A Novel System to Measure Infants' Nutritive Sucking During Breastfeeding: the Breastfeeding Diagnostic Device (BDD)

A Novel Method to Sanitize Breast Pump Equipment in the Neonatal Intensive Care Unit

BACKGROUND

Enhancing the current breast pump sanitization method may improve maternal satisfaction and increase a mother's likelihood of providing human milk for their hospitalized infants in the Neonatal Intensive Care Unit (NICU). Other than Centers for Disease Control (CDC) data, there is lack of studies on sanitization practices. Currently, the only option in the hospital setting for breast pump equipment cleaning is a steam sanitization plastic bag.

PURPOSE

Using the Q. Basin will increase participant satisfaction compared to the steam sanitization bag.

METHODS

A multi-phased pilot study was conducted in our quaternary care NICU to test the Q. Basin, a novel design developed to wash, dry, and safely steam sanitize breast pump equipment compared to the standard steam bag. A bacterial study was conducted on breast pump equipment from 10 mothers by swabbing the equipment immediately at hour zero and 24 hours. Twenty NICU mothers concurrently evaluated their satisfaction via a 3-question survey comparing the Q. Basin and the steam sanitization plastic bag method.

RESULTS

The results showed a 20% increase in satisfaction with Q. Basin compared to the steam bag method.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Data analysis from the satisfaction survey concludes that mothers pumping preferred the Q. Basin as a quicker, faster, and more environmentally friendly method for breast pump part sanitization. Additional safety and materials studies are required before using the Q. Basin in the clinical environment.

Application of Statistical Analysis and Machine Learning to Identify Infants' Abnormal Suckling Behavior

OBJECTIVE

Identify infants with abnormal suckling behavior from simple non-nutritive suckling devices.

BACKGROUND

While it is well known breastfeeding is beneficial to the health of both mothers and infants, breastfeeding ceases in 75 percent of mother-child dyads by 6 months. The current standard of care lacks objective measurements to screen infant suckling abnormalities within the first few days of life, a critical time to establish milk supply and successful breastfeeding practices.

MATERIALS AND METHODS

A non-nutritive suckling vacuum measurement system, previously developed by the authors, is used to gather data from 91 healthy full-term infants under thirty days old. Non-nutritive suckling was recorded for a duration of sixty seconds. We establish normative data for the mean suck vacuum, maximum suck vacuum, suckling frequency, burst duration, sucks per burst, and vacuum signal shape. We then apply computational methods (Mahalanobis distance, KNN) to detect anomalies in the data to identify infants with abnormal suckling. We finally provide case studies of healthy newborn infants and infants diagnosed with ankyloglossia.

RESULTS

In a series of case evaluations, we demonstrate the ability to detect abnormal suckling behavior using statistical analysis and machine learning. We evaluate cases of ankyloglossia to determine how oral dysfunction and surgical interventions affect non-nutritive suckling measurements.

CONCLUSIONS

Statistical analysis (Mahalanobis Distance) and machine learning [K nearest neighbor (KNN)] can be viable approaches to rapidly interpret infant suckling measurements. Particularly in practices using the digital suck assessment with a gloved finger, it can provide a more objective, early stage screening method to identify abnormal infant suckling vacuum. This approach for identifying those at risk for breastfeeding complications is crucial to complement complex emerging clinical evaluation technology.

CLINICAL IMPACT

By analyzing non-nutritive suckling using computational methods, we demonstrate the ability to detect abnormal and normal behavior in infant suckling that can inform breastfeeding intervention pathways in clinic.Clinical and Translational Impact Statement: The work serves to shed light on the lack of consensus for determining appropriate intervention pathways for infant oral dysfunction. We demonstrate using statistical analysis and machine learning that normal and abnormal infant suckling can be identified and used in determining if surgical intervention is a necessary solution to resolve infant feeding difficulties.

[Latest Findings on the Suck-Swallow-Breathe Mechanism of Direct Breastfeeding From the Breast to an Infant]

A mother's breast milk is the best nourishing food for infants. No only does it provide sufficient nutrition, but it is also well suited to infants' immature digestive function, thus promoting their growth and organ maturation. A 6-month period of breastfeeding can provide infants with the necessary nutrients, energy, and fluids. The best feeding method is direct breastfeeding from the breast to an infant, yet the difficulties involved in breastfeeding should not be overlooked. Approximately 1/3 the mothers who are performing direct breastfeeding from the breast to an infant experience moderate or higher levels of feeding difficulties. Difficulties in direct breastfeeding from the breast to an infant can lead to decreased feeding efficiency, hamper the growth and development of infants, and affect the emotional communication between mothers and infants. At present, many relevant studies have focused on topics such as the mothers' psychology, family and social support, and the immature development of infants. However, little research has been done to investigate suck-swallow-breathe, a physiological mechanism that infants undertake during the process of direct breastfeeding from the breast to an infant. In this paper, we summarized published literature, research parameters, measurement instruments, and physical intervention methods of the suck-swallow-breathe mechanism in infants, aiming to facilitate the early identification of breastfeeding difficulties and the subsequently provision of early intervention measures and to promote the early identification of neurodevelopmental abnormalities and other developmental abnormalities in infants.

