Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants

Foster, Jann P; Psaila, Kim; Patterson, Tiffany

doi:10.1002/14651858.cd001071.pub3

Cited by 86 publications

(95 citation statements)

References 74 publications

(18 reference statements)

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“…Nonnutritive sucking (NNS) is used during gavage feeding and in the transition from gavage to oral feeding in preterm infants. The rationale for this intervention is that nonnutritive sucking facilitates the development and maturation of sucking behaviour and improves digestion of enteral feedings . Nonnutritive sucking on the expressed breast (mother pumps first and then places the baby to the breast) can be attempted as soon as the baby is extubated and stable with success noted as early as at 28 weeks corrected gestational age …”

Section: Methodsmentioning

confidence: 99%

“…Bingham et al, 2010 45 Greene et al, 2013 34 Foster et al, 2016 44 LUBBE rationale for this intervention is that nonnutritive sucking facilitates the development and maturation 43 of sucking behaviour and improves digestion of enteral feedings. 44 Nonnutritive sucking on the expressed breast (mother pumps first and then places the baby to the breast) can be attempted as soon as the baby is extubated and stable with success noted as early as at 28 weeks corrected gestational age. 11 Nonnutritive sucking precedes nutritive sucking and is characterised by shorter sucking bursts.…”

Section: Nonnutritive Suckingmentioning

confidence: 99%

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Clinicians guide for cue‐based transition to oral feeding in preterm infants: An easy‐to‐use clinical guide

Lubbe

2017

Evaluation Clinical Practice

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Rationale, aims and objectivesThis article aims to provide evidence to guide multidisciplinary clinical practitioners towards successful initiation and long‐term maintenance of oral feeding in preterm infants, directed by the individual infant maturity.MethodA comprehensive review of primary research, explorative work, existing guidelines, and evidence‐based opinions regarding the transition to oral feeding in preterm infants was studied to compile this document.ResultsCurrent clinical hospital practices are described and challenged and the principles of cue‐based feeding are explored. “Traditional” feeding regimes use criteria, such as the infant's weight, gestational age and being free of illness, and even caregiver intuition to initiate or delay oral feeding. However, these criteria could compromise the infant and increase anxiety levels and frustration for parents and caregivers. Cue‐based feeding, opposed to volume‐driven feeding, lead to improved feeding success, including increased weight gain, shorter hospital stay, fewer adverse events, without increasing staff workload while simultaneously improving parents' skills regarding infant feeding. Although research is available on cue‐based feeding, an easy‐to‐use clinical guide for practitioners could not be found. A cue‐based infant feeding regime, for clinical decision making on providing opportunities to support feeding success in preterm infants, is provided in this article as a framework for clinical reasoning.ConclusionsCue‐based feeding of preterm infants requires care providers who are trained in and sensitive to infant cues, to ensure optimal feeding success. An easy‐to‐use clinical guideline is presented for implementation by multidisciplinary team members. This evidence‐based guideline aims to improve feeding outcomes for the newborn infant and to facilitate the tasks of nurses and caregivers.

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Section: Methodsmentioning

confidence: 99%

Section: Nonnutritive Suckingmentioning

confidence: 99%

Clinicians guide for cue‐based transition to oral feeding in preterm infants: An easy‐to‐use clinical guide

Lubbe

2017

Evaluation Clinical Practice

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“…Oral stimulation interventions that promote oral feeding include nonnutritive sucking and finger stimulation. Both interventions have been shown to decrease the duration of oral feeding transition and the length of hospital stay . In our NICU, we used oral stimulation interventions on selected infants who exhibited no oral feeding after 36 1/7 weeks of PMA and weighed >1750 g. We recognize that this approach should be initiated at the earlier PMA as a standard care in NICU.…”

Section: Discussionmentioning

confidence: 99%

“…The transition from gavage to oral feeding requires coordination of sucking, swallowing, and breathing and organized sleep/wake cycles. The duration of this process differs from nursery to nursery because of the use of associate techniques such as responsive feeding, nonnutritive sucking, and finger stimulation …”

