Nonnutritive sucking modulates behavioral state for preterm infants before feeding.

Forty-two pre-term infants were studied to determine the effect of nonnutritive sucking pre-feeding on behavioral state. Infants were randomly assigned to pacifier or rest groups. Pacifiers or rest were given for 5 minutes following routine caregiving and before each of the first 16 bottle feedings. A 12-category scale was used to measure state immediately before the 5-minutes and after. Frequencies of states that precede optimal feedings changed for infants given pacifiers versus rest: alert inactivity (+6 vs. -2), quiet awake (+19 vs. -6), and active awake (-24 vs. +12); infants given pacifiers had more sleep and fewer restless states. Group differences were non-significant before nonnutritive sucking (p = 0.16) but significant after (p = 0.00001). When self-regulatory feeding policies based on early hunger cues are not allowed, nonnutritive sucking for 5 minutes pre-feeding is simple, brief, and appropriate for busy intensive care units. These findings confirm those from earlier less conclusive research and indicate that nonnutritive sucking modulates behavioral state.     

Facilitating inactive awake states in preterm infants: a study of three interventions.

Inactive awake behavioral states have been associated with reduced heart rates and more successful feeding in preterm infants. The purpose of this study was to test the efficacy of three different interventions to facilitate these optimal feeding states. Twenty preterm infants (gestational ages 27-33 weeks, M = 31.6, SD = 1.7; birth weights 931-2,140 grams, M = 34, SD = 373) serving as their own controls were randomly administered nonnutritive sucking, nonnutritive sucking plus rocking, and stroking interventions; and a control condition. There were significantly more inactive awake states with the nonnutritive sucking and nonnutritive sucking plus rocking interventions than with the stroking intervention and the control conditions. The results suggest that there are interventions that can help preterm infants in the transition from gavage to oral feeding and potentially shorten their hospital stays.     

Effect of nonnutritive sucking on behavioral state in preterm infants before feeding

To describe the effect of nonnutritive sucking (NNS) on behavioral state (BSt) in preterm infants before feedings 24 preterm infants were randomly assigned and studied before each of their first 16 bottle feedings. Twelve received NNS by pacifier for 5 minutes; 12 did not receive a pacifier. BSt was measured with a 12-category scale for 30 seconds before the 5-minute period (BSt1) and for 30 seconds after (BSt2). Sleep states decreased for both groups. BSts considered more optimal for feeding increased more during NNS (86 vs. 46). Restless states were three times less frequent after NNS (23 vs. 68). Differences between groups were nonsignificant at BSt1, but were significant at BSt2, p less than .001. In the absence of self-regulatory feeding policies based on early hunger cues, NNS for 5 minutes prefeeding is simple, brief, and suitable for implementation in busy neonatal intensive care units. Nonnutritive sucking was an effective modulator of behavioral state for this sample.     

口腔刺激和非营养性吸吮对早产儿经口喂养表现的干预效果

目的探讨口腔刺激和非营养性吸吮单独使用和联合使用对早产儿经口喂养表现的影响。方法按照简单随机化分组的方法,将122例早产儿随机分为4组,其中非营养性吸吮组28例,在管饲喂养期间,喂养前、喂养后各给予安慰奶嘴吸吮5 min,7~8次/d;口腔刺激组29例,在管饲喂养前15 min进行12 min的口腔刺激,1次/d;非营养性吸吮和口腔刺激联合使用组33例,在管饲喂养之前15 min进行12 min的口腔刺激和3 min的非营养性吸吮,1次/d;对照组32例,接受新生儿重症监护室喂养护理常规。记录4组早产儿从开始经口喂养过渡到完全经口喂养所需要的时间,并对4组早产儿的喂养表现进行测定。结果非营养性吸吮组、口腔刺激组和两者联合使用组从管饲喂养过渡到完全经口喂养所需要的过渡时间差异无统计学意义(P0.05),但均小于对照组,差异具有统计学意义(P0.05);开始经口喂养时,非营养性吸吮组、口腔刺激组和两者联合使用组之间喂养效率差异无统计学意义(P0.05),但均高于对照组(P0.05);达到完全经口喂养时,两者联合使用组早产儿喂养效率高于对照组(P0.05),其他3组差异无统计学意义(P0.05);开始经口喂养时,两者联合使用组的喂养成效和摄入奶量比高于对照组,差具有统计学意义(P0.05),其他3组差异无统计学意义(P0.05);达到完全经口喂养时,4组早产儿的喂养成效和摄入奶量比差异均无统计学意义(P0.05)。结论口腔运动干预能够缩短早产儿从开始经口喂养过渡到完全经口喂养所需要的时间,能够增加喂养效率,非营养性吸吮和口腔刺激联合使用有助于喂养成效和摄入奶量比的提高。     