Non-Nutritive Suckling System for Real-Time Characterization of Intraoral Vacuum Profile in Full Term Neonates

Infant breastfeeding diagnostics remain subjective due to the absence of instrumentation to objectively measure and understand infant oral motor skills and suckling characteristics. Qualitative diagnostic exams, such as the digital suck assessment which relies upon a clinician's gloved finger inserted into the infant's mouth, produce a diversity of diagnoses and intervention pathways due to their subjective nature. In this paper, we report on the design of a non-nutritive suckling (NNS) system which quantifies and analyzes quantitative intraoral vacuum and sucking patterns of full-term neonates in real time. In our study, we evaluate thirty neonate suckling profiles to demonstrate the technical and clinical feasibility of the system. We successfully extract the mean suck vacuum, maximum suck vacuum, frequency, burst duration, number of sucks per burst, number of sucks per minute, and number of bursts per minute. In addition, we highlight the discovery of three intraoral vacuum profile shapes that are found to be correlated to different levels of suckling characteristics. These results establish a framework for future studies to evaluate oromotor dysfunction that affect the appearance of these signals based on established normal profiles. Ultimately, with the ability to easily and quickly capture intraoral vacuum data, clinicians can more accurately perform suckling assessments to provide timely intervention and assist mothers and infants towards successful breastfeeding outcomes.

Computational simulation of pacifier deformation and interaction with the palate

Objectives

The objective of this study is to demonstrate that computational finite element models can be used to reliably simulate dynamic interaction between a pacifier, the palate, and the tongue during nonnutritive sucking (NNS). The interactions can be quantified by the results of finite element analyses which include deformation, strain, stress, contact force, and contact area.

Materials and Methods

A finite element model was created based upon CAD solid models of an infant pacifier and palate. The silicone pacifier bulb is represented by a hyperelastic constitutive law. Contact surfaces are defined between the pacifier and palate. A time and spatially varying pressure load is applied to the bulb representing peristaltic interaction with the tongue. A second time‐varying, periodic pressure representing NNS is applied to the model simultaneously. A large displacement, nonlinear transient dynamic analysis is run over two NNS cycles.

Results

Results from the finite element analysis show the deformed shape of the bulb with maximum principal elastic strain of 0.23 and a range of maximum principal stress on the palate from 0.60 MPa (tensile) to −0.27 MPa (compressive) over the NNS cycles. The areas of contact between the pacifier and the palate are shown in surface contour plots.

Conclusions

A nonlinear transient dynamic finite element model can simulate the mechanical behavior of a pacifier and its interaction with the tongue and contact with the palate subject to NNS. Quantitative results predicting deformation, strain, stress, contact force, and contact area can be used in comparative studies to provide insight on how pacifiers cause changes in dental, orthognathic, and facial development.

The contractile patterns, anatomy and physiology of the hyoid musculature change longitudinally through infancy

All mammalian infants suckle, a fundamentally different process than drinking in adults. Infant mammal oropharyngeal anatomy is also anteroposteriorly compressed and becomes more elongate postnatally. While suckling and drinking require different patterns of muscle use and kinematics, little insight exists into how the neuromotor and anatomical systems change through the time that infants suckle. We measured the orientation, activity and contractile patterns of five muscles active during infant feeding from early infancy until weaning using a pig model. Muscles not aligned with the long axis of the body became less mediolaterally orientated with age. However, the timing of activation and the contractile patterns of those muscles exhibited little change, although variation was larger in younger infants than older infants. At both ages, there were differences in contractile patterns within muscles active during both sucking and swallowing, as well as variation among muscles during swallowing. The changes in anatomy, coupled with less variation closer to weaning and little change in muscle firing and shortening patterns suggest that the neuromotor system may be optimized to transition to solid foods. The lesser consequences of aspiration during feeding on an all-liquid diet may not necessitate the evolution of variation in neuromotor function through infancy.

Challenges in the interpretation and therapeutic manipulation of human ingestive microstructure

This minireview focuses on the interpretative value of ingestive microstructure by summarizing observations from both rodent and human studies. Preliminary data on the therapeutic manipulation of distinct microstructural components of eating are also outlined. In rodents, the interpretative framework of ingestive microstructure mainly concentrates on deprivation state, palatability, satiation, and the role of learning from previous experiences. In humans, however, the control of eating is further influenced by genetic, psychosocial, cultural, and environmental factors, which add complexity and challenges to the interpretation of the microstructure of meal intake. Nevertheless, the presented findings stress the importance of microstructural analyses of ingestion, as a method to investigate specific behavioral variables that underlie the regulation of appetite control.