Effect of the Premature Infant Oral Motor Intervention on Sucking Capacity in Preterm Infants in Turkey: A Randomized Controlled Trial

Background: Preterm infants have oral feeding difficulty that often delays discharge, indicating a need for evidence-based interventions for oral-motor development. Purpose: To test the Premature Infant Oral Motor Intervention (PIOMI) on the development of oral-motor function, feeding, and anthropometric outcomes using sucking manometry. Methods: A single-blind randomized experimental design was conducted with a sample of 60 preterm infants from 2 neonatal intensive care units between May 2019 and March 2020. The experimental group received PIOMI for 5 min/d for 14 consecutive days. Sucking capacity, anthropometrics (weight and head circumference), bottle feeding, breast/chest feeding initiation, and length of hospital stay were measured. The Yakut Sucking Manometer (PCT/TR2019/050678) was developed specifically for this study and tested for the first time. Results: The experimental group had a statistically significant percent increase over controls in sucking power (69%), continuous sucking before releasing the bottle (16%), sucking time (13%), and sucking amount (12%) with partial η2values of interaction between the groups of 0.692, 0.164, 0.136, and 0.121, respectively. The experimental group had a higher increase in weight (89%) and head circumference (81%) over controls (F = 485.130, P <.001; F = 254.754, P <.001, respectively). The experimental group transitioned to oral feeding 9.9 days earlier than controls (t = -2.822; P =.007), started breast/chest feeding 10.8 days earlier (t = 3.016; P =.004), and were discharged 3.0 days earlier. Implications for Research/Practice: The PIOMI had a significant positive effect on anthropometrics, sucking capacity, readiness to initiate bottle and breast/chest feeding, and a 3-day reduction in length of hospital stay. © 2022 Lippincott Williams and Wilkins. All rights reserved

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

Purpose: Preterm infants frequently experience oral feeding difficulties due to underdeveloped oral motor skills and the lack of coordination of sucking, swallowing, and respiration. The infants’ ability to consume all feedings orally while maintaining physiologic stability and weight gain is necessary for their discharge. Therefore, difficulty with oral feeding leads to longer hospital stays and higher costs. For example, with more than half a million of premature infants born each year, a 3-day decrease in hospital stay would save more than 2 billion dollars annually. There is a need for evidenced-based interventions that facilitate development of oral-motor skills, leading to improved oral feeding, thus shortening hospital stays and lowering costs. The purpose of this research was to test the newly developed Premature Infant Oral Motor Intervention (PIOMI) beginning at 29 weeks postmenstrual age (PMA), before oral feedings were introduced, to determine whether the prefeeding intervention would result in a shorter transition from gavage to total oral feedings and a shorter length of hospital stay (LOS). The PIOMI is a 5-minute oral motor intervention that provides assisted movement to activate muscle contraction and provides movement against resistance to build strength. The focus of the intervention is to increase functional response to pressure and movement and control of movements for the lips, cheeks, jaw, and tongue. The cheeks (internal and external), lips, gums, tongue, and palate were stimulated per specific protocol with finger stroking. Subjects: A total of 19 infants from 1 level III NICU born between 26 and 29 weeks PMA: 10 in the experimental group and 9 in the control group. Design: A randomized, blinded, clinical trial was conducted to examine outcomes related to the newly developed PIOMI. Methods: Beginning at 29 weeks PMA (and before the introduction of oral feeding), the experimental group received the PIOMI for 5 minutes per day for 7 consecutive days. The control group received a sham intervention to keep staff and parents blinded to the infants’ group assignment. Physiological and behavioral stabilities were continually assessed throughout the intervention. A chart review was then conducted to compare the transition from gavage feeding to total oral feedings between the experimental and control group, as well as LOS. Results: The PIOMI was well tolerated by 29-week PMA infants, as evidenced by physiological and behavioral cues. Infants who received the once-daily PIOMI transitioned from their first oral feeding to total oral feedings 5 days sooner than controls (P = .043) and were discharged 2.6 days sooner than controls. Conclusion: This pilot work supports further study on the use of the PIOMI with preterm infants to enhance oral-feeding skills and decrease LOS