Effects of the pacifier activated lullaby on weight gain of premature infants

Within the past 5 years there has been an increase of premature infants surviving in the neonatal intensive care unit as well as an increasing cost for each day the infant is kept there. It is important for the premature infant to acquire the feeding skills necessary for weight gain, which lead to discharge from the hospital, and recent advancements have indicated the effectiveness in using contingent music to teach sucking skills to premature infants. The purpose of the first analysis in this study was to determine the effects of Pacifier Activated Lullaby (PAL) trials on weight gain of premature infants. During a 2-year time period, 62 infants from a sample of 188 met criteria for analysis. A one-way analysis of variance showed no significance in daily weight gain for the number of PAL trials completed. The mean weight gains for infants with 1 PAL trial = 13.85 grams, 2 trials = 26.67, 3 trials = 29.64, and 4 or more = 22.89. The Pearson product-moment correlation between the mean percent of music earned via nonnutritive sucking (NNS) and mean weight gain of all trials approached significance (p = .077, r = 0.18). In a second analysis, weight gained prior to use of PAL, during use of PAL, and post use of PAL was analyzed. Results indicated no significant difference between weight gain 1 day prior to use of PAL, the day of PAL trial, and 1 day post use of PAL. Mean weight gain for those infants who participated in 1 PAL trial was 8.49 grams for 1 day prior to use of PAL, 18.73 the day of PAL trial, and 24.81 for 1 day post use of PAL. Mean weight gain for 3 days prior to using the PAL was 10.78, 11.30 on the day of PAL trial, and 24.78 grams for 3 days post PAL use. The analyses show definite trends of greater weight gain with PAL use; however, individual variability within groups was greater than group differences leading to no significance in statistical analysis. In the third analysis the effect of proximity between premature infants' feeding schedule and PAL trial on amount of time the infant received contingent music via NNS was examined; the infants' feeding and sleep schedules were divided into 5 blocks of time. Results indicated no statistical significance among the amount of time premature infants sucked/received music according to their schedule, although there were noticeable differences in the average percent of music reinforcement received according to assigned block. Infants who participated in PAL trials 30 minutes prior to feeding scored the highest average at 77.25 %, followed by 71% for infants who participated in PAL trials during feeding. Other times, primarily after the infants' feeding, resulted in averages of 59% and 54.5%; these infants often fell asleep after their feeding and did not complete the full 15-minute trial. Based on this research and previous research on NNS, it seems beneficial for premature infants to participate in PAL opportunities 30 minutes prior to feeding.     

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.     

The Effects of Nonnutritive Sucking and Oral Support on the Feeding Efficiency of Preterm Infants

The purpose of this study is to describe the influence of oral support and nonnutritive sucking (NNS) across time on the feeding efficiency of preterm infants. The study was conducted as a three-group repeated-observation control group design. One hundred fifty-six infants were included in the analysis. Repeated-measures analysis of variance was performed at baseline, immediately after a 1-week intervention, and 7 days postintervention on the formula intake at 5 minutes, length of feeding, bursts, pauses, and pause duration. It was concluded that oral support and NNS are beneficial for preterm infants and that both interventions have immediate and continuing effects on the amount of formula taken in the first 5 minutes of feeding. The effects on sucking pattern characteristics are mixed with continuing effects noted on the number and length of bursts after the use of oral support and NNS but not immediately after the intervention.     

The effect of music-reinforced nonnutritive sucking on state of preterm, low birthweight infants experiencing heelstick

This study examined the physiologic and behavioral effects of music-reinforced nonnutritive sucking (NNS) for preterm, low birthweight (LBW) infants experiencing heelstick. Subjects were 60 infants, age 32 to 37 weeks post conceptional age in a neonatal intensive care unit. Infants were randomly assigned to one of three treatment groups: pacifier-activated lullaby (PAL), pacifier-only, and no-contact. Experimental infants were provided the Sondrex PAL System, which plays music contingent on infant sucking. Pacifier-only infants did not receive music reinforcement for sucking, and no-contact infants were not provided a pacifier or music at any point during the procedure. Stress level and behavior state were assessed continuously and heart, respiratory, and oxygen saturation rates were recorded at 15-second intervals for all infants. Most physiologic data results were inconclusive. However, analysis of behavior state and stress level revealed the following significant differences for the PAL and pacifier-only groups compared to the no-contact group, all of which were greatest between the PAL and no-contact groups: lower during-heelstick behavior state means, less time in undesirable behavior states, lower during- and post-heelstick stress level means, and smaller behavior state and stress level differences between intervals. In addition, the PAL group had a significantly lower pre-heelstick stress level mean than the no-contact group. Behavior state and stress level were also more stable across time for the PAL group than the other groups, and patterns of changes in oxygen saturation, behavior state, and stress level indicate that music-reinforced NNS may facilitate return to homeostasis.     

