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      Non-nutritive sucking evaluation in preterm newborns and the start of oral feeding: a multicenter study

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          Abstract

          OBJECTIVES:

          The assessment of early sucking by preterm infants provides information on the ability of these infants to efficiently and safely receive nutrients via an oral route (oral feeding). To analyze the application and reliability of an instrument in assessing non-nutritive sucking that indicates a capacity for oral feeding in the routine care of different neonatal units.

          METHODS:

          A multicenter, prospective cohort study was conducted in seven neonatal units. A non-nutritive sucking assessment with a formulary validated by Neiva et al (2008) (variables evaluated: rooting reaction; easy initiation of sucking; labial sealing; tongue central groove; peristaltic tongue movements; jaw raising and lowering movements; labial, tongue and jaw coordination; sucking strength; sucking rhythm; bites; excessive jaw excursion; stress signals) was applied to 199 pre-term newborns, who had a chronological age ≥ 2 days and were clinically stable. These infants were divided into two groups based on their corrected gestational age at the first assessment, as follows: Group I-infants with a gestational age ≤ 33 weeks and Group II-infants with a gestational age between 34 and 36 6/7 weeks.

          RESULTS:

          The mean gestational age was 31.66±2 weeks, and the mean birth weight was 1494 ± 373 g. The mean scores on the non-nutritive sucking assessment were 46 ± 25 in Group I and 49 ± 24 in Group II. The beginning of oral feeding was successful in 43 (67.2%) infants in Group I and 64 (81%) infants in Group II ( p = 0.089).

          CONCLUSION:

          The method identified preterm infants who were able to feed orally based on 33 points in the non-nutritive sucking assessment and a corrected gestational age of 32 weeks or more. The corrected gestational age was the most important factor in predicting the success of oral feeding.

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          Most cited references18

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          Characterization of the developmental stages of sucking in preterm infants during bottle feeding.

          It is acknowledged that the difficulty many preterm infants have in feeding orally results from their immature sucking skills. However, little is known regarding the development of sucking in these infants. The aim of this study was to demonstrate that the bottle-feeding performance of preterm infants is positively correlated with the developmental stage of their sucking. Infants' oral-motor skills were followed longitudinally using a special nipple/bottle system which monitored the suction and expression/compression component of sucking. The maturational process was rated into five primary stages based on the presence/absence of suction and the rhythmicity of the two components of sucking, suction and expression/compression. This five-point scale was used to characterize the developmental stage of sucking of each infant. Outcomes of feeding performance consisted of overall transfer (percent total volume transferred/volume to be taken) and rate of transfer (ml/min). Assessments were conducted when infants were taking 1-2, 3-5 and 6-8 oral feedings per day. Significant positive correlations were observed between the five stages of sucking and postmenstrual age, the defined feeding outcomes, and the number of daily oral feedings. Overall transfer and rate of transfer were enhanced when infants reached the more mature stages of sucking. We have demonstrated that oral feeding performance improves as infants' sucking skills mature. In addition, we propose that the present five-point sucking scale may be used to assess the developmental stages of sucking of preterm infants. Such knowledge would facilitate the management of oral feeding in these infants.
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            Early introduction of oral feeding in preterm infants.

            To determine whether transition from tube to all oral feeding can be accelerated by the early introduction of oral feeding in preterm infants. It is hypothesized that this shortened transition time will lead to earlier attainment of all oral feeding. Twenty-nine infants (<30 weeks' gestation) were randomized to an intervention or control group. The intervention group (n = 13) was initiated to oral feeding 48 hours after achieving full tube feeding (120 kcal/kg/d), and the feeding progression followed a structured protocol. The oral feeding management of the control infants (n = 16) was left to the discretion of their attending physicians. Oral feeding progress was monitored for achievement of selected feeding milestones: achievement of first and all successful oral feedings. Feeding performance was assessed by overall transfer (percent volume transferred during a feeding/total volume offered) and rate of milk transfer (mL/min), which were measured from introduction of oral feeding to first successful oral feeding. Infants in the experimental group, when compared with their control counterparts, were introduced to oral feeding significantly earlier (31.1 +/- 1.3 vs 33.7 +/- 0.9 weeks' postmenstrual age, respectively) and attained all oral feeding significantly earlier as well (34.5 +/- 1.6 vs 36.0 +/- 1.5 weeks' postmenstrual age, respectively). The transition time from full tube feeding to all oral feeding was 26.8 +/- 12.3 days for the experimental group and 38.4 +/- 14.0 days for the control group. Both groups of infants demonstrated similar increase in overall transfer and rate of milk transfer from introduction of oral feeding until achievement of first successful oral feeding. Early introduction of oral feeding accelerates the transition time from tube to all oral feeding. This not only allows earlier attainment of all oral feeding, but it also provides practice opportunities that enhance the oral motor skills necessary for safe and successful feeding.
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              The reliability of the Neonatal Oral-Motor Assessment Scale.

              Sucking problems in preterm infants can be specified by means of visual observation. The Neonatal Oral-Motor Assessment Scale (NOMAS) is the visual observation method most commonly used to assess the non-nutritive sucking (NNS) and nutritive sucking (NS) skills of infants up to approximately 8 weeks postterm. During the first 2 min of a regular feeding the infant's sucking skill is assessed, either immediately or on video. Although NOMAS has been used since 1993, little is known about the method's reliability. The aim of our study was to determine the test-retest and inter-rater reliability of NOMAS.
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                Author and article information

                Journal
                Clinics (Sao Paulo)
                Clinics (Sao Paulo)
                Clinics
                Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
                1807-5932
                1980-5322
                June 2014
                : 69
                : 6
                : 393-397
                Affiliations
                [I ]University Hospital Jundiai, College of Medicine, Jundiai/SP, Brazil.
                [II ]Faculdade de Medicina da Universidade de São Paulo, Department of Pediatrics, São Paulo/SP, Brazil.
                [III ]Universidade de São Paulo, School of Public Health, Department of Mother and Child Health, São Paulo/SP, Brazil.
                [IV ]São Vicente de Paula Hospital of Passo Fundo, Passo Fundo/RS, Brazil.
                [V ]Marilia College of Medicine (Famema), Marilia/SP, Brazil.
                [VI ]Pedro Ernesto University Hospital, Rio de Janeiro/RJ, Brazil.
                [VII ]Lutheran University of Brazil, Clinic Hospital, Porto Alegre/RS, Brazil.
                [VIII ]Fernandes Figueira Institute, Rio de Janeiro/RJ, Brazi.
                [IX ]Faculdade de Medicina da Universidade de São Paulo/SP, Brazi.
                Author notes

                Neiva FC participated in the study design, results analysis, drafting of the manuscript and coordination of the data collection in the neonatal units. Leone CR participated in the study design, results analysis and drafting of the manuscript. Leone C participated in the design, results analysis, drafting of the manuscript text and statistical analysis. Siqueira L, Uema KA, Evangelista D, Delgado S, Rocha A and Buhler KB participated in the data collection in the neonatal units.

                [* ]corresponding author
                E-mail: flaviacbn@ 123456yahoo.com.br Tel.: 55 11 4522-4495
                Article
                cln_69p393
                10.6061/clinics/2014(06)05
                4050319
                24964303
                3dbc3557-ecfb-4984-a243-c058221aaced
                Copyright © 2014 Hospital das Clínicas da FMUSP

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 August 2013
                : 10 September 2013
                : 10 September 2013
                Page count
                Pages: 5
                Categories
                Clinical Science

                Medicine
                preterm infants,sucking behavior,feeding behavior
                Medicine
                preterm infants, sucking behavior, feeding behavior

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