Impact of Oral Sensory Motor Stimulation on Feeding Performance, Length of Hospital Stay, and Weight Gain of Preterm Infants in NICU

Effect of an oral stimulation protocol on breastfeeding among preterm infants: a randomised controlled trial

OBJECTIVES

The objectives are to assess the effectiveness of a modified and adapted oral sensorimotor intervention (MA-OSMI) protocol for infants in India on the rate and performance of breastfeeding among preterm (PT) infants at discharge.

DESIGN

Single-centre randomised control trial.

SETTING

Level III B neonatal intensive care unit in a quaternary care hospital in South India.

PATIENTS

A total of 76 PT infants born between 26 and 33+6 weeks of gestational age, stratified into <30 weeks and 30-33+6 weeks, were randomised to intervention group (MA-OSMI) or standard care (SC).

INTERVENTIONS

MA-OSMI in addition to SC versus SC alone. The stimulation included 12 techniques administered by the principal investigator. SC included kangaroo mother care and non-nutritive sucking.

OUTCOME MEASURES

Exclusive breastfeeding (EBF) rate and breastfeeding performance at the time of discharge, assessed using standardised tools by clinician and mothers.

RESULTS

Infants in MA-OSMI group (66%) had significantly higher EBF rate compared with the SC group (16%) (OR: 10.25; 95% CI: 3.41 to 30.80). Improved breastfeeding performance was noted as per the clinician's observation. Significantly lower scores for MA-OSMI groups (63.42±36.43) than SC groups (126.61±60.94) on mothers' ratings suggested better feeding skills.

CONCLUSION

Prefeeding oral stimulation contributed significantly to the achievement of EBF among PT infants at discharge. The present findings may benefit speech-language pathologists, paediatricians/neonatologists and nurses in the intervention of oral feeding among neonates.

Tube Feeding Duration Associated with Socioeconomic Factors in Infants with Congenital Heart Disease: Single Center Study

Infants with congenital heart disease are often discharged home with tube feeding after undergoing cardiac surgery. Clinical factors have been shown to impact tube feeding duration after cardiac surgery, but there is less information about how socioeconomic factors impact tube feeding duration. This retrospective cohort study was conducted among infants who underwent congenital heart disease surgery within 60 days of birth and were discharged from the hospital with tube feeding from 2016 to 2023 (N = 102). Tube feeding duration, neighborhood socioeconomic status (SES), self-reported race and ethnicity, and insurance type were collected. Neighborhood SES was calculated based on the previously published method by Diez-Roux and using the Childhood Opportunity Index. The median total tube feeding duration was 490.5 days, with 60.8% infants requiring tube feeding for greater than 1 year. Compared to other racial and ethnic groups, Hispanic/Latino patients had the highest median duration of tube feeding in days (1065). Longer length of stay, Hispanic/Latino ethnicity, and lower neighborhood SES score (ORs: 1.023-7.773) were associated with increased odds of needing a feeding tube for greater than 1 year. Further understanding of what is leading to these disparities is needed to guide improvement in equity.

Exercise during pregnancy Dose: Influence on preterm birth outcomes

BACKGROUND

Preterm delivery typically increases health risk for neonates and is associated with longer infant hospital stay and financial burden. Prenatal exercise dose (frequency, intensity, type, time, volume) have been shown to influence birth outcomes. Increased prenatal exercise dose could therefore provide a critical reduction in health risk and financial burden in preterm neonates.

OBJECTIVE

It was our aim to explore the effects of prenatal exercise dose from a supervised exercise intervention in pregnant women on the occurrence of preterm (<37 weeks gestation) births, and the impact on health outcomes in preterm neonates.

STUDY DESIGN

This study is a retrospective, secondary analysis of pooled data from three blinded, prospective, randomized controlled trials. Prenatal exercise dose were assessed in supervised aerobic, resistance, and combination sessions throughout pregnancy. In addition to gestational age, birth weight, resting heart rate, neonatal morphometrics (body circumferences, ponderal index), and health status (Apgar-1 and -5) metrics were obtained for 21 women at birth. One-way analysis of variance tests were used to assess the differences between dose grouped as tertiles, while Pearson correlations determined the association between dose and birth outcomes.

