Preterm newborn readiness for oral feeding: systematic review and meta-analysis

Abstract

PURPOSE: To identify and systematize the main studies on the transition from enteral to oral feeding in preterm infants. RESEARCH STRATEGY: Articles that describe the transition from oral to enteral feeding in preterm infants were located in MEDLINE, LILACS, and SciELO databases. SELECTION CRITERIA: Original studies, with available abstract, published in the last 10 years were included. DATA ANALYSIS: Analysis of the methodology and the main results of the studies, and meta-analysis of the effects of sensory-motor-oral stimulation at the time of transition to full oral feeding and duration of hospitalization were conducted. RESULTS: Twenty-nine national and international publications were considered. Most studies were clinical trials (44.8%) and did not use rating scales to start the transition process (82.7%). In the meta-analysis, positive effect of stimulation of the sensory-motor-oral system was observed with respect to the transition time to oral diet (p=0.0000), but not in relation to the length of hospital stay (p=0.09). However, heterogeneity between studies was found both in the analysis of the transition time to full oral feeding (I2=93.98) and in the length of hospital stay (I2=82.30). CONCLUSION: The transition to oral feeding is an important moment, and various physical and clinical characteristics of preterm infants have been used to describe this process. Despite the impossibility of generalizing the results due to the heterogeneity of the studies, we have noted the importance of strategies for stimulation of sensory-motor-oral system to decrease the period of transition to full oral feeding system.

Saturação de oxigênio e frequência cardíaca em prematuros: comparação entre as técnicas de copo e sonda-dedo

“…From a recent systematic review on the transition from enteral feeding to oral diet in PTNBs, it was possible to verify that several physical and clinical characteristics of preterm infants have been used to describe this process and observed the importance of stimulation strategies of the oral sensorimotor system to decrease the transition period to full oral feeding (23) .…”

Habilidades de recém-nascidos prematuros para início da alimentação oral

“…The lower the gestational age of premature newborns, the greater the physiological immaturity, which in addition to neurological immaturity, muscle hypotonia, poor reflexes, difficulty in self-regulation and oral and respiratory disorders decrease oral and motor skills and hampers feeding. Breast milk is the ideal food to meet the nutritional needs of premature babies, especially when produced by the mother, because protection factors make up this milk, and it is also a way of reducing children morbidity and mortality and impacts on health promotion of the mother--son binomial (3)(4)(5) .…”

“…However, premature newborn baies have difficulties to overcome due to the instability of their basic vital functions and the immaturity of sucking, swallowing and breathing reflexes. As a result, feeding is performed by a gastric probe (gavage) until they are able to start oral feeding (3,8) .…”

“…The multidisciplinary team has to monitor and evaluate the transition process by continuously observing sucking, swallowing and breathing coordination of the premature newborn, until they obtain adequate nutritional intake that allows growth, physiological stability and progress in the feeding function. It is one of the great challenges that the premature baby must overcome after they obtained physiological stability (3,9) .…”

“…However, we observe that, in practice, premature babies begin oral feeding in an unsystematic manner, with no evaluation standard of the right time. Research is diversified as to the use and content of evaluation protocols for oral feeding initiation (3,(7)(8)(9) .…”