Early Intervention to Improve Sucking in Preterm Newborns: A Systematic Review of Quantitative Studies

BACKGROUND

Premature birth is associated with feeding difficulties due to inadequate coordination of sucking, swallowing, and breathing. Nonnutritive sucking (NNS) and oral stimulation interventions may be effective for oral feeding promotion, but the mechanisms of the intervention effects need further clarifications.

PURPOSE

We reviewed preterm infant intervention studies with quantitative outcomes of sucking performance to summarize the evidence of the effect of interventions on specific components of sucking.

METHODS

PubMed, CINAHL, MEDLINE, EMBASE, and PSYCOLIST databases were searched for English language publications through August 2017. Studies were selected if they involved preterm infants, tested experimental interventions to improve sucking or oral feeding skills, and included outcome as an objective measure of sucking performance. Specific Medical Subject Headings (MeSH) terms were utilized.

RESULTS

Nineteen studies were included in this review: 15 randomized, 1 quasi-randomized, and 3 crossover randomized controlled trials. Intervention types were grouped into 6 categories (i) NNS, (ii) NNS with auditory reinforcement, (iii) sensorimotor stimulation, (iv) oral support, (v) combined training, and (vi) nutritive sucking. Efficiency parameters were positively influenced by most types of interventions, though appear to be less affected by trainings based on NNS alone.

IMPLICATIONS FOR PRACTICE

These findings may be useful in the clinical care of infants requiring support to achieve efficient sucking skills through NNS and oral stimulation interventions.

IMPLICATIONS FOR RESEARCH

Further studies including quantitative measures of sucking performance outcome measures are needed in order to best understand the needs and provide more tailored interventions to preterm infants.

The Association of Birth Weight and Infant Growth with Energy Balance-Related Behavior - A Systematic Review and Best-Evidence Synthesis of Human Studies

BACKGROUND

Suboptimal prenatal and early postnatal growths are associated with obesity in later life, but the underlying mechanisms are unknown. The aim of this study was to systematically review the literature that reports on the longitudinal association of (i) birth size or (ii) infant growth with later (i) energy intake, (ii) eating behaviors, (iii) physical activity or (iv) sedentary behavior in humans.

METHODS

A comprehensive search of MEDLINE, EMBASE, PsycINFO and The Cochrane Library was conducted to identify relevant publications. We appraised the methodological quality of the studies and synthesized the extracted data through a best-evidence synthesis.

RESULTS

Data from 41 publications were included. The quality of the studies was high in three papers, moderate in 11 and low in the large majority (n = 27) of papers appraised. Our best-evidence synthesis indicates that there is no evidence for an association of birth weight with later energy intake, eating behavior, physical activity or sedentary behavior. We found moderate evidence for an association of extreme birth weights (at both ends of the spectrum) with lower physical activity levels at a later age. Evidence for the association of infant growth with energy balance-related behavior was generally insufficient.

CONCLUSIONS

We conclude that current evidence does not support an association of early-life growth with energy balance-related behaviors in later life, except for an association of extreme birth weights with later physical activity.

Neonatal neurobehavioral organization after exposure to maternal epidural analgesia in labor

OBJECTIVE

To explore relationships between maternal epidural analgesia and two measures of neurobehavioral organization in infants at the initial feeding 1 hour after birth.

DESIGN

Prospective comparative design.

SETTING

Inner-city community hospital, Chicago, Illinois.

PARTICIPANTS

Convenience sample of 52 low-risk, mainly Black and Latino, mother/infant dyads.

METHODS

Mothers self-selected to labor with epidural or no labor pain medication. Neonatal neurobehavioral organization was measured in term infants at the initial feeding 1 hour after birth. A nutritive sucking apparatus generated data on total number of sucks and sucking pressure. Video recordings of infants (before and after the initial feeding) were coded for behavioral states, with analysis on frequency of alertness.

RESULTS

Total number of sucks and sucking pressure were not related to epidural exposure, although an epidural drug dosage effect on total number of sucks was evident when gender was a factor. Unmedicated girls demonstrated more sucks than girls in the high-dosage epidural group (p=.027). Overall, girls exhibited stronger sucking pressure than boys (p=.042). Frequency of alertness was not related to epidural exposure, although longer labor was related to greater alertness (p=.003), and Latino infants were more alert than Black infants (p=.002).

CONCLUSIONS

Results suggest attenuated neonatal nutritive sucking organization in girls after exposure to high maternal epidural dosages. In comparison to boys, girls may have enhanced neurobehavioral organization at birth. Race/ethnicity and alertness may have spurious associations in which hidden factors drive the relationship.

Feeding patterns of full-term and preterm infants at forty weeks postconceptional age

Little research exists that addresses the differences in feeding skills between preterm (PT) infants at term and full-term (FT) infants. The purpose of this study was to quantify and examine the differences in sucking abilities of PT infants when measured at 40 weeks postconceptional age (PCA) and newly born FT infants. The sample consisted of 213 infants who were divided into three groups on the basis of their gestational age at birth (24-29 wk, 30-32 wk, and 38-42 wk). The Kron Nutritive Sucking Apparatus (KNSA) was used to examine the microstructure of sucking and feeding behaviors. There were significant differences among the three groups in several of the sucking variables: number of bursts (p = .005), intersuck interval (p = .0212), sucks per burst (p = .0003), suck width (p < .0001), intersuck width (p < .0001), mean maximum pressure (p < .0001), and intersuck width/interburst width (p = .02). The findings from this study demonstrate the importance of both maturation at birth and experience as factors influencing feeding behaviors.

Masseter muscle activity in bottle feeding with the chewing type bottle teat: evidence from electromyographs

It was reported that the activity of the masticatory muscles is reduced in bottle fed babies. The effects of chewing type bottle teats distributed in Japan on masticatory muscle activity were evaluated. Myoelectric activities of the masseter muscles of 12 babies bottle fed with chewing type bottle teats were recorded and analyzed by the same method as in the previous study. The electromyographic records of 12 breast fed babies and 12 babies bottle fed with regular sucking type bottle teats, which were reported in a previous study, were used as controls. The results show that the masseter muscle activity of babies bottle fed with chewing type bottle teats was similar to that of breast fed babies qualitatively as well as quantitatively. However, activity was visibly different from that of babies bottle fed with sucking type bottle teats, showing significant difference by ANOVA. These data suggest that babies who are ingesting milk from chewing type bottle teats do so with a chewing action similar to that of breast feeding, but very different from that of bottle feeding with sucking type bottle teats. The conclusion was that the chewing type bottle teat is useful for establishing masseter muscle activity.

Neonatal sucking behaviors

Neonatal sucking responses or behaviors have been of great interest to researchers and clinicians since the early 1800s. Since 1960, there has been a resurgence of interest in the objective study of sucking behaviors in both the psychological and medical literature. The studies have examined both nutritive and non-nutritive sucking measurements. Sucking behaviors have been studied to understand the development of the feeding mechanism as well as to track neurobehavioral development. The relationship between sucking behaviors and behavioral organization of the newborn are considered, along with a historical perspective of sucking measurements, relevant literature on nutritive sucking, physiologic correlates, differences in breast and bottle feeding patterns, non-nutritive sucking, and factors that modify sucking organization. Implications for nursing practice will be discussed.

Non-organic failure to thrive: growth failure secondary to feeding-skills disorder

In this article the authors propose that non-organic failure to thrive (FTT) is a growth failure secondary to feeding-skills disorder, and that this disorder is neurophysiological in origin. The symptoms of feeding-skills disorder were suggestive of an oral sensorimotor impairment which is usually present from birth or early life, but tends to go unrecognized. Data from 38 infants with non-organic and 22 infants with organic FTT demonstrated that early clinical symptoms of feeding impairment, and observed maternal and infant feeding behaviours and interactions, were similar for both groups, suggesting a need to redefine the term 'non-organic'.

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.

Sucking behaviors of normal 3-day-old female neonates during a 24-hr period

Feeding behaviors were measured during six feeding sessions distributed throughout a 24-hr period in 10 normal 3-day-old female infants. Infants were individually videotaped during feeding sessions at 13:00, 17:00, 21:00, 01:00, 05:00, and 09:00 hours. Total mealtime, nutritive sucking time, pause time, number of nutritive sucks, and amount of nutrient consumed were measured. None of these feeding variables were affected by the time of day an infant was fed. Maternal interactions with their infants such as auditory stimulation, caretaking touches or tender touches were unaffected by the time of a feed. These maternal behaviors did not correlate with any of the feeding variables. These findings suggest that 3-day-old infants experiencing routine nursery care do not express specific day-night feeding differences and that certain maternal behaviors do not influence the infants' feeding pattern.

Psychological characteristics and development of narcotic-addicted infants

This paper reviews neonatal and developmental behavioral characteristics of children born to heroin- and methadone-addicted women. Evidence of behavioral effects is clearer and more consistent for the neonatal period than in later infancy and childhood. It has not been shown that additional risk for psychological disturbance in childhood is contributed by passive addiction in utero. Methodologic problems in this literature are described and suggestions for strategies and directions in research are offered.

Maternal and child nutritional status: its association with the risk of pregnancy

Breastfeeding reduces the interval between births by its effect on prolonging the period of postpartum anovulation and in some cases, reducing the likelihood of conception once ovulation has occurred. Extended durations of postpartum amenorrhea (18 months and longer) are observed among many women in developing countries, while shorter durations (6 months or less) are common among women in developed countries. This differential effect has been suggested to be related to maternal nutritional status, but numerous other factors also differ. This paper reviews the literature in this area, and suggests that most studies indicate a small and demographically insignificant effect of maternal nutritional status on the period of postpartum amenorrhea. Factors associated with suckling patterns appear to be more important in determining the length of postpartum infertility. Suckling frequency and intensity which affects the hormonal stimulus preventing ovulation appear to be affected by the type of and how supplemental feeding is given to the child (use of bottles), whether suckling is on demand or scheduled, the frequency of night-time feedings (influenced by whether or not the mother sleeps with the child), whether or not pacifiers are used, and the child's nutritional and health status.

Early behavioral differences: gender or circumcision?

In human studies, the possible long-term effects on behavior of early physical insult or pharmacological agents have received little attention. We present both circumstantial and direct evidence that circumcision of male infants leads to behavioral changes. In some American studies using circumcised infants, reported gender differences may instead be the result of the altered behavior of circumcised males. We suggest that circumcision requires more study in its own right, and that it requires description if not control in all neonatal and infancy studies.