Oral Support Measures Used in Feeding the Preterm Infant

Hill, Alice S.; Kurkowski, Traci B.; Garcia, Jose

doi:10.1097/00006199-200001000-00002

Cited by 37 publications

(31 citation statements)

References 18 publications

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“…Our oral support protocol can be considered as training for endurance and coordination because the therapist organizes the sucking-swallowing-breathing sequences during feeding, imposing pauses after six to eight consecutive swallows to facilitate breathing. Hill et al 14 O 2 saturation levels were lower than prefeeding levels in preterm infants. During bottle feeds, when the preterm infant sucks with great force, it is sometimes difficult to impose a rhythm, and the therapist appears as a coregulator as described previously.…”

Section: Discussionmentioning

confidence: 91%

“…During bottle feeds, when the preterm infant sucks with great force, it is sometimes difficult to impose a rhythm, and the therapist appears as a coregulator as described previously. 19,20 Our oral support protocol was similar to that described previously 13,14 but there were three differences: first, both hands were involved for the cheeks and around the mouth; second, the little finger compresses the floor of the oral cavity under the chin to stabilize the jaw and reinforce deglutition; and third, the imposed rhythm organizes ingestion. The efficacy of oral support can be assessed on the basis of acoustic study of swallowing behaviour because acoustic recordings provide information about the nutritive period (swallows and bursts).…”

Section: Discussionmentioning

confidence: 99%

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Effects of oral stimulation and oral support on non‐nutritive sucking and feeding performance in preterm infants

Boiron

Nobrega

Roux

et al. 2007

Develop Med Child Neuro

112

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This study compared the effects of oral stimulation with those of oral support on non-nutritive sucking and feeding parameters in preterm infants. Preterm infants (23 males, 20 females) born between 29 and less than 34 weeks' gestational age (GA; mean GA 31.2wks [standard error of mean{SEM} 0.39]; mean birthweight 1580g [SEM 120]) were allocated to one of three experimental groups: (Stimulation+support [five males, four females]; Stimulation [four males, seven females]; and Support [seven males, five females]) or a control group. Non-nutritive sucking pressure and sucking activity were quantified in the gavage and transition periods. Oral support minimizes fluid loss, stabilizes the jaw, and organizes deglutition. The time of transition, the quantity of milk ingested per day, and the number of bottle feeds per day were recorded. Variables were analyzed by repeated-measures analysis of variance, with birthweight as covariate (ANCOVA). Transition time was reduced (p<0.0001) for the Stimulation+support and Support groups. ANCOVA computed during gavage showed increased nonnutritive sucking pressure and sucking activity (p<0.001) for the Stimulation and Stimulation+support groups. ANCOVA computed during transition revealed increases in non-nutritive sucking pressure and daily bottle feeds (p<0.001) for the three experimental groups and in daily milk ingested (p=0.002) for the Stimulation+support and Support groups. We demonstrated that oral support is the result of both the action of chin and cheek support, and the aid to deglutition. An analysis of the organization of sucking patterns should be undertaken to provide better understanding of the mechanisms involved in oral support.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Effects of oral stimulation and oral support on non‐nutritive sucking and feeding performance in preterm infants

Boiron

Nobrega

Roux

et al. 2007

Develop Med Child Neuro

112

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“…Both full-term and preterm infants typically engage in the longest sucking bursts at the onset of feeding. 24 During this "continuous" sucking period, more milk is consumed. 34 Minute ventilation is also lower (i.e., less air is moved per minute) due to lower respiratory frequency.…”

Section: Ability To Maintain Physiologic Stabilitymentioning

confidence: 99%

“…These include the size and speed of flow of the fluid bolus, 18-20 the impact of nasogastric tubes in place during feeding, 21 and the type of feeding support provided by the caregiver. [22][23][24][25][26] During its emergent phase, motor skill expression varies considerably. 27 Early feeding skills can vary from feeding to feeding and even across a given feeding.…”