Milk Flow Rates From Bottle Nipples: What We Know and Why It Matters

Feeding difficulties are common in infants hospitalized in the NICU and can be a challenge to manage. The purpose of this article is to explain how and why the flow rate from the bottle nipple affects physiologic stability in infants and to describe the current evidence available on the flow rates of nipples used in the hospital and after discharge. Study results have indicated that flow rate varies widely among different types of nipples. Within the same type of nipple, there can be significant variability in flow from one nipple to another. Other factors, such as type of infant formula and thickening, also affect flow. Altering the flow rate of the bottle nipple is a relatively simple intervention that may support safe oral feeding.     

Bottle-feeding behaviors in preterm infants with and without bronchopulmonary dysplasia.

OBJECTIVE: This study compared bottle-feeding behaviors in preterm infants with and without bronchopulmonary dysplasia (BPD) during the initial hospitalization. METHOD: Individual sucking characteristics and feeding transitional rates were compared in 41 preterm infants (22 boys, 19 girls) with BPD and 99 infants (44 boys, 55 girls) without BPD. Observations of the first bottle feeding and observations of the last feeding before discharge were obtained from medical records of all infants retrospectively. RESULTS: On discharge, infants with BPD, unlike those without BPD, continued to have an immature sucking pattern and required longer hospital stays to attain full oral feeding (p < .001). No differences were found between the BPD and non-BPD groups in time needed for feeding and use of oral support. CONCLUSION: These results suggest that feeding transitional rate, rather than sucking pattern, may be a better discharge indicator for infants with BPD.     

Meta analysis: effects of interventions on premature infants feeding

Nipple feeding of premature infants presents a challenge to neonatal nurses who are trying to prepare the infants for eventual discharge from the hospital. To determine what empirical evidence there was to support interventions that positively influence feeding performance and feeding efficiency a meta-analysis is presented. The effects of NPO, nasogastric tubes, different nipples, breast versus bottle feeding, gestational age, oral support, oral stimulation, and nonnutritive sucking on volume intake are evaluated. The results suggest that nursing care should: (a) consider the infant's gestational age; (b) maturational ability and development; (c) keep track of and attempt to minimize the length of time an infant is NPO; and (d) provide prefeeding oral stimulation and oral support.     

Nipple confusion, alternative feeding methods, and breast-feeding supplementation: State of the science

Mothers of preterm and term infants frequently experience breast-feeding problems that make it necessary for them to use supplemental or complementary feedings. Although bottle feeding is used most frequently, alternatives to bottle feeding are frequently recommended to avoid nipple confusion. This report reviews the evidence of a relationship between exposure to artificial nipples and the development of nipple confusion. It also examines the effects of alternative feeding methods such as cup feeding, finger feeding, spoon feeding and gavage feeding on physiological responses of infants and long-term breast-feeding outcomes. This report recommends further research before alternatives to bottle feeding are routinely implemented. Copyright © 2001 by W.B. Saunders Company     

一例皮-罗序列征新生儿的早期经口喂养护理与指导

总结1例皮-罗序列征新生儿早期经口喂养护理与指导要点.建立多学科团队,制定护理干预措施,包括:选择侧卧结合45°俯卧位以保持呼吸道通畅;实施促进喂养技术结合口腔运动进行综合干预;根据吸吮情况及奶量选择滴管喂养及唇腭裂婴儿专用特需喂哺瓶;严格管理新生儿摄入量等.该例新生儿于出生后3d开始经口喂养,于第6天出院.3个月回访...     

