Effects on Growth of Smell and Taste of Milk During Tube Feeding of Preterm Infants

Abstract

IMPORTANCE Smell and taste of food increase food anticipation, activate gut motility, and stimulate digestion and metabolism. Despite poor growth of many preterm infants in neonatal intensive care units, the smell and taste of milk with tube feeding are not generally considered a regular component of care.OBJECTIVE To determine the effect of smell and taste of milk with tube feeding on weight z scores at discharge from the hospital. DESIGN, SETTING, AND PARTICIPANTSA randomized, controlled, nonblinded, superiority trial was conducted at 2 perinatal centers between May 9, 2017, and February 1, 2020. Eligible infants (n = 659) were born at less than 29 weeks' postmenstrual age (PMA) and/or with a birth weight of less than 1250 g. INTERVENTIONSInfants were randomly assigned to receive either the smell and taste of milk with each tube feeding or routine care without the provision of smell and taste of milk. MAIN OUTCOMES AND MEASURESThe primary outcome was weight z score at discharge from any hospital. Secondary outcomes included anthropometric measures at predefined time points, time to full enteral feeds, and other health outcomes associated with prematurity. RESULTSOf the 658 infants, a total of 396 infants were randomized; some parents had not been approached for consent (n = 144) or declined participation (n = 117), and 1 infant with consent was not randomized. Of the 396 infants, 196 were assigned to the treatment group (51% male; mean [SD] PMA at birth, 27.5 [2.2] weeks) and 200 were assigned to the control group (52% male; mean [SD] PMA at birth, 27.6 (2.3) weeks). Mean weight z scores at discharge were −0.87 (95% CI, −1.02 to −0.72) for the treatment group and −0.97 (95% CI, −1.11 to −0.83) for the control group (P = .40). The mean difference in z scores between the treatment and control groups at 36 weeks' PMA was 0.21 (95% CI, 0.01 to 0.4; P = .04) for head circumference and 0.26 (95% CI, 0.05 to 0.51; P = .04) for length. There were no clinically notable differences between the study groups for any other anthropometric, feeding, or health outcomes. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, regular smell and taste of milk included with tube feeding did not improve weight at discharge in preterm infants. Secondary outcomes suggest exposure to smell and taste may improve head circumference and length at 36 weeks' PMA, but not at discharge. Regular exposure to the smell and taste of milk is a simple and inexpensive intervention with potential benefits and no apparent adverse effects.

Effect of Olfactory and Gustatory Stimulations on Preterm Neonates’ Feeding Progression and Sniffing Away Feeding Tube

“…Preterm neonates have rapid growth particularly of the brain and need high caloric. Furthermore enteral feeding is often poorly tolerated which may lead to delay the transition to full enteral feeds, growth failure and longterm neurodevelopmental impairment (Beker et al, 2021).…”

Experience-dependent plasticity of gustatory insular cortex circuits and taste preferences

“…In summary, our findings highlight the importance of early experience with food and tastants not only for the development of food preferences in adulthood, but also for the postnatal maturation of cortical circuits and sensory processing. They also provide support for the notion that absence of taste experiences early in life, as is the case for tube-fed preterm infants, may have long-term deleterious effects on brain development (Beker et al, 2021).…”

Experience-dependent plasticity of gustatory insular cortex circuits and taste preferences

“…Absence of taste experiences early in life, as is the case for tube-fed preterm infants, may have long-term deleterious effects on brain development ( 64 ). In addition, children with neurodevelopmental disorders are often picky eaters ( 65 ); show hypersensitivity to certain aspects of the taste experience, including smell, texture, and aftertaste ( 66 ); and tend to show food selectivity ( 67 ).…”