RESULTS

Women exercised for an average of 19.6 wks (range: 6 - 21 wks) during pregnancy. Exercise during pregnancy tended to result in later preterm deliveries (p = 0.08). Greater prenatal exercise volume and duration were associated with reduced infant hospital stay post-delivery (p = 0.02). Weekly exercise volume was associated with increased Apgar scores (p = 0.01).

CONCLUSION

Increased prenatal exercise volume and duration is associated with improved birth outcomes in preterm neonates.

The effectiveness of oral motor interventions on the weight gain, independent oral feeding, and length of hospital stay in hospitalized preterm infants: A systematic review and meta-analysis

Background and Aims

Oral feeding for preterm infants has been a challenging issue globally. In an effort to enhance the effectiveness of oral feeding in preterm infants, oral motor intervention (OMI) was developed. Present systematic review and meta-analysis study aims to examine the impact of various OMI techniques on key outcomes, including body weight at the time of discharge, the duration required to achieve independent oral feeding, and the length of hospital stay for preterm infants.

Methods

A systematic search of the literature was performed across various databases such as PubMed, Scopus, and Web of Science and Google Scholar up to September 28, 2023. Quality assessment was conducted using the Joanna Briggs Institute (JBI) checklist. The overall effect measure was calculated using a random-effects model and was presented as the standard difference of the mean (SDM), accompanied by the standard error and a 95% confidence interval (CI). We used I 2 statistic for investigating the heterogeneity between studies. Data analysis was performed by CMA software (Version 2).

Results

Finally, 22 articles included in this review. The overall effect for body weight at discharge was found to be statistically significant in the prefeeding oral stimulation (PFOS) (SDM = 7.91, 95% CI: 5.62, 10.2, p = 0.000, I 2 = 86.31) and Premature Infant OMI (PIOMI) (SDM = 3.71, 95% CI: 0.72, 6.69, p = 0.01, I 2 = 96.64) groups versus control group. The overall effect of independent oral feeding was significant for PFOS-only (SDM = -0.64, 95% CI: -1.1, -0.17, p = 0.007, I 2 = 75.45), PIOMI only (SDM = -1.48, 95% CI: -2.49, -0.46, p = 0.004, I 2 = 93.73) and nonnutritive sucking (NNS) only (SDM = -0.53, 95% CI: -0.76, -0.30, p = 0.001, I 2 = 0) groups versus control groups. The overall effect of length of hospital stay was significant for NNS group (SDM = -0.45, 95% CI: -0.67, -0.23, p = 0.067, I 2 = 0) and PIOMI group (SDM = -0.42, 95% CI: -0.69, -0.15, p = 0.002, I 2 = 20.18) versus control group.

Conclusion

Among OMIs, the PIOMI approach generally exhibited a more favorable impact on body weight gain at discharge, the duration required to achieve independent oral feeding, and the length of hospital stay.

The transition from tube feeding to oral feeding algorithm in preterm infants: case-control study

BACKGROUND

Oral feeding is a complex sensorimotor process influenced by many variables, making it challenging for healthcare providers to introduce and manage it. Feeding practice guided by tradition or a trial-and-error approach may be inconsistent and potentially delay the progression of oral feeding skills.

AIM

To apply a new feeding approach that assesses early oral feeding independence skills of preterm infants in the neonatal intensive care unit (NICU). To prove its effectiveness, compare two approaches of oral feeding progression based on clinical outcomes in preterm infants, the traditional approach used in the NICU of Mansoura University Children Hospital (MUCH) versus the newly applied approach.

METHODS

A quasi-experimental, exploratory, and analytical design was employed using two groups, control and intervention groups, with 40 infants for the first group and 41 infants for the second one. The first group (the control) was done first and included observation of the standard practice in the NICU of MUCH for preterm oral feeding, in which oral feeding was dependent on post-menstrual age (PMA) and weight for four months. The second group (the intervention) included early progression to oral feeding depending on early assessment of Oral Feeding Skills (OFS) and early supportive intervention and/or feeding therapy if needed using the newly developed scoring system, the Mansoura Early Feeding Skills Assessment "MEFSA" for the other four months. Infants in both groups were studied from the day of admission till discharge.