Premature Infant Oral Motor Intervention (PIOMI): Translating Interventional Research into Interdisciplinary Practice

Translating interventional research into practice requires a multifaceted approach. Rogers’ (2003) diffusion of innovations (DOL) model provides a framework within which to implement a new intervention into practice. The model asserts that the adoption of an innovation is influenced by the nature of the innovation and the manner in which it is communicated to users in a social system. The Premature Infant Oral Motor Intervention (PIOMI) was developed by a nurse researcher with expertise in neonatal science, in collaboration with an expert in oral motor therapy. The safety and efficacy of the new intervention was tested (Lessen, 2011), followed by a formal study on its reliability. Adoption of this innovative intervention must target several disciplines including medicine, nursing, occupational therapy, and speech-language therapy. The process of a neonatal intensive care unit adopting the PIOMI as the standard of oral motor therapy practice among disciplines is described using the DOL model, and the specific training program is presented, including its modifications after formal reliability testing. With the reliability of the PIOMI documented and accurate training issues identified and corrected, further studies on its efficacy should be pursued. Presented at the at the 12th National Neonatal Nurses Conference and 15th National Mother Baby Nurses Conference, Chicago, IL, September 6-8, 2012. Abstracts published by Neonatal Network: The Journal of Neonatal Nursing

Effect of Oral Stimulation on Feeding Progression in Preterm Infants

This is a poster presentation of original research conducted to assess the safety and efficacy of a newly developed prefeeding oral stimulation intervention (Beckman Oral Motor Intervention-Premature Infant) on feeding progression and length of stay on preterm infants younger than 30 weeks PMA

Reliability of the Premature Infant Oral Motor Intervention (PIOMI)

Problem/Literature Review: Recent multidisciplinary research continues to examine various types of oral motor therapy in preterm infants but none have formally tested the reliability of specific oral motor interventions. The premature infant oral motor intervention (PIOMI) is a five minute, pre-feeding intervention developed to improve feeding skills. As further research is planned, the reliability of the intervention needed to be tested. The purpose of this study was to determine the interobserver, interuser, and test-retest reliability of the PIOMI, as well as determining if the specific training program developed was sufficient enough to reach high reliabilities. Methodology: The study was conducted at a Level III NICU using a purposeful convenience sample. A specific training plan was established, and a reliability rating tool was developed. Two observers rated three RNs performing the PIOMI twice each on premature infants. Data Analysis: The PIOMI demonstrated overall high percent agreement for interobserver (97.57 percent), interuser (97.59 percent), and test-retest (97.58 percent) reliabilities. However, three specific steps of the 8-step intervention yielded weaker reliabilities, directing modifications of the training program. Interpretation: Strong reliability is essential to assure that an intervention can be fully and properly implemented before translating evidence-based interventions into practice, and the importance of effective training to achieve high levels of reliability is discussed. This study suggests that with a specific training program the PIOMI can be reliably performed among different RNs (interuser) and by the same RN more than once (test-retest). Using the reliability rating tool the PIOMI can also be reliably rated by different observers (interobserver). With the reliability of the PIOMI documented and accurate training issues identified and corrected, further studies on its efficacy should be pursued. Presented at the 12th National Neonatal Nurses Conference and 15th National Mother Baby Nurses Conference, Chicago, IL, September 6-8, 2012. Abstracts published in Neonatal Network: The Journal of Neonatal Nursing

Establishing Intervention Fidelity of an Oral Motor Intervention for Preterm Infants

Purpose: To establish intervention fidelity of the premature infant oral motor intervention (PIOMI) Design and sample: A rating tool was developed and tested for interrater reliability before being used to test the fidelity of intervention behaviors. A purposeful convenience sample of three users was recruited to perform the intervention under direct observation. Main outcome variables: Three types of reliabilities were calculated: (1) interrater reliability to test the rating tool, followed by (2) interuser reliability, and (3) test–retest reliabilities to test the intervention behaviors of several registered nurses (RNs) over repeated performances of the intervention. Results: The rating tool demonstrated a high interrater reliability (97.57 percent), indicating its accuracy for systematically rating the specific intervention behaviors. Subsequently, the rating tool was used to determine interuser and test–retest performances of the PIOMI and resulted in high reliabilities (97.59 percent and 97.58 percent, respectively). This demonstrates that the intervention can be reliably delivered as prescribed, supporting intervention fidelity