The effect of contingent music to increase non-nutritive sucking of premature infants

This study assessed music as reinforcement for non-nutritive sucking of 12 premature infants born at an average gestation of 29.3 weeks and an average birthweight of 1111.9 g. At the time of the study, the infants' average post conception age was 35.5 weeks, and their average weight was 1747.3 g. A pacifier was fitted with a pressure transducer so that a sufficient suck activated frequency and duration signals as well as 10 seconds of recorded music consisting of lullabies sung by female vocalists. A 14-minute ABAB study design included a silence baseline for 2 minutes, 5 minutes of contingent music, 2 minutes of silence, and 5 minutes of contingent music. Frequency data were recorded for each 5-second interval in which the duration light was activated for at least 3 seconds. Results demonstrated that sucking rates during the periods of contingent music were 2.43 times greater than baseline (silence) sucking rates. In this study, music contributed significantly to the development of non-nutritive sucking of premature infants.     

An efficacy study of occupational therapy with high-risk neonates

This single-subject research study with replication evaluated the effect of daily occupational therapy on the nutritive and nonnutritive sucking behaviors of three high-risk, premature infants. At the time of entrance into the study, the infants were 34 to 35 weeks old and were documented poor feeders. Treatment consisted of individual, multimodal sensory stimulation, with emphasis on proprioceptive and vestibular input, graded to the sensory needs of the infants. Movement components of the jaw and tongue during nutritive and nonnutritive sucking were measured during baseline and intervention phases to assess the infants' sucking ability. A comparison of testing results revealed that during intervention the total sucking scores improved significantly for two of the three infants and that rapid changes occurred in the oral-motor function of all three infants. The results of the study suggest that occupational therapy can improve the rate of development of sucking in the premature neonate. However, future research needs to be done to isolate the specific techniques of treatment that produce positive changes.     

Effects of single-hole and cross-cut nipple units on feeding efficiency and physiological parameters in premature infants

The purpose of this study was to compare the amount of total milk intake, feeding time, sucking efficiency, heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2) of premature infants when fed with either signal-hole or cross-cut nipple units. Twenty stable infants admitted to a level II nursery in a tertiary care center with gestational ages averaging 32.2+/-3.2 wks were enrolled. Subjects had an average postmenstrual age of 34.1+/-1.6 wks, and average body weight of 1996+/-112 gm. A crossover design was used and infants were observed for two consecutive meals separated by a four-hour interval. They were bottle fed with equal feeding amounts using a single-hole and cross-cut nipple administered in random order. Results showed that infants fed with single-hole nipple units took more milk (57.5+/-8.3 ml vs. 51.6+/-9.5 ml, p=.011), had a shorter feeding time per meal (11.5+/-4.9 min vs. 20.9+/-5.0 min, p<.001), and sucked more efficiently (5.8+/-2.5 ml/min vs. 2.7+/-1.0 ml/min, p<.001) compared to those fed through cross-cut nipples. Infants using cross-cut nipple units had a higher RR (44.4+/-4.6 breaths/minutes vs. 40.8+/-4.9 breaths/minutes, p=.002) and SpO2 (96.1+/-1.4% vs. 94.6+/-3.2%, p=.044) than those using single-hole nipples. Oxygen desaturation (SpO2<90% and lasting for longer than 20 sec) and bradycardia were not recorded in either group of infants during feeding. Compared to using cross-cut nipple units, premature infants using single-hole nipple units take more milk and tend to tolerate feedings better. A single-hole nipple may be a choice for physiologically stable bottle-fed premature infants.     

Physiological responses of preterm infants to breast-feeding and bottle-feeding with the orthodontic nipple

BACKGROUND: Although the orthodontic nipple has been recommended for many years to supplement breast-feeding infants, it is not known if this nipple is suitable for hospitalized preterm infants whose mothers wish to breast-feed. OBJECTIVES: To describe and compare short-term physiologic responses of preterm infants serving as their own controls for two feeding methods, breast-feeding and bottle-feeding with the orthodontic nipple. METHOD: The sample consisted of eight preterm infants, mean birth weight of 1,370 grams and mean gestational age at birth of 30.2 weeks' gestation, who served as their own controls for breast- and bottle-feeding sessions. The dependent variables, sucking, breathing, and oxygen saturation, were measured noninvasively throughout breast- and bottle-feeding sessions and recorded on a polygraph. Data were analyzed quantitatively and qualitatively for 14 breast-feeding sessions and 15 bottle-feeding sessions. RESULTS: Statistically significant differences were found in that infants breathed more during sucking bursts for breast-feeding sessions when compared to bottle-feeding sessions and had fewer episodes of oxygen desaturation during breast-feeding. A characteristic sucking waveform associated with organized breathing was observed for some infants during bottle-feeding with the orthodontic nipple. CONCLUSIONS: These data suggest that the orthodontic nipple is appropriate for supplementing breast-feeding for some preterm infants. Further research is needed to examine long-term outcomes.     