RESULTS

In addition to age and weight criteria, other indicators for oral feeding readiness and oral motor skills were respected, such as oral feeding readiness cues, feeding practice, feeding maintenance, and feeding techniques. By following this approach, preterm infants achieved earlier start oral feeding (SOF) and full oral feeding (FOF) and were discharged with shorter periods of tube feeding. Infants gained weight without increasing their workload to the NICU team.

CONCLUSION

The newly applied approach proved to be a successful bedside scoring system scale for assessing preterm infants' early oral feeding independence skills in the NICU. It offers an early individualized experience of oral feeding without clinical complications.

Interventions to Enhance Achievement to Independent Oral Feeds in Premature Infants: A Scoping Review

AIM

To assess the effectiveness of interventions aimed at facilitating the transition from full tube to independent oral feeds in premature infants.

METHODS

Scoping review methodology using the Preferred Reporting items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA_ScR). A search of six databases (EMBASE, MEDLINE, CINAHL, Web of Science, COCHRANE, and OT Seeker), using keywords related to oral feeding and premature infants retrieved 11,870 articles. Full-text screening was completed for 36 articles, and 21 articles were included in this review.

RESULTS

Review of the 21 articles revealed five intervention types: oral stimulation (n = 14), swallow/gustatory stimulation (n = 3), olfactory stimulation (n = 2), tactile/kinesthetic stimulation (n = 1), and auditory stimulation (n = 1). Oral stimulation had the most studies with consistent evidence supporting its beneficial effect to facilitate achievement to independent oral feeds, swallow/gustatory stimulation appeared to have some benefit, but evidence for olfactory, tactile/kinesthetic, and auditory stimulation was sparse.

CONCLUSION

Oral stimulation has the most studies with consistent evidence, and thus is suggested as a suitable early intervention strategy that can be used by health providers to facilitate the achievement to independent oral feeds in premature infants. The alternate forms of stimulation have limited evidence and necessitate further studies to confirm their benefits.

Oral stimulation for promoting oral feeding in preterm infants

BACKGROUND

Preterm infants (< 37 weeks' post-menstrual age (PMA)) are often delayed in attaining oral feeding. Normal oral feeding is suggested as an important outcome for the timing of discharge from the hospital and can be an early indicator of neuromotor integrity and developmental outcomes. A range of oral stimulation interventions may help infants to develop sucking and oromotor co-ordination, promoting earlier oral feeding and earlier hospital discharge. This is an update of our 2016 review.

OBJECTIVES

To determine the effectiveness of oral stimulation interventions for attainment of oral feeding in preterm infants born before 37 weeks' PMA.

SEARCH METHODS

Searches were run in March 2022 of the following databases: CENTRAL via CRS Web; MEDLINE and Embase via Ovid. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. Searches were limited by date 2016 (the date of the search for the original review) forward. Note: Due to circumstances beyond our control (COVID and staffing shortages at the editorial base of Cochrane Neonatal), publication of this review, planned for mid 2021, was delayed. Thus, although searches were conducted in 2022 and results screened, potentially relevant studies found after September 2020 have been placed in the section, Awaiting Classification, and not incorporated into our analysis.

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials comparing a defined oral stimulation intervention with no intervention, standard care, sham treatment or non-oral intervention (e.g. body stroking protocols or gavage adjustment protocols) in preterm infants and reporting at least one of the specified outcomes.

DATA COLLECTION AND ANALYSIS

Following the updated search, two review authors screened the titles and abstracts of studies and full-text copies when needed to identify trials for inclusion in the review. The primary outcomes of interest were time (days) to exclusive oral feeding, time (days) spent in NICU, total hospital stay (days), and duration (days) of parenteral nutrition. All review and support authors contributed to independent extraction of data and analysed assigned studies for risk of bias across the five domains of bias using the Cochrane Risk of Bias assessment tool. The GRADE system was used to rate the certainty of the evidence. Studies were divided into two groups for comparison: intervention versus standard care and intervention versus other non-oral or sham intervention. We performed meta-analysis using a fixed-effect model.

