Smell and Taste to Improve Nutrition in Very Preterm Infants: A Randomized Controlled Pilot Trial

Abstract

Background: The perception of smell and taste, though present early in development, is not routinely considered in the care of preterm infants. Smell and taste are known to increase gut motility, insulin secretion, and the release of appetite, digestive and metabolic hormones. Objective: We aimed to investigate the effect of regular smell and taste on the time from birth to full enteral feeds, and the feasibility of the study protocol in very preterm infants. Methods: In a randomized controlled trial, infants <29 weeks' postmenstrual age (PA) were assigned to receive either the smell and taste of milk before each feed or to have no exposure to the smell and taste of milk (control). Results: Infants in the treatment group (n = 28) and control group (n = 23) were born at a mean (SD) PA of 26.7 (1.5) and 27.2 (1.4) weeks, respectively. They reached full enteral feeds at a median (IQR) of 13.5 (10.0-19.0) and 15.5 (11.0-22.0) days, respectively. Survival analysis showed an adjusted hazard ratio of 1.63 (95% confidence interval 0.91-2.91; p = 0.10) for the effect on the time to establish full enteral feeds. Repeated-measures analysis indicated significant group differences in weight z scores at 36 weeks' PA and at discharge in favor of the intervention (p < 0.05). Conclusion: These data indicate that the smell and taste of milk may improve milk tolerance and weight in preterm infants. The role of regular smell and taste in promoting enteral nutrition and growth in preterm infants merits a larger trial powered to detect important outcomes.

Nutritional management of moderate–late preterm infants: Survey of current practice

“…The routine use of providing a smell and taste of maternal milk to babies prior to enteral feeds to provide the cues of maternal odour seems to be an emerging practice in some units; however, there is minimal evidence of its benefits . Smell and taste initiate a metabolic response through the secretions of hormones insulin and ghrelin; taste receptors are apparent from 18 weeks’ gestation and flavour perception from 24 weeks’ gestation .…”

The effect of smell and taste of milk during tube feeding of preterm infants (the Taste trial): a protocol for a randomised controlled trial

“…Univariate and multivariable GEE analyses will be used for the primary outcome, weight z-scores at discharge from hospital and other continuous secondary outcome measures. Time to full enteral feeds will be analysed using a multilevel survival analysis (mestreg command in Stata) 28. Secondary outcomes with categorical data will be analysed using a mixed effects logistic regression (melogit Stata command).…”

Smell and taste in the preterm infant

“…Longer exposure of tube-fed preterm babies to smell or to smell and taste may shorten time to full enteral feeds, although further research is needed. A trial of 51 infants < 29 weeks' gestation randomised babies to smell and taste of milk before each feed or no olfactory/gustatory exposure to milk until 32 weeks' gestation [24]. Babies in the intervention group tended to reach full enteral feeds earlier (median 13.5 vs 15.5 days).…”