Section: Introductionmentioning

confidence: 99%

Impact of Feeding Interval on Time to Achieve Full Oral Feeding in Preterm Infants: A Randomized Trial

et al. 2019

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Background Preterm infants are scheduled to receive total feeding amount in either 3‐hour or 2‐hour intervals. A gavage feeding may be required if the scheduled amount is not completed orally. Feedings every 2 hours are one‐third smaller than feedings every 3 hours. Thus, if the volume of each feed is reduced by decreasing the feeding interval from 3 to 2 hours, the likelihood that the infant completes each volume orally increases, and the probability of requiring gavage feeding decreases. The impact of feeding with 2‐hour or 3‐hour intervals on time to achieve full oral feeding in preterm infants was investigated. Methods Infants on full enteral gavage feedings were randomized into 2 groups to receive feedings in either 3‐hour or 2‐hour intervals. The time to achieve full oral feeding and the duration of feeding transition from gavage to oral feedings were investigated. Data were presented as median (interquartile range). Results The study included 100 infants (gestational age: 29 [28–31] weeks, birth weight: 1205 [1040–1380] g) with 50 in each group. The postmenstrual age to achieve full oral feeding was 35 (35–37) weeks in the 3‐hour‐interval group and 35 (34–36) weeks in the 2‐hour‐interval group; P = 0.131. The duration of feeding transition was similar between groups. Conclusions Feeding every 2 hours caused no improvement in the time to achieve full oral feeding. The 3‐hour‐interval feeding is appropriate for the neonatal units, where less handling of preterms and decreased workload of nurses are valuable.

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“…The exposure of the naso-oropharyngeal mucosa of healthy newborns to their own mother’s milk occurs physiologically during breastfeeding. But in VLBW infants on a neonatal intensive care unit (NICU), this contact is usually bypassed by feeding via gavage tube, a small tube that is placed up the nose into the stomach [11]. So far, the role of nasal breast milk exposure for effects on the central nervous system has never been investigated.…”

Section: Introductionmentioning

confidence: 99%

Intranasal breast milk for premature infants with severe intraventricular hemorrhage—an observation

et al. 2018

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For nasal application of neurotrophins and mesenchymal stem cells, successful delivery to the brain and therapeutic effects are known from experimental data in animals. Human breast milk contains neurotrophins and stem cells, but gavage tube feeding in preterm infants bypasses the naso-oropharynx. This is a first exploration on additional nasal breast milk and neuromorphological outcome after severe neonatal brain injury. We present a retrospective summary of 31 very low birth weight preterm infants with intraventricular hemorrhage °3/4 from one third-level neonatal center. All were breast milk fed. Sixteen infants additionally received nasal drops of fresh breast milk daily with informed parental consent for at least 28 days. Cerebral ultrasound courses were reviewed by a pediatric radiologist blinded to the intervention. The main outcome measure was severity of porencephalic defects before discharge. Clinical covariates were comparable in both groups. With nasal breast milk, a trend to a lower incidence for severe porencephalic defects (21% vs. 58%) was detected. Incidences were lower for progressive ventricular dilatation (71% vs. 91%) and surgery for posthemorrhagic hydrocephalus (50% vs. 67%).Conclusion: The hypothesis is generated that early intranasal application of breast milk could have a beneficial effect on neurodevelopment in preterm infants. Controlled investigation is needed. What is Known: • Successful delivery to the brain and therapeutic effects are known for nasal application of neurotrophins and mesenchymal stem cells from experimental data in animal studies.• Human breast milk contains neurotrophins and stem cells, but gavage tube feeding in preterm infants bypasses the naso-oropharynx. What is New: • This is the first report on additional nasal breast milk application in very low birth weight preterm infants with severe brain injury observing a trend for less severe porencephalic defects.• The hypothesis is generated that nasal breast milk might exert neuroprotective effects in preterm infants.Electronic supplementary materialThe online version of this article (10.1007/s00431-018-3279-7) contains supplementary material, which is available to authorized users.

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Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants

Abstract: Foster JP, Psaila K, Patterson T. Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants.

Cited by 86 publications

References 74 publications

Clinicians guide for cue‐based transition to oral feeding in preterm infants: An easy‐to‐use clinical guide

Clinicians guide for cue‐based transition to oral feeding in preterm infants: An easy‐to‐use clinical guide

Impact of Feeding Interval on Time to Achieve Full Oral Feeding in Preterm Infants: A Randomized Trial

Intranasal breast milk for premature infants with severe intraventricular hemorrhage—an observation

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