How does non-nutritive sucking support infant feeding?

Fifty nine premature infants participated in a randomized controlled study to determine the effectiveness of non-nutritive sucking (NNS). It was predicted that NNS would not accelerate the development of full oral feeding or early language skills as sometimes perceived in practice. However, it was predicted that using NNS as a strategy to support parents to identify and respond to early communication and oral readiness signs would increase confidence in infant management and enable quicker discharge home. Infants were aged 26-35 weeks gestation. Infants with no significant difficulties were randomly assigned to one of three groups; Group 1, NNS pre-tube feeding (n=19); Group 2, NNS on onset of tube feeding (n=20) and Group 3, Control (n=20). Follow-up occurred at 6 months. There were no significant differences with number of days to full oral feeding between the groups receiving NNS and the Control group, χ(2)(2, n=59)=4.33, p=.115. A significant difference in number of days in hospital between the Control group and the other two groups was found χ(2) (2, n=59)=7.678, p=.022. Significant changes were noted with the development of more normal sucking patterns in Groups 1-3. At 6 months there were no significant differences in receptive or expressive language skills between all groups. NNS had no significant impact on the transition to full oral feeding or later language development. There was a significant difference in the number of days in hospital between the Control group and the other two groups which involved parents in identification of early communication signs. Possible reasons for this change and future directions are discussed

Neuropeptide Y2 Receptor (NPY2R) Expression in Saliva Predicts Feeding Immaturity in the Premature Neonate

Background: The current practice in newborn medicine is to subjectively assess when a premature infant is ready to feed by mouth. When the assessment is inaccurate, the resulting feeding morbidities may be significant, resulting in long-term health consequences and millions of health care dollars annually. We hypothesized that the developmental maturation of hypothalamic regulation of feeding behavior is a predictor of successful oral feeding in the premature infant. To test this hypothesis, we analyzed the gene expression of neuropeptide Y2 receptor (NPY2R), a known hypothalamic regulator of feeding behavior, in neonatal saliva to determine its role as a biomarker in predicting oral feeding success in the neonate. Methodology/Principal Findings: Salivary samples (n = 116), were prospectively collected from 63 preterm and 13 term neonates (post-conceptual age (PCA) 26 4/7 to 41 4/7 weeks) from five predefined feeding stages. Expression of NPY2R in neonatal saliva was determined by multiplex RT-qPCR amplification. Expression results were retrospectively correlated with feeding status at time of sample collection. Statistical analysis revealed that expression of NPY2R had a 95 % positive predictive value for feeding immaturity. NPY2R expression statistically significantly decreased with advancing PCA (Wilcoxon test p value,0.01), and was associated with feeding status (chi square p value = 0.013). Conclusions/Significance: Developmental maturation of hypothalamic regulation of feeding behavior is an essential component of oral feeding success in the newborn. NPY2R expression in neonatal saliva is predictive of an immatur

Avaliação da estimulação sensório-motora-oral na transição da alimentação enteral para a via oral plena em recém-nascidos pré-termo Evaluation of sensory-motor-oral stimulation in the transition from gastric tube to full oral feeding in preterm newborns

OBJETIVOS: avaliar a influência da estimulação sensório-motora-oral (SMO) sobre o ganho de peso, tempo para realizar a transição da sonda para a via oral e, indiretamente, sobre a alta hospitalar de pré-termos. MÉTODOS: estudo de intervenção, do tipo ensaio clínico controlado, que incluiu 24 pré-termos, internados na UTI Neonatal do Hospital Universitário de Santa Maria, Rio Grande do Sul, Brasil, entre maio de 2007 e março de 2008, alocados, por sorteio, em grupo estimulado (GE) e controle (GC). A análise das diferenças entre os grupos foi testada utilizando o teste t-Student independente e exato de Fisher (valor de p<0,05). RESULTADOS: não houve diferença estatística para as medidas antropométricas, embora o incremento diário de peso tenha sido maior no GE (p=0,16). O GE realizou a transição completa da sonda para a via oral em média 1,6 dias antes que o GC, sendo que 83,3% das crianças do GE fizeram essa transição em até sete dias, enquanto apenas 38,9% do GC alcançaram esse prazo. Não houve diferença no tempo de permanência hospitalar entre os grupos (p=0,48). CONCLUSÕES: a estimulação SMO favoreceu uma transição mais rápida da sonda para a via oral, não comprometendo o ganho de peso de recém-nascidos pré-termo. Não foi possível observar sua influência sobre o tempo de permanência hospitalar.<br>OBJECTIVES: to evaluate the influence of sensory-motor-oral (SMO) stimulation on weight gain, the time taken to make the transition from tube-to oral feeding and, indirectly, on the duration of hospitalization of preterm infants. METHODS: a controlled clinical intervention study was carried out with 24 preterm infants hospitalized in the Neonatal ICU of the Santa Maria University Hospital in the State of Rio Grande do Sul, Brazil, between May 2007 and March 2008, divided randomly into a treatment (TG) and control group (CG). The analysis of the differences between the groups was tested using Student&#39;s independent t-test and Fisher&#39;s exact test (with a p value <0.05). RESULTS: there was no statistical difference in terms of anthropometrical measurements, although the daily weight gain was higher in the TG (p=0.16). The TG group made a full transition from tube-to oral feeding on average 1.6 days earlier than the CG, 83.3% of the children in the TG making the transition within seven days, compared to only 38.9% of the control group. There was no difference in terms of the length of stay in hospital between the two groups (p=0.48). CONCLUSIONS: SMO stimulation was likely to lead to a swifter transition from tube-to oral feeding, without any adverse effect on weight gain in preterm newborns. No influence on the length of stay in hospital was observed