The Effect of Oral Motor Intervention on Oral Feeding Readiness and Feeding Progression in Preterm Infants

Background: Advances in neonatal intensive care have markedly improved survival in preterm infants. These babies need hospitalization due to the immaturity of the respiratory and digestive systems. The timing for the initiation of proper feeding in premature infants admitted to neonatal intensive care units (NICUs) is an important challenge for physicians, parents, and nurses. Therefore, this study aimed to investigate the effect of oral motor intervention (OMI) on the early onset of oral feeding in preterm infants. Methods: This clinical trial was carried out on 40 premature infants who were admitted to the NICU of Ali-ibn Abi Talib Hospital, Zahedan, Iran, in 2012 with the gestational age of 28-32 weeks. The subjects were randomly allocated to two equal groups of intervention and control. In the intervention group, 5-minute oral stimulations were performed based on premature infant OMI (PIOMI) by the researcher on a daily basis 15 minutes before gavage for seven days. On the other hand, the control group received routine care. Then, the groups were compared using the premature oral feeding readiness assessment scale in terms of timing, initiation of oral feeding, and hospitalization duration. Results: The intervention group achieved independent feeding significantly earlier than the control group (P=0.034). In addition, the duration of hospitalization was shorter in the intervention group, compared to that of the control group (P=0.027). Conclusion: The utilization of PIOMI method to stimulate oral movements is beneficial in the early onset of oral feeding and reduces the duration of hospitalization. Therefore, this method can be effective in treating premature infants and reducing treatment costs

Feeding readiness in preterm infants: the relationship between preterm behavioral state and feeding readiness behaviors and efficiency during transition from gavage to oral feeding

The purpose of this secondary analysis was to assess whether alert behavioral states were associated with an increased number of feeding readiness behaviors (FRBs) and whether the number of FRBs were associated with subsequent feeding efficiency in healthy premature infants born between 29 to 35 weeks gestation. (post-print forthcoming

Prolonged Oral Motor Stimulation Treatment was Effective for Breastfeeding Achievement in Full Term Infants With Feeding Problems

Objectives: Feeding problems can occur in early-term infants born at 37 weeks. Early-term and full-term infants may benefit from oral motor therapy to attain successful breastfeeding. The present study aims to determine the impact of the 5-minute premature infant oral motor intervention (PIOMI) and the 15-minute oral stimulation program (15-minute oral stimulation program) on 37 to 41 weeks infants in attaining successful breastfeeding. Methods: This clinical trial was conducted on early-term and full-term infants in the neonatal intensive care units (NICUs) of two hospitals in Mashhad City, Iran. They were randomly divided into two intervention groups (5-minute PIOMI or 15-minute oral stimulation program) and one control group (17 infants in each group). These three groups were then compared to each other after the intervention by pediatricians and speech and language specialists regarding their breastfeeding. All statistical analysis was performed using R software, version 4.0.2, and the significance level was set at 0.05. Results: Infants in both intervention groups attained different levels of breastfeeding compared to pre-intervention. This outcome could be due to our interventions or natural growth and development (P<0.05). However, the longer the infants’ oral motor therapy time was, the more likely they were to breastfeed successfully. The 15-minute oral stimulation program group had a significantly higher number of male infants attaining breastfeeding after treatment than the control and PIOMI groups (P=0.03).  Discussion: The PIOMI has been confirmed as an effective early intervention for small preterm infants as young as 29 weeks, and the short 5-minute therapy time is accepted in the preterm infant population. The program affects the brain’s plasticity and improves neurosensory and motor skill development for feeding. The current study indicates that PIOMI remains effective versus the control group in the full-term babies. However, the longer 15-minute oral stimulation program, is more effective in full-term infants. This finding shows that full-term infants can endure and benefit from longer than 5 minutes per day of oral motor therapy