MAIN RESULTS

We included 28 RCTs (1831 participants). Most trials had methodological weaknesses, particularly in relation to allocation concealment and masking of study personnel. Oral stimulation compared with standard care Following meta-analysis, it is uncertain whether oral stimulation reduces the time to transition to oral feeding compared with standard care (mean difference (MD) -4.07 days, 95% confidence interval (CI) -4.81 to -3.32 days, 6 studies, 292 infants; I2 =85%, very low-certainty evidence due to serious risk of bias and inconsistency). Time (days) spent in the neonatal intensive care unit (NICU) was not reported. It is uncertain whether oral stimulation reduces the duration of hospitalisation (MD -4.33, 95% CI -5.97 to -2.68 days, 5 studies, 249 infants; i2 =68%, very low-certainty evidence due to serious risk of bias and inconsistency). Duration (days) of parenteral nutrition was not reported. Oral stimulation compared with non-oral intervention Following meta-analysis, it is uncertain whether oral stimulation reduces the time to transition to exclusive oral feeding compared with a non-oral intervention (MD -7.17, 95% CI -8.04 to -6.29 days, 10 studies, 574 infants; I2 =80%, very low-certainty evidence due to serious risk of bias, inconsistency and precision). Time (days) spent in the NICU was not reported. Oral stimulation may reduce the duration of hospitalisation (MD -6.15, 95% CI -8.63 to -3.66 days, 10 studies, 591 infants; I2 =0%, low-certainty evidence due to serious risk of bias). Oral stimulation may have little or no effect on the duration (days) of parenteral nutrition exposure (MD -2.85, 95% CI -6.13 to 0.42, 3 studies, 268 infants; very low-certainty evidence due to serious risk of bias, inconsistency and imprecision).

AUTHORS' CONCLUSIONS

There remains uncertainty about the effects of oral stimulation (versus either standard care or a non-oral intervention) on transition times to oral feeding, duration of intensive care stay, hospital stay, or exposure to parenteral nutrition for preterm infants. Although we identified 28 eligible trials in this review, only 18 provided data for meta-analyses. Methodological weaknesses, particularly in relation to allocation concealment and masking of study personnel and caregivers, inconsistency between trials in effect size estimates (heterogeneity), and imprecision of pooled estimates were the main reasons for assessing the evidence as low or very low certainty. More well-designed trials of oral stimulation interventions for preterm infants are warranted. Such trials should attempt to mask caregivers to treatment when possible, paying particular attention to blinding of outcome assessors. There are currently 32 ongoing trials. Outcome measures that reflect improvements in oral motor skill development as well as longer term outcome measures beyond six months of age need to be defined and used by researchers to capture the full impact of these interventions.

Effects of an Oral Stimulation Program on Feeding Outcomes in Preterm Infants: A Systematic Review and Meta-Analysis

AIMS

To review the literature on the effects of unimodal sensorimotor stimulation protocols on feeding outcomes in very preterm and moderate to late preterm infants (PIs).

METHODS

Five databases were searched up to April 2022. Studies comparing unimodal sensorimotor stimulation protocols based on the combination of manual oral stimulation with NNS against usual care in PIs, on-time transition to full oral feeding (FOF), feeding efficacy, length of hospital stay, and/or body weight gain.

RESULTS

Eleven studies were included. Compared to usual care, unimodal sensorimotor stimulation protocols based on manual oral stimulation combined with NNS demonstrated to be more effective in decreasing time transition to FOF (standardized mean difference [95%CI] - 1.08 [-1.74, -0.41]), improving feeding efficacy (2.15 [1.18, 3.13]) and shortening length of hospital stay (-0.35 [-0.68, -0.03]). However, the proposed intervention was not effective in improving weight gain (0.27 [-0.40, 0.95]). There were no significant differences according to gestational age (p > .05).

CONCLUSIONS

Based on fair-to-high quality evidence, unimodal sensorimotor stimulation protocols combined with NNS reduce time transition to FOF, improve feeding efficacy, and shorten the length of hospital stay; yet the proposed intervention yielded no significant effects on body weight gain when compared to usual care in PIs.

Feeding practices in public hospitals' neonatal intensive care units: An exploration into the ways in which COVID-19 affected the best practice in Gauteng

BACKGROUND

 South Africa's healthcare system has a multitude of pre-existing challenges prior to the onset of the coronavirus disease 2019 (COVID-19) pandemic, ranging from reduced number of staff, lack of resources and units being at overcapacity both in the adult and paediatric populations. The neonatal intensive care units (NICUs) require a team approach to ensure best practice with vulnerable infants, but little is known about how the onset of the COVID-19 pandemic and the resultant lockdown restrictions impacted the feeding practices within the NICU.

