<p>Individualizing Oral Feeding Assessment and Therapies in the Newborn</p>

Abstract

Oral feeding competency is a milestone most infants must achieve prior to discharge. It is a developmentally complex task that requires integration of multiple sensory inputs, central nervous system maturation, motor coordination, and respiratory stability. While ensuring safety during oral feeding is important to reduce morbidities, we must optimize developmental windows to expedite feeding maturation. Currently, many of the assessments and therapies related to oral feeding skills focus solely on nutritive and nonnutritive sucking. Yet, this essential reflex is only one component of oral feeding. Specific challenges faced by individual newborns are often unique, and delays in development in any one of the many systems involved in oral feeding can lead to prolonged oral feeding maturation. Expanding the field to go beyond targeting oral motor skills to consider all aspects of feeding maturity, inclusive of sensory integration and hunger signaling, is needed to advance care. As technology continues to develop at a rapid pace, the field must compare the efficacy of these clinical and technologic assessments and therapies. In this review, we will address the complexity of neonatal feeding, review assessment tools and interventions for feeding safety and developmental readiness, and propose an individualized, multi-faceted approach to oral feeding evaluation and intervention.

Investigation into the flow rate of bottle teats typically used on an Australian neonatal unit

“…Results identified a wide range of flow rates (7.33mL/min-25.33mL/min) and variability of flow within each teat tested, confirming the study hypotheses that suggested this would be the case. Preterm and medically fragile infants present with immature oral feeding skills and often receive their first oral suck feed on the unit, developing and refining oral feeding competence alongside other skills in readiness for discharge home (Azuma and Maron 2020). Learning to bottle feed can be interrupted by variable flow rate of milk from a teat which subsequently influences timing and trigger of the swallow, thereby increasing risk of apnoeic episodes and aspiration (Chen, Wang, Chang & Chi, 2000).…”

Feeding Problems and Long-Term Outcomes in Preterm Infants—A Systematic Approach to Evaluation and Management

“…In the neonatal period, this is thought to be regulated by bilateral brainstem neural networks in the pontine and medullary reticular formation, called the suck central pattern generator (CPG). The CPG is responsive to stimulation and can be trained using oral stimulation with pacifiers, nipples, breastfeeding, and olfactory, tactile, or thermal stimulation [ 13 , 17 , 18 , 19 ]. Sucking is reflexive in neonates and becomes more voluntary as the infant grows and learns to masticate [ 15 ].…”

“…Feeding problems are dynamic and continue to evolve as the infant grows, requiring an ongoing assessment, intervention, and re-evaluation to optimize management. Early diagnosis and treatment of feeding problems involve a holistic approach to the individual’s specific feeding difficulties in order to decrease potential long-term challenges [ 16 , 19 ]. Figure 3 suggests an algorithmic approach for managing feeding problems in the neonatal period continuing into childhood.…”

“…A multidisciplinary team approach to feeding in the NICU with established algorithms for early oral motor stimulation, initiation, and advancement of oral feeds using quality improvement methodologies is vital for the mitigation of future feeding problems [ 92 ]. Furthermore, predicting feeding problems in infants based on risk factors, instrumental assessments, and novel technologies such as salivary transcriptomics [ 19 ] can potentially target interventions before feeding problems become overtly apparent. Research in this area with large-scale, randomized control trials is highly warranted.…”

Abnormal Nutritive Sucking as an Indicator of Neonatal Brain Injury

“…The nfant SSB Sensor connects to the coupling and wirelessly transmits real-time data on nipple movement to a tablet via the nfant Mobile App. nFS addresses a significant limitation of other devices as the real-time feedback of sucking performance allows the healthcare team to see the immediate impact of an intervention to improve feeding ( 98 ). Following a feeding, waveforms of NNS and NS nipple movement are transmitted to the HIPAA protected nfant Cloud Database and the signals converted via custom algorithms, to identify key features and measures that describe sucking performance.…”