Stress Signals During Sucking Activity Are Associated With Longer Transition Time to Full Oral Feeding in Premature Infants

Abstract

Several treatments have been proposed to shorten the time to the attainment of full oral feeding (FOF) for premature infants, but there are only a few evaluation methods useful in estimating predictors of this period. We investigated whether specific items within the disorganized sucking patterns described by the Neonatal Oral-Motor Assessment Scale (NOMAS) could estimate the time to FOF in preterm infants with feeding difficulty. Preterm infants diagnosed with a disorganized sucking pattern in the NOMAS evaluation before 50 weeks of postmenstrual age were included. Video recordings of at least 2 min of oral feeding were further analyzed retrospectively by two assessors and the premature infants who exhibited disorganized sucking patterns (n = 109) were divided into three clusters (clusters 2–4). The observational items compatible with disorganization in the original NOMAS were divided into three groups: cluster 2 (disorganized: arrhythmical), cluster 3 (disorganized: arrhythmical + unable to sustain), and cluster 4 (disorganized: arrhythmical + incoordination ± unable to sustain) and further divided into incoordination-positive (cluster 4) and incoordination-negative groups (clusters 2 and 3). Premature infants in the incoordination-positive group (cluster 4, which means stress signals) showed a median transition time of 22 days (range: 4–121 days) which was longer than that in the incoordination-negative group (median 6 days; range: 1–25 days). Univariate linear regression analysis revealed that the presence of incoordination among disorganized sucking patterns (NOMAS cluster 4 vs. clusters 2 and 3), birth weight, total parenteral nutrition (TPN) duration, non-invasive positive pressure ventilation duration, the presence of moderate to severe bronchopulmonary dysplasia, pulmonary hypertension, sepsis, small for gestational age (SGA), and necrotizing enterocolitis are associated with the transition time to FOF. In a multivariate linear regression analysis, the variables revealed to be associated with the transition time were TPN duration, SGA, and the presence of stress signals (incoordination-positive group) among disorganized sucking patterns. When selecting premature infants to be treated with swallowing therapy, it is reasonable to pay more attention to the incoordination-positive group described in the NOMAS, that is, premature infants with stress signals to shorten the time to attain FOF.

Reference Values for Abdominal Circumference in Premature Infants

“…Feeding intolerance (FI) is a multifactorial phenomenon that occurs frequently during the hospital stay of a premature infant (4,5). While FI is a benign condition in most cases, it may also be an initial manifestation of necrotizing enterocolitis (NEC) (6).…”

Prevalence and associated prenatal and perinatal risk factors for oropharyngeal dysphagia in high-risk neonates in a South African hospital

“…Neurological disturbances such as neonatal encephalopathy, hypoxic-ischaemic encephalopathy, and intraventricular haemorrhage are increasingly associated with OPD in neonates (Faqeih et al, 2018; Krüger, Kritzinger, & Pottas, 2017). Associated medical conditions of OPD may include necrotising enterocolitis, respiratory distress syndrome, tachypnoea or apnoea, patent ductus arteriosus as well as bronchopulmonary dysplasia (Jadcherla et al, 2017; Yi et al, 2018). In addition, OPD may be the result of structural impairments because of an underlying genetic condition (Blake & Hudson, 2017).…”

Association of uncoordinated sucking pattern with developmental outcome in premature infants: a retrospective analysis

“…Preterm infants often have difficulty in coordinating SSR [5–8]. It is reported that incoordination of SSR is associated with a longer transition time to full oral feeding in premature infants with tube feeding [9]. Additionally, lack of muscle strength and/or endurance could precipitate the inability to sustain sucking in premature infants [10].…”