitude increased. It is speculated that feeding difficulties in preterm infants are more likely to result from inappropriate swallow-respiration interfacing than suck-swallow interaction.     

Newborns spontaneous arm movements are influenced by the environment

The spontaneous arm movements of 28 healthy full-term newborn infants were observed for 1 min in four different environmental conditions: each infant was placed in a vertical position in a bathtub filled with water with the water level up to her or his neck in a vertical position in water with the water level up to her or his waist in a supine position out of the water in a vertical position out of the water. It was hypothesised that these different environmental constraints would influence the infants spontaneous activity. From video recordings spontaneous arm movements were categorised according to the classifications of Hannan (Hannan TE. Young infant's hand and finger expressions: An analysis of category reliability. In: Field T, Fogel A, editors. Emotion and Early Interaction. New Jersey: Elbaum 1982;253-265). The statistical analyses showed, firstly, that the frequency of occurrence of various arm movements is greater out of the water than in the water. Secondly, for those out of the water the frequency of occurrence of various arm movements is greater in the vertical position in comparison to the supine position. Thirdly, the infants showed more active arm movements (more upward movements) in the vertical position out of the water in comparison to the two water and supine conditions. These findings lead to the conclusion that different environmental constraints influenced the spontaneous arm movements.     

PERORAL ENDOSCOPIC DUODENAL BIOPSY IN INFANTS AND CHILDREN

ABSTRACT. Peroral endoscopic duodenal biopsy was used in the diagnosis and follow-up of forty-nine infants and children with suspected small intestine disease. Their ages ranged between one month and 12 years. Fifty-four upper gastrointestinal endoscopy procedures were performed and 139 biopsies were taken. The mean procedure time was 3.2 min with a range of 1.5–5.5 min. There were no complications. Tissue adequate for histopathologic examination was obtained in all but one of the fifty-four procedures. On the basis of this experience we think that peroral endoscopic duodenal biopsy is faster, safer and as diagnostic as conventional suction biopsy in infants and children. It is also more informative when other diseases of the upper gastrointestinal tract are suspected.