Transcutaneous Auricular Vagus Nerve Stimulation-Paired Rehabilitation for Oromotor Feeding Problems in Newborns: An Open-Label Pilot Study

Abstract

Neonates born premature or who suffer brain injury at birth often have oral feeding dysfunction and do not meet oral intake requirements needed for discharge. Low oral intake volumes result in extended stays in the hospital (>2 months) and can lead to surgical implant and explant of a gastrostomy tube (G-tube). Prior work suggests pairing vagus nerve stimulation (VNS) with motor activity accelerates functional improvements after stroke, and transcutaneous auricular VNS (taVNS) has emerged as promising noninvasive form of VNS. Pairing taVNS with bottle-feeding rehabilitation may improve oromotor coordination and lead to improved oral intake volumes, ultimately avoiding the need for G-tube placement. We investigated whether taVNS paired with oromotor rehabilitation is tolerable and safe and facilitates motor learning in infants who have failed oral feeding. We enrolled 14 infants [11 premature and 3 hypoxic-ischemic encephalopathy (HIE)] who were slated for G-tube placement in a prospective, open-label study of taVNS-paired rehabilitation to increase feeding volumes. Once-daily taVNS was delivered to the left tragus during bottle feeding for 2 weeks, with optional extension. The primary outcome was attainment of oral feeding volumes and weight gain adequate for discharge without G-tube while also monitoring discomfort and heart rate (HR) as safety outcomes. We observed no adverse events related to stimulation, and stimulation-induced HR reductions were transient and safe and likely confirmed vagal engagement. Eight of 14 participants (57%) achieved adequate feeding volumes for discharge without G-tube (mean treatment length: 16 ± 6 days). We observed significant increases in feeding volume trajectories in responders compared with pre-stimulation (p < 0.05). taVNS-paired feeding rehabilitation appears safe and may improve oral feeding in infants with oromotor dyscoordination, increasing the rate of discharge without G-tube, warranting larger controlled trials.

tVNS Increases Liking of Orally Sampled Low-Fat Foods: A Pilot Study

“…However, in an effort allocation task, concurrent tVNS increased participants' drive to obtain lesswanted prospective food rewards (Neuser et al, 2020). Two weeks of tVNS concurrent with bottle-feeding improved oral intake in about half of premature or brain injured infants who had failed oral feeding until that time (Badran et al, 2020). These results suggest that concurrent tVNS may affect hedonic responses to orally sampled foods and food intake, which has not been examined to our awareness.…”

International Consensus Based Review and Recommendations for Minimum Reporting Standards in Research on Transcutaneous Vagus Nerve Stimulation (Version 2020)

“…A pilot study of tVNS in schizophrenia found no effect on symptom severity (Hasan et al, 2015 ). Moreover, many potential targets for treatment via tVNS have been suggested, including attention deficit hyperactivity disorder (ADHD) (Beste et al, 2016 ), autism spectrum disorders (Jin and Kong, 2016 ), Alzheimer's dementia (Jacobs et al, 2015 ), post-operative cognitive dysfunction (Xiong et al, 2009 ), increased risk of type II diabetes (Huang et al, 2014 ), preterm infants with oromotor dysfunction (Badran et al, 2020 ), chronic stroke patients (Capone et al, 2017 ), coronary insufficiency (Afanasiev et al, 2016 ) and chronic migraine (Straube et al, 2015 ). The idea that tVNS might be a promising treatment in Alzheimer's dementia has received support through recent evidence that tVNS can recover impaired microglia function in a mouse model of Alzheimer's dementia (Kaczmarczyk et al, 2017 ; Huffman et al, 2019 ), and there is an ongoing clinical trial of tVNS as a treatment for mild cognitive impairment (NCT03359902).…”

A Review of Parameter Settings for Invasive and Non-invasive Vagus Nerve Stimulation (VNS) Applied in Neurological and Psychiatric Disorders

“…MAAVNS, however, pairs taVNS with motor activity, using 500 µs pulses at 25 Hz that are turned on during the duration of a targeted motor activity (Cook et al, 2020b). MAAVNS has been demonstrated to be a promising neurorehabiltiation tool (Badran et al, 2018c(Badran et al, , 2020 and in early studies has demonstrated promise in facilitating motor learning in neonates MAAVNS is further continued to be explored in adult post-stroke rehabilitation trials.…”