ABSTRACT:Our aim was to obtain a better understanding of the differences between breast-feeding and bottle-feeding, particularly with regard to how sucking performance changes from nonnutritive sucking (NNS) to nutritive sucking (NS). Twenty-two normal term infants were studied while breast-feeding at 4 and 5 d postpartum. Five of the 22 infants were exclusively breast-fed, but we tested the other 17 infants while breast-feeding and while bottle-feeding. Before the milk ejection reflex (MER) occurs, little milk is available. As such, infants perform NNS before MER. For bottle-feeding, a oneway valve was affixed between the teat and the bottle so that the infants needed to perform NNS until milk flowed into the teat chamber. At the breast, the sucking pressure (-93.1 Ϯ 28.3 mm Hg) was higher during NNS compared with NS (-77.3 Ϯ 27.0 mm Hg). With a bottle, the sucking pressure was lower during NNS (-27.5 Ϯ 11.2 mm Hg) compared with NS (-87.5 Ϯ 28.5 mm Hg). Sucking frequency was higher and sucking duration was shorter during NNS compared with that during NS both at the breast and with a bottle. There were significant differences in the changes of sucking pressure and duration from NNS to NS between breast-and bottle-feeding. The change in sucking pressure and duration from NNS to NS differed between breast-feeding and bottle-feeding. Even with a modified bottle and teats, bottle-feeding differs from breast-feeding. O ne of the differences between breast-feeding and bottlefeeding is that infants need to suck nonnutritively at the breast until the MER occurs, because little milk is available before MER (1-3). MER is identified not only by pain or pressure in the breast but also by a change in the sucking pattern of the infant. Inch and Garforth (4) reported that infants demonstrated short, fast bursts of sucking when they attached to the breast. This description is similar to our experience, but, to the best of our knowledge, few objective evaluations of the changes in sucking pattern before and after MER exist. Infants have to suckle the breast to stimulate MER even though they do not obtain milk flow immediately. With MER, milk begins to flow and the infant's sucking pattern changes to a long, slow, continuous pattern. Since the sucking pattern is dependent on the milk flow, it is understandable that infants suck slowly after MER (5). Whether or not infants can suck at the breast effectively and continuously until milk flows into their mouth is an important factor in successful breastfeeding. The first objective is to evaluate changes in the sucking pattern of breast-feeding infants before and after MER.With bottle-feeding, an infant obtains milk flow when a teat is inserted into the mouth. There are numerous articles regarding sucking performance with artificial teats during NNS or NS. However, there exist few studies that evaluate how infants change their sucking performance sequentially from NNS to NS. Forty years ago, Wolff (6) examined the NNS and NS patterns of full-term infants and found that sucking frequen...
This study aimed to determine whether neonatal feeding performance can predict the neurodevelopmental outcome of infants at 18 months of age. We measured the expression and sucking pressures of 65 infants (32 males and 33 females, mean gestational age 37.8 weeks [SD 0.5]; range 35.1 to 42.7 weeks and mean birthweight 2722g [SD 92]) with feeding problems and assessed their neurodevelopmental outcome at 18 months of age. Their diagnoses varied from mild asphyxia and transient tachypnea to Chiari malformation. A neurological examination was performed at 40 to 42 weeks postmenstrual age by means of an Amiel-Tison examination. Feeding performance at 1 and 2 weeks after initiation of oral feeding was divided into four classes: class 1, no suction and weak expression; class 2, arrhythmic alternation of expression/suction and weak pressures; class 3, rhythmic alternation, but weak pressures; and class 4, rhythmic alternation with normal pressures. Neurodevelopmental outcome was evaluated with the Bayley Scales of Infant Development -II and was divided into four categories: severe disability, moderate delay, minor delay, and normal. We examined the brain ultrasound on the day of feeding assessment, and compared the prognostic value of ultrasound and feeding performance. There was a significant correlation between feeding assessment and neurodevelopmental outcome at 18 months (p<0.001). Improvements of feeding pattern at the second evaluation resulted in better neurodevelopmental outcome. The sensitivity and specificity of feeding assessment were higher than those of ultrasound assessment. Neonatal feeding performance is, therefore, of prognostic value in detecting future developmental problems.
The aim of this study was to gain a better understanding of the development of sucking behavior in infants with Down's syndrome. The sucking behavior of 14 infants with Down's syndrome was consecutively studied at 1, 4, 8 and 12 mo of age. They were free from complications that may cause sucking difficulty. The sucking pressure, expression pressure, frequency and duration were measured. In addition, an ultrasound study during sucking was performed in sagittal planes. Although levels of the sucking pressure and duration were in the normal range, significant development occurred with time. Ultrasonographic images showed deficiency in the smooth peristaltic tongue movement. Conclusion: The sucking deficiency in Down's syndrome may result from not only hypotonicity of the perioral muscles, lips and masticatory muscles, but also deficiency in the smooth tongue movement. This approach using the sucking pressure waveform and ultrasonography can help in the examination of the development of sucking behavior, intraoral movement and therapeutic effects.
Aim: To determine whether the feeding behaviour of infants with cleft lip and palate is improved with a type‐P teat, which is widely used in Japan by such infants, compared with a standard teat. The difference in intra‐oral movements between the type‐P teat, modified for the evaluation of feeding behaviour, and an unmodified type‐P teat was also compared using ultrasonography. Methods: In part 1 of the study, 15 infants aged 2 to 3 mo and 7 infants aged 2 wk were evaluated for sucking pressure, expression pressure, frequency and duration of sucking. All the infants had a complete unilateral cleft lip and palate without any other abnormalities. In part 2, an ultrasonographic analysis of intra‐oral movement was done for 5 infants enrolled in part 1 of the study. Results: Sucking pressure did not occur in all infants. It was found that feeding efficiency improved with the type‐P teat compared with the standard teat. The expression pressure with the type‐P teat was significantly higher than that with the standard teat, and the feeding frequency with the type‐P teat was lower than that with the standard teat. Conclusion: A type‐P teat is suitable for infants with cleft lip and palate who have sucking difficulties. However, a type‐P nipple with a squeezable bottle does not fully solve the feeding problems of infants with cleft lip and palate. New artificial teats that allow a higher expression pressure are desirable, and the measurement of the expression pressure may be helpful in the evaluation of artificial nipples.
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