Oral Feeding Assessment Predicts Length of Hospital Stay in Late Preterm Infants

Lau, Chantal; Bhat, K. Sham; Potak, Debra; Schanler, Richard J.

doi:10.19104/japm.2016.102

Cited by 12 publications

(16 citation statements)

References 21 publications

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“…This requires advanced sensorimotor integration of muscles of the face, head, and neck with the myelinated vagal regulation of breathing and heart rate (HR; Porges, 1992;Portales et al, 1997;Suess et al, 2000;Porges and Furman, 2011). Feeding difficulty is the primary reason for delayed hospital discharge in preterm infants with brain dysmaturation or near-term/term infants with hypoxic-ischemic encephalopathy (HIE) who are otherwise clinically stable and ready for discharge (Adamkin, 2006;Lau et al, 2015;Jackson et al, 2016). This increases hospital costs and is associated with a negative impact on long-term neurodevelopment, particularly with receptive and expressive language deficits (Adams-Chapman et al, 2013;Malas et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Transcutaneous Auricular Vagus Nerve Stimulation-Paired Rehabilitation for Oromotor Feeding Problems in Newborns: An Open-Label Pilot Study

Badran

Jenkins

Cook

et al. 2020

Front. Hum. Neurosci.

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Neonates born premature or who suffer brain injury at birth often have oral feeding dysfunction and do not meet oral intake requirements needed for discharge. Low oral intake volumes result in extended stays in the hospital (>2 months) and can lead to surgical implant and explant of a gastrostomy tube (G-tube). Prior work suggests pairing vagus nerve stimulation (VNS) with motor activity accelerates functional improvements after stroke, and transcutaneous auricular VNS (taVNS) has emerged as promising noninvasive form of VNS. Pairing taVNS with bottle-feeding rehabilitation may improve oromotor coordination and lead to improved oral intake volumes, ultimately avoiding the need for G-tube placement. We investigated whether taVNS paired with oromotor rehabilitation is tolerable and safe and facilitates motor learning in infants who have failed oral feeding. We enrolled 14 infants [11 premature and 3 hypoxic-ischemic encephalopathy (HIE)] who were slated for G-tube placement in a prospective, open-label study of taVNS-paired rehabilitation to increase feeding volumes. Once-daily taVNS was delivered to the left tragus during bottle feeding for 2 weeks, with optional extension. The primary outcome was attainment of oral feeding volumes and weight gain adequate for discharge without G-tube while also monitoring discomfort and heart rate (HR) as safety outcomes. We observed no adverse events related to stimulation, and stimulation-induced HR reductions were transient and safe and likely confirmed vagal engagement. Eight of 14 participants (57%) achieved adequate feeding volumes for discharge without G-tube (mean treatment length: 16 ± 6 days). We observed significant increases in feeding volume trajectories in responders compared with pre-stimulation (p < 0.05). taVNS-paired feeding rehabilitation appears safe and may improve oral feeding in infants with oromotor dyscoordination, increasing the rate of discharge without G-tube, warranting larger controlled trials.

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Section: Introductionmentioning

confidence: 99%

Transcutaneous Auricular Vagus Nerve Stimulation-Paired Rehabilitation for Oromotor Feeding Problems in Newborns: An Open-Label Pilot Study

Badran

Jenkins

Cook

et al. 2020

Front. Hum. Neurosci.

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“…LPT infants have immature feeding skills. 10,11 They are less coordinated in their ability to suck, swallow, and breathe, and they transfer less milk during feedings because of weaker sucking pressures. 10,12 Mothers of LPT infants often have risk factors for delayed onset of lactogenesis, including cesarean delivery, obesity, hypertension, and diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 They are less coordinated in their ability to suck, swallow, and breathe, and they transfer less milk during feedings because of weaker sucking pressures. 10,12 Mothers of LPT infants often have risk factors for delayed onset of lactogenesis, including cesarean delivery, obesity, hypertension, and diabetes. [13][14][15] Taken together, these issues put LPT infants at high risk for excessive weight loss and dehydration, which can lead to readmission.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Implementation of a NICU-Based Late Preterm Infant Feeding Guideline

Burnham

Lopera

Mao

et al. 2018

Hospital Pediatrics

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“…Oral feeding skills are measured by proficiency (PRO) and transfer rate (TR), which reflect, respectively, the minimum fatigue/ability to feed orally in the first five minutes of feeding and the resistance to OF of the prescribed volume. From these two variables (PRO and TR), four levels of oral feeding skills are defined (4,26,28,29) . Our findings were favorable to an adequate level of feeding skills, compared to those found in the literature.…”

Section: Discussionmentioning

confidence: 99%

Desempenho da alimentação oral em recém-nascidos prematuros estimulados pela técnica treino de deglutição

Otto

Almeida

2017

Audiol., Commun. Res.

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Introduction: Prematurity can affect proper development of a newborn. Purpose: To evaluate performance of oral feeding in preterm infants stimulated by the swallowing training technique. Methods: The study was conducted in a neonatal intensive care unit from March to August 2015. The study was developed as a Times Series Quasi Experiment with 14 preterm newborns (PTNB) with corrected gestational age between 30-36 weeks. The readiness to feed orally protocol for preterm infants (pre and post-swallowing training) was applied. Swallowing exercises were conducted once a day and on average for six consecutive days. Results: Improvement post-stimulation was observed, comparing the preintervention and post-intervention protocol data. Regarding oral feeding skills, 50% of preterm infants were classified as level 4. Oral feeding commenced, on average, 1 day after the end of swallowing training; the gastric tube was removed approximately 7 days after beginning oral feeding. There was a borderline inverse relationship between improvement in the readiness score and transition time from tube to full oral feeding and an inverse relationship between improvement in the readiness score and corrected gestational age. Conclusion: The intervention with swallowing training made it possible to improve feeding skills in 50% of the sample population, starting oral feeding and obtaining exclusive oral feeding in a short period of time, with oral readiness at early gestational ages.

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Oral Feeding Assessment Predicts Length of Hospital Stay in Late Preterm Infants

Abstract: Background-When compared with term infants, late preterm (LP) infants have greater morbidity and mortality, longer hospital stay, and greater rate of hospital readmission. Oral feeding difficulty is one of the prominent reasons for delayed discharge in LP infants.

Cited by 12 publications

References 21 publications

Transcutaneous Auricular Vagus Nerve Stimulation-Paired Rehabilitation for Oromotor Feeding Problems in Newborns: An Open-Label Pilot Study

Transcutaneous Auricular Vagus Nerve Stimulation-Paired Rehabilitation for Oromotor Feeding Problems in Newborns: An Open-Label Pilot Study

Outcomes of Implementation of a NICU-Based Late Preterm Infant Feeding Guideline

Desempenho da alimentação oral em recém-nascidos prematuros estimulados pela técnica treino de deglutição

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