Efficacy and safety of sucrose for procedural pain relief in preterm and term neonates

BACKGROUND: Preterm and acutely ill term neonates who are hospitalized in a neonatal intensive care unit are subjected to multiple frequent invasive and painful procedures aimed at improving their outcome. Although several trials to determine the efficacy of sucrose for managing procedural pain in preterm and acutely ill term neonates have been developed, these have generally lacked methodological rigor and have not provided clinicians with clear practice guidelines. OBJECTIVES: To compare the efficacy and safety of three interventions for relieving procedural pain associated with heel lances in preterm and term neonates, and to explore the influence of contextual factors including sex, severity of illness, and prior painful procedures on pain responses. METHODS: In a randomized controlled trial, 190 neonates were stratified by gestational age and then randomized to receive (a) sucrose and nonnutritive sucking (n = 64), (b) sucrose alone (n = 62), or (c) sterile water and nonnutritive sucking (control) (n = 64) to evaluate the efficacy (pain response as measured using the Premature Infant Pain Profile) (Stevens, Johnson, Petryshen, & Taddio, 1996) and safety (adverse events) following a scheduled heel lance during the first week of life. Stratification was used to control for the effects of age on pain response. RESULTS: Significant differences in pain response existed among treatment groups (F = 22.49, p <.001), with the lowest mean Premature Infant Pain Profile scores in the sucrose and nonnutritive sucking group. Efficacy of sucrose following a heel lance was not affected by severity of illness, postnatal age, or number of painful procedures. Intervention group and sex explained 12% of the variance in Premature Infant Pain Profile scores. Few adverse events occurred (n = 6), and none of them required medical or nursing interventions. CONCLUSIONS: The combination of sucrose and nonnutritive sucking is the most efficacious intervention for single heel lances. Research on the effects of gestational age on the efficacy and safety of repeated doses of sucrose is required.     

Preterm infants' behavioural indicators of oxygen decline during bottle feeding

BACKGROUND: During the time when preterm infants' oral feeding skills are developing they often experience physiological instability and need assistance from caregivers to maintain adequate oxygenation. Assisting infants to maintain optimal oxygenation during oral feeding requires an understanding of how they express and aim to self-regulate their oxygen status. AIM: The purpose of this study was to identify potential behavioural indicators of declining oxygenation during preterm infant early bottle-feeding. METHOD: The design was explorative. Data were collected from a secondary analysis of 20 videotapes of preterm infant bottle feedings which included concurrent oxygen saturation data. In this analysis infant behaviours and quality of breathing were coded and compared across three periods: high oxygen saturation, immediately preceding an oxygen desaturation event, and during an oxygen desaturation event. FINDINGS: Infants gave limited behavioural indicators of declining oxygenation. Immediately prior to a desaturation event, they had an increase in eye flutter and were typically sucking and apnoeic. During a desaturation event, they typically relaxed their arms/hands and stopped sucking. CONCLUSIONS: Reliance on preterm infant behavioural cues will be insufficient for detection of oxygen desaturation during oral feeding. Attention to changes in breath sounds and to the pattern of sucking are potentially important intervention strategies for the prevention of and appropriate response to oxygen decline during feeding. Sucking pauses may be a time when preterm infants aim to regulate their breathing pattern and thereby increase oxygenation. Interventions that focus on detection and minimization of apnoea during feeding, and which aim to protect infant sucking pauses, may reduce the number and severity of desaturation events preterm infants experience during bottle feeding.     

口腔运动干预对促进早产儿经口喂养的作用研究

目的探讨口腔运动干预对促进早产儿经口喂养进程及表现的影响。方法选择我院2015年5月-2016年4月新生儿科的60例早产儿,按随机数字表分为干预组和对照组,每组30例。对照组采用常规早产儿喂养护理。干预组在常规护理的基础上进行采用包括口周、口腔及非营养性吸吮等口腔运动干预。比较两组经口喂养效率及体质量增长等方面。结果干预组在开始经口喂养的喂养效率、完全经口喂养的喂养效率均优于对照组,差异有统计学意义(P0.05);干预组出院体质量高于对照组,差异有统计学意义(P0.05);干预组恢复出生体质量时间大于对照组,差异均有统计学意义(P0.05),在喂养不良事件(P=0.01)等方面差异也有统计学意义(P0.05)。结论实施口腔运动干预能够促进早产儿吸吮和吞咽反射的建立,提高协调性,改善喂养效果。