Synthetic orocutaneous stimulation entrains preterm infants with feeding difficulties to suck

Abstract

Background: Prematurity can disrupt the development of a specialized neural circuit known as suck central pattern generator (sCPG), which often leads to poor feeding skills. The extent to which suck can be entrained using a synthetically patterned orocutaneous input to promote its development in preterm infants who lack a functional suck is unknown.Objective: To evaluate the effects of a new motorized 'pulsating' pacifier capable of entraining the sCPG in tube-fed premature infants who lack a functional suck and exhibit feeding disorders.Methods: Prospective cohort study of 31 preterm infants assigned to either the oral patterned entrainment intervention (study) or non-treated (controls) group, matched by gestational age, birth weight, oxygen supplementation history and oral feed status. Study infants received a daily regimen of orocutaneous pulse trains through a pneumatically controlled silicone pacifier concurrent with gavage feeds.Results: The patterned orocutaneous stimulus was highly effective in accelerating the development of non-nutritive suck (NNS) in preterm infants. A repeated-measure multivariate analysis of covariance revealed significant increases in minute rates for total oral compressions, NNS bursts, and NNS cycles, suck cycles per burst, and the ratiometric measure of NNS cycles as a percentage of total ororhythmic output. Moreover, study infants also manifest significantly greater success at achieving oral feeds, surpassing their control counterparts by a factor of 3.1 Â (72.8% daily oral feed versus 23.3% daily oral feed, respectively).Conclusion: Functional expression of the sCPG among preterm infants who lack an organized suck can be induced through the delivery of synthetically patterned orocutaneous pulse trains. The rapid emergence of NNS in treated infants is accompanied by a significant increase in the proportion of nutrient taken orally.

Estimulação sensoriomotora intra e extra-oral em neonatos prematuros: revisão bibliográfica

“…They described that the resource reflects in the increase of cerebral skills, organization of the oral dynamic system and non-nutritive pattern (skills that is initial to the complexity that involves oral feeding and the success of other skills as chewing and speaking). The fast advent of NNS in children submitted to NTrainer®therapyaccelerated the transition to OF diet 34,35 . Similar NTrainer®technology was not reported in any national article analyzed.…”

“…Four articles 30,[33][34][35] out pf the six international studies analyzed, used the pacifier as resource for the non-nutritive sucking stimulation. Two articles 31,32 used the non-nutritive sucking in gloved finger.…”

“…Pooreet al 34 and Barlow et al 35 developed trials in order to evaluate the effectiveness of NNS with electronic pacifier (pressured) named NTrainer® in PTNB. According to authors, the NTrainer® is a biomedical device which develop the function of a NNS synthetic, in which pulsing stimulus are sent to pacifier (as a pulsing nipple) attached to an electronic device.…”

How does non-nutritive sucking support infant feeding?

“…There are many methods of administering NNS in the literature and these are often a prescribed programme of oral -motor and sensory exercises implemented by a health care professional which do not involve parents (Barlow, Finan & Lee, 2008;Boiron, Da Nobrega & Roux, 2007;Fucile, Gisel & McFarland, 2011;Hwang, Vergana & Lin, 2010;Pimenta, Moreira & Rocha, 2008;Rocha & Lopes Moreira, 2006;Gaebler & Hanzlik, 1996). The focus of this study is from a speech and language therapy and nursing perspective, and it recognises the benefits that NNS can have.…”

“…This approach fits well within the Developmental Care model of interpreting the infant's needs (Als, 1986). Some of the literature published about NNS suggests that it can hasten oral feeding skills, and also have benefits in overall oral-motor development (Barlow, Finan & Lee, 2008;Boiron, Da Nobrega & Roux, 2007;Fucile, Gisel & McFarland, 2011;Hwang, Vergana & Lin, 2010;Pimenta, Moreira & Rocha, 2008;Rocha & Lopes Moreira, 2006;Gaebler & Hanzlik, 1996). Indeed, Boiron, Da Nobrega & Roux (2007) state that "Non-nutritive sucking promotes the coordination of sucking and swallowing, accelerates the maturation of the sucking reflex….…”