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confidence: 99%

The Early Feeding Skills Assessment for Preterm Infants

Thoyre

Shaker²,

Pridham³

2005

Neonatal Network

213

143

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Preterm infants develop the skills necessary to begin oral feeding as their health stabilizes and as they reach a postconceptional age that supports coordination of breathing and swallowing with oralmotor functioning. The time from initiation of oral feeding to full oral feedings (with adequate intake for growth and maintenance of physiologic stability) can vary from days to months for the preterm infant. The approach to feeding the infant during this transition period must be developmentally supportive and tailored to meet the needs of the individual. To accomplish this, caregivers-notably nurses and parents-need to communicate about the specific skills that the infant has gained, about skills that are emerging, and about skills that the infant has not yet developed. The Early Feeding Skills (EFS) Assessment is a checklist for assessing infant readiness for and tolerance of feeding and for profiling the infant's developmental stage regarding specific feeding skills: the abilities to remain engaged in feeding, organize oral-motor functioning, coordinate swallowing with breathing, and maintain physiologic stability. This article introduces the EFS.Neonatal clinicians, clinicians who work with families during the early postdischarge period, and parents of preterm infants are in an important position to observe and support the development of an emergent motor skill: oral feeding. Oral feeding skills have commonly been conceptualized by health care providers as an infant's ability to organize and coordinate oralmotor functions to efficiently consume enough calories for growth. Early feeding skills are much more complex than this, however. They also involve the infant's ability to (1) engage and remain engaged in a physiologically and behaviorally challenging task, (2) organize oralmotor movements so as to have long-term functional benefits, (3) coordinate breathing with swallowing to avoid prolonged apnea or aspiration of fluids, and (4) regulate the depth and frequency of breathing to maintain physiologic stability.Motor skill development corresponds to changes in an infant's brain, body, and experience. 1 According to research, two factors affect progression in ability to feed orally: the infant's state of health 2-6 and oral feeding experience. [7][8][9][10][11] According to other research, neuromaturation of the following contributes to an individual infant's skill in feeding: the ability to regulate oxygen, 11,12 development of alertness, 13-15 and development of sucking strength and organization of the sucking pattern. 16,17 External influences can also change the nature of the task. These include the size and speed of flow of the fluid bolus, 18-20 the impact of nasogastric tubes in place during feeding, 21 and the type of feeding support provided by the caregiver. [22][23][24][25][26] During its emergent phase, motor skill expression varies considerably. 27 Early feeding skills can vary from feeding to feeding and even across a given feeding. Some infants adapt and improve in skill as the feeding pro...

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“…However, the ability to suck nutritively requires time to develop; this development occurs in patterns that have been previously described. 6,17,18 In infants born preterm, the synchrony of sucking with swallowing and breathing is irregular. 19 This results in infant fatigue, probably as the result of interrupted breathing related to swallowing, when a suck results in a large amount of fluid being taken in.…”

Section: Discussionmentioning

confidence: 99%

Relationship of the First Suck Burst to Feeding Outcomes in Preterm Infants

Pickler

Chiaranai

Reyna

2006

The Journal of Perinatal & Neonatal Nursing

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Objective-This study examined the relationship between the number of sucks in the first nutritive suck burst and feeding outcomes in preterm infants. The relationships of morbidity, maturity, and feeding experience to the number of sucks in the first suck burst were also examined.Methods-A nonexperimental study of 95 preterm infants was used. Feeding outcomes included proficiency (percent consumed in first 5 min of feeding), efficiency (volume consumed over total feeding time), consumed (percent consumed over total feeding), and feeding success (proficiency ≥ 0.3, efficiency ≥ 1.5 mL/min, and consumed ≥ 0.8). Data were analyzed using correlation and regression analysis.Results and Conclusions-There were statistically significant positive relationships between number of sucks in the first burst and all feeding outcomes-proficiency, efficiency, consumed, and success (r = 0.303, 0.365, 0.259, and τ = 0.229, P < .01, respectively). The number of sucks in the first burst was also positively correlated to behavior state and feeding experience (τ = 0.104 and r = 0.220, P < .01, respectively). Feeding experience was the best predictor of feeding outcomes; the number of sucks in the first suck burst also contributed significantly to all feeding outcomes. The findings suggest that as infants gain experience at feeding, the first suck burst could be a useful indicator for how successful a particular feeding might be. Keywords feeding behavior; feeding efficiency; feeding outcomes; infant feeding A numbers of factors have been associated with preterm infants' ability to nipple-feed successfully. Among these factors are gestational age, muscle tone, heart rate, respiratory status, behavioral state, energy level, and sucking behaviors. 1-3 Nonnutritive sucking (NNS) has been associated with improved behavior state for feeding. 4,5 Although NNS is often used as an indicator that the preterm infant is ready to initiate oral feedings, there is little evidence that this activity is related to feeding outcomes. 6 Less attention has been paid to the relationships between the characteristics of nutritive sucking and feeding outcomes. In particular, because there continues to be no standardized criteria for initiating oral feedings or empirically tested feeding patterns most useful for progressing oral feedings, efforts to determine clinically valuable indicators that an infant will be successful at any given oral feeding are needed.

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Oral Support Measures Used in Feeding the Preterm Infant

Cited by 37 publications

References 18 publications

Effects of oral stimulation and oral support on non‐nutritive sucking and feeding performance in preterm infants

Effects of oral stimulation and oral support on non‐nutritive sucking and feeding performance in preterm infants

The Early Feeding Skills Assessment for Preterm Infants

Relationship of the First Suck Burst to Feeding Outcomes in Preterm Infants

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