OBJECTIVES

 This study aimed to explore the impact that COVID-19 had on the feeding practices within the NICU settings in public hospitals in Gauteng.

METHODS

 A qualitative design was employed with data collected in two NICUs in Gauteng. Data were collected in the form of observations and semi-structured interviews with healthcare workers (HCWs) in the NICU. Data were analysed using inductive thematic analysis.

RESULTS

 Although the sample size of participants was limited, social distancing proved to be a challenge resulting in mothers and healthcare workers being given restricted access. This had effects on the ability to provide adequate feeding practices and resulted in anxiety for the mothers and mental health challenges for the HCWs when feeding these at-risk infants. A limitation of this study was the use of only two sites.

CONCLUSION

 COVID-19 amplified the existing challenges in the NICU. A multidisciplinary and family-centred approach to address feeding challenges is required to offset the challenges resulting from the pandemic and subsequent lockdown.

Effects of Oral Stimulation and Supplemental Nursing System on the Transition Time to Full Breast of Mother and Sucking Success in Preterm Infants: A Randomized Controlled Trial

This study aimed to investigate the effect of oral stimulation and a supplemental nursing system on the time to full maternal breastfeeding and sucking success in preterm infants. The sample consisted of 70 preterm babies. Oral motor stimulation and a supplemental nursing system were applied to the preterm infants in the experimental group, while no intervention was applied to those in the control group. Significant differences were found between the two groups concerning transition time to oral feeding, transition weight, transition time to full maternal breast, discharge age, duration, and weight, LATCH mean scores, continuing to suck in the first month after discharge, and weight averages. Oral stimulation and a supplemental nursing system shortened the transition period to oral feeding and full breastfeeding, increased breastfeeding rates and the sustainability of breastfeeding, and did not affect the period of discharge and vital signs during feeding in preterm babies.

[Effectiveness of 2 interventions for independent oral feeding in pre-terms]

INTRODUCTION

Oral feeding of pre-term newborns (PTNB) is hampered by their immaturity and intercurrent diseases, which can prolong their hospital stay. The objective of this study was to assess the effectiveness of a program that combines tactile, kinesthetic and oral stimulation (T+K+OS) compared to another intervention based on exclusively oral stimulation (OS), in the time necessary to achieve independent feeding and hospital discharge.

PATIENTS AND METHODS

A clinical study of 2 randomized groups (OS vs. T+K+OS) was carried out on 42 PTNB with gestational age between 27-32 weeks and birth weight>900g. The stimulation programs were carried out in sessions of 15min, for 10 days.

RESULTS

The PTNBs in the T+K+OS group achieved independent oral feeding earlier, compared to the OS group (24.9±10.1 vs. 34.1±15.6 days, P=.02). An analysis of covariance was performed, which confirmed that the birth weight and gestational age covariates had significant effects on time to reach suction feeding (birth weight: F[1, 38]=5.79; P=.021; gestational age: F[1, 38]=14.12; P=.001) and that once its effect was controlled, the intervention continued to have a significant effect (F[1, 38]=6.07; P=.018). The T+K+OS group, compared to the OS group, achieved an earlier hospital discharge (39±15 vs. 45±18 days), although the differences were not significant (P=.21).

CONCLUSIONS

Combined therapies that include T+K+OS are more effective than OS alone, in order to achieve independent oral feeding in PTNBs.

