Vacuum characteristics of the sucking cycle and relationships with milk removal from the breast in term infants

Cannon, Anna; Sakalidis, Vanessa S.; Lai, Ching Tat; Perrella, Sharon L.; Geddes, Donna T.

doi:10.1016/j.earlhumdev.2016.02.003

Cited by 19 publications

(17 citation statements)

References 29 publications

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“…Sucking rates of the preterm infants (89 ± 7 sucks/min) were similar to those documented for term breastfeeding infants [ 66 , 71 – 73 ]. However, sucking rate was calculated excluding single sucks, which rarely occurs in term breastfeeding infants and may be another marker of maturation of infant feeding.…”

Section: Discussionsupporting

confidence: 74%

Characterisation of sucking dynamics of breastfeeding preterm infants: a cross sectional study

Geddes

Chooi

Nancarrow

et al. 2017

BMC Pregnancy Childbirth

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BackgroundFull breastfeeding is the ultimate aim for preterm infants to ensure they receive the full benefits of human milk however, preterm infants face a number of challenges associated with their immaturity and associated morbidities. In order to facilitate oral feeding, it is essential to have a sound knowledge of the sucking dynamics of the breastfed infant. The aim of this study was to measure and describe the sucking dynamics of the preterm breastfeeding infant.MethodsA prospective cross sectional observational study was carried out at King Edward Memorial Hospital, Perth. 38 mothers and their preterm infants (birth gestation age: 23.6–33.3 weeks; corrected gestation age 32.7 to 39.9 weeks) were recruited. Intra-oral vacuum levels, tongue movement and milk intake for a single breastfeed was measured. Statistical analysis employed linear regression and linear mixed effects models.ResultsSynchronised ultrasound and intra-oral vacuum measurements show that the preterm infant generates vacuum by lowering their tongue in a parallel fashion, without distortion of the nipple/nipple shield. Baseline (B), mean (M) and (P) peak suck burst vacuums weakened over the course of a feed (B: p = 0.015; M: p = 0.018; P: p = 0.044) and mean and peak vacuums were weaker if the mother fed with a nipple shield (M: p = 0.012; P: p = 0.021). Infant milk intakes were higher when infants sucked for longer (p = 0.002), sucked for a greater proportion of the feed (p = 0.002), or had a greater sucking efficiency (p < 0.001).ConclusionsBreastfeeding preterm infants generated intra-oral vacuum in the same manner as term infants. Nipple shields were associated with weaker intra-oral vacuums. However, vacuum strengths were not associated with milk intake rather time spent actively sucking was related to milk volumes. Further research is required to elucidate factors that influence preterm infant milk intake during breastfeeding.

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Section: Discussionsupporting

confidence: 74%

Characterisation of sucking dynamics of breastfeeding preterm infants: a cross sectional study

Geddes

Chooi

Nancarrow

et al. 2017

BMC Pregnancy Childbirth

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“…Clinical assessment of tongue motion during feeding is difficult; however, ultrasound studies have shown milk extraction from a bottle occurs by a combination of positive pressure and peristaltic motion of the anterior tongue (Ardran et al, ; Weber et al, ; Woolridge and Baum, ). Breastfeeding, however, has been shown to rely primarily on creation of intraoral negative pressure and sucking motion associated with en block movement of the anterior and mid‐tongue (Geddes et al, ; Elad et al, ; Cannon et al, ; Geddes and Sakalidis, ) with tongue elevation appearing to be important in creating the intraoral vacuum. An ultrasound study has shown that patterns of tongue motions differed both in infants with ankyloglossia (with breastfeeding problems) and those without ankyloglossia, but as no anatomical variables of the lingual frenulum were included in this study, it is not possible to correlate the differences seen on ultrasound to frenulum morphology