Nutritive sucking pattern—From very low birth weight preterm to term newborn

Abstract

The contribution of maturation and stimulation to the development of oral feeding was investigated, with two main objectives: (1) to analyze the nutritive sucking pattern of very-low-birth-weight newborns from their first oral feeding to the acquisition of independent oral feeding, and (2) to compare the nutritive sucking patterns of these babies, after feeding autonomy, with healthy term newborns. Methods: Two groups were considered for analysis. Group 1: N = 15 Very-Low-Birth-Weight (VLBW), gestacional age (GA) = 28.15 ± 1.5, birth weight (BW) = 1178.3 ± 174.4. The intervention program began at 30.19 ± 1.52 weeks GA. Group 2: N = 25 term newborns, healthy, GA = 39.04 ± 1.2, BW = 3370.42 ± 310.76. Repeated measures of the following variables were taken (weekly for group 1): suction efficacy (SEF), rhythm of milk transfer (RMT), suctions, bursts and pauses. Group 2 was analysed only once between the 2nd and 5th day of life. Results: Group 1 has revealed a minimal suction number at 32 GA weeks (82 ± 77.6) and maximal suction number at 36-37 GA weeks (162.7 ± 60.7). The number of sucks seemed to be dependent of weight (p = 0.005), duration of intervention (p = 0.001) and chronological age (p = 0.000). Significant statistical effects of gestational age were not observed (p = 0.904). Sucks in bursts represented 77% at the beginning of oral feeding (32 weeks GA), and 96% at 33 weeks GA, remaining constant thereafter. The number of sucks and bursts increased with GA and weeks of feeding. The mean duration of the pauses decreased from first to fourth week of feeding (week1 = 14.1 ± 9.1 and week4 = 6.4 ± 1.4 s). The sucking efficacy (SEF) was better explained by weight (p = 0.000), number of sucks in 5 min (p = 0.025) and chronological age (p = 0.044). Gestational age (p = 0.051) and nutritive intervention duration (NDI) (p = 0.110) did not contribute to explain SEF. Despite the observation of significant statistical differences between groups regarding GA (35.9/39.08; p = 0.00), chronological age (53.3/2.5; p = 0.00) and weight (1875/3360; p = 0.00), the nutritive suction pattern was not statistically different between groups after feeding autonomy. Conclusion: in VLBW oral feeding before 32 weeks GA allows the attainment of a mature nutritive suction pattern before term (37-40 weeks). Experience seems to be one of the influencing factors in the change of the nutritive suction pattern.

Evaluating sucking maturation using two pressure thresholds

“…As an infant’s sucking pattern matures, an increased number of sucks is expected [11]. For each PMA group, the number of sucks increased at each weekly feeding evaluation indicating a maturation of sucking that is consistent with previous research [2,20,21]. This finding persisted when 7 mm Hg, rather than the previously used pressure threshold of 20 mm Hg, was used as the minimum pressure threshold to detect a suck.…”

Effect of the Premature Infant Oral Motor Intervention on Feeding Progression and Length of Stay in Preterm Infants

“…Initiation of the first feeding is typically based on feeding readiness cues exhibited by the infant. 23 In this pilot study, the physicians ordered the first attempt for an oral feeding at the same PMA in both groups (M ϭ 31.5 weeks). It would not be expected that infants in either the control or the intervention group would be eliciting clear and measurable feeding readiness cues at this early PMA, as preterm infants between 30 and 31 weeks do not alert readily and may never exhibit vigorous crying.…”

Multisensory Intervention for Preterm Infants Improves Sucking Organization

“…10 Length-of-feeding assessments varied, with a 5-minute assessment being the most frequently used. 11,12 Most investigators have used number of sucks (NOS) and number of sucks per burst (SPB) as a baseline estimate of feeding skills. Additional parameters may include quantity of milk ingested, average milk ingested per suction, proportion of time pausing and/or sucking pressures.…”

“…Additional parameters may include quantity of milk ingested, average milk ingested per suction, proportion of time pausing and/or sucking pressures. 9,12-14,15 …”