The Effectiveness of an Oral Sensorimotor Stimulation Protocol for the Early Achievement of Exclusive Oral Feeding in Premature Infants. A Randomized, Controlled Trial

Aims: This study is aimed to investigate the effectiveness of an oral stimulation protocol in preterm infants compared to usual care, to reduce the time for achieving safe full oral feeding.Methods: 47 preterm infants (25- 30 weeks of gestational age) were randomized into two groups. Babies of the EG (n = 24) received a 10-minute oral stimulation protocol while the CG (n = 23) received the standard care. The primary outcome were the days from the initiation of the intervention until the achievement of full oral feeding. Secondary outcomes were: days from the first day the intervention started until achieving a first oral intake of 30% in the first 5 minutes, days from the first day the intervention started until achieving a first oral intake of 100%, and days of hospitalization. A parametric survival model with Gaussian distribution was used.Results: The EG achieved full oral feeding 8.3 days before the CG (p = 0.013). EG also achieved the first oral intake of 30% in the first five minutes, 6.03 days before (p = 0.019) and of 100%, 5.88 days before (p = 0.040). EG also spent 6.9 days less hospitalized than CG (p = 0.028).Conclusion: Oral stimulation in preterm infants significantly shortens the time to achieve full oral feeding and reduces the length of hospitalization.

The Effect of Non-Nutritive Sucking and Maternal Milk Odor on the Independent Oral Feeding in Preterm Infants

OBJECTIVES

Given the positive effects of stimulation with breast milk odor and non-nutritive sucking (NNS) on preterm feeding skills, we examined the effect of NNS and milk odor, on the time of achieving independent oral feeding in preterm infants.

MATERIALS & METHODS

This study was conducted at two Neonatal Intensive Care Units of Tehran, Iran in 2016. Overall, 32 neonates with gestational ages of 28-32 wk were enrolled in two groups; NNS with and without olfactory stimuli (breast milk odor). The simulations were performed in both groups during the first five minutes of gavage, three times per day, and over ten consecutive days. Weight gain, time of achieving oral feeding and chronological age at discharge were as measures of the effectiveness of the interventions. The results of the interventions were analyzed and compared using SPSS.18.

RESULTS

NNS with breast milk odor resulted to a lower post-menstrual age at the first oral feeding, independent oral feeding and discharge from the hospital, but had no effects on their daily weight gain and weight at the time of discharge.

CONCLUSION

These results show the effectiveness of combining milk odor and NNS as two important stimuli in achieving oral feeding and earlier discharge from the hospital.

Identification of Risk Factors for Poor Feeding in Infants with Congenital Heart Disease and a Novel Approach to Improve Oral Feeding

Many infants with complex congenital heart disease (CHD) do not develop the skills to feed orally and are discharged home on gastrostomy tube or nasogastric feeds. We aimed to identify risk factors for failure to achieve full oral feeding and evaluate the efficacy of oral motor intervention for increasing the rate of discharge on full oral feeds by performing a prospective study in the neonatal and cardiac intensive care units of a tertiary children's hospital. 23 neonates born at ≥37weeks gestation and diagnosed with single-ventricle physiology requiring a surgical shunt were prospectively enrolled and received oral motor intervention therapy. 40 historical controls were identified. Mean length of stay was 53.7days for the control group and 40.9days for the study group (p=0.668). 13/23 patients who received oral motor intervention therapy (56.5%) and 18/40 (45.0%) controls were on full oral feeds at discharge, a difference of 11.5% (95% CI -13.9% to 37.0%, p=0.378). Diagnosis of hypoplastic left heart syndrome, longer intubation and duration of withholding enteral feeds, and presence of gastroesophageal reflux disease were predictors of poor oral feeding on univariate analysis. Although we did not detect a statistically significant impact of oral motor intervention, we found clinically meaningful differences in hospital length of stay and feeding tube requirement. Further research should be undertaken to evaluate methods for improving oral feeding in these at-risk infants.

Oral stimulation for promoting oral feeding in preterm infants

BACKGROUND

Preterm infants (< 37 weeks' postmenstrual age) are often delayed in attaining oral feeding. Normal oral feeding is suggested as an important outcome for the timing of discharge from the hospital and can be an early indicator of neuromotor integrity and developmental outcomes. A range of oral stimulation interventions may help infants to develop sucking and oromotor co-ordination, promoting earlier oral feeding and earlier hospital discharge.

OBJECTIVES

To determine the effectiveness of oral stimulation interventions for attainment of oral feeding in preterm infants born before 37 weeks' postmenstrual age (PMA).To conduct subgroup analyses for the following prespecified subgroups.• Extremely preterm infants born at < 28 weeks' PMA.• Very preterm infants born from 28 to < 32 weeks' PMA.• Infants breast-fed exclusively.• Infants bottle-fed exclusively.• Infants who were both breast-fed and bottle-fed.

SEARCH METHODS

We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed (1966 to 25 February 2016), Embase (1980 to 25 February 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 25 February 2016). We searched clinical trials databases, conference proceedings and the reference lists of retrieved articles.

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials comparing a defined oral stimulation intervention with no intervention, standard care, sham treatment or non-oral intervention in preterm infants and reporting at least one of the specified outcomes.

DATA COLLECTION AND ANALYSIS

One review author searched the databases and identified studies for screening. Two review authors screened the abstracts of these studies and full-text copies when needed to identify trials for inclusion in the review. All review authors independently extracted the data and analysed each study for risk of bias across the five domains of bias. All review authors discussed and analysed the data and used the GRADE system to rate the quality of the evidence. Review authors divided studies into two groups for comparison: intervention versus standard care and intervention versus other non-oral or sham intervention. We performed meta-analysis using a fixed-effect model.

MAIN RESULTS

This review included 19 randomised trials with a total of 823 participants. Almost all included trials had several methodological weaknesses. Meta-analysis showed that oral stimulation reduced the time to transition to oral feeding compared with standard care (mean difference (MD) -4.81, 95% confidence interval (CI) -5.56 to -4.06 days) and compared with another non-oral intervention (MD -9.01, 95% CI -10.30 to -7.71 days), as well as the duration of initial hospitalisation compared with standard care (MD -5.26, 95% CI -7.34 to -3.19 days) and compared with another non-oral intervention (MD -9.01, 95% CI -10.30 to -7.71 days).Investigators reported shorter duration of parenteral nutrition for infants compared with standard care (MD -5.30, 95% CI -9.73 to -0.87 days) and compared with another non-oral intervention (MD -8.70, 95% CI -15.46 to -1.94 days). They could identify no effect on breast-feeding outcomes nor on weight gain.

AUTHORS' CONCLUSIONS

Although the included studies suggest that oral stimulation shortens hospital stay, days to exclusive oral feeding and duration of parenteral nutrition, one must interpret results of these studies with caution, as risk of bias and poor methodological quality are high overall. Well-designed trials of oral stimulation interventions for preterm infants are warranted. Such trials should use reliable methods of randomisation while concealing treatment allocation, blinding caregivers to treatment when possible and paying particular attention to blinding of outcome assessors.

Sensorimotor therapy and time to full oral feeding in <33weeks infants

BACKGROUND

Previous research has shown that oral stimulation improves feeding skills in preterm infants. However, it remains unclear whether other sensorimotor therapies have similar effect.

OBJECTIVE

To investigate the effect of sensorimotor therapy on the time to reach full oral feeding (FOF) in infants <33weeks.

METHODS

Retrospective review compared two time periods between 2009 and 2014, before (PRE TX) and after (POST TX) initiation of sensorimotor therapy to infants <33weeks. Type and number of sensorimotor therapy, time to FOF and length of stay (LOS) were collected. Statistical analysis used SPSS 22 for descriptive, non-parametric testing, chi-square and multivariate linear regression computation.

RESULTS

Of 245 records, 137 were excluded due to death, record unavailability/incompleteness or transfer. The remaining 55 in PRE TX and 53 in POST TX infants differed by small for gestational age (SGA) (36.4% vs. 28.3%, p=0.02); sepsis (81.8% vs. 54.7%, p=0.002); patent ductus arteriosus (PDA) (5.5% vs. 22.6%, p=0.01) and bradycardia (47.3% vs. 83%, p<0.0001). Infants in (POST TX) achieved FOF in 6.3±4.3days vs. 8.8±6.6days in (PRE TX) (p=0.02); their LOS was 56.8±26.4 vs. 52.2±25.1 (p=0.36). Predictors of days to FOF were any number of therapy sessions (β=-4.31; 95% CI: -6.47:-2.15), LOS (β=0.05; 95% CI: 0.004:0.09), PDA (β=3.23; 95% CI: 0.27:6.19) and bradycardia (β=2.94; 95% CI: 0.62:5.26).

CONCLUSION

Providing any type of sensorimotor therapy decreased time to reach FOF in infants <33weeks. Structured guidelines may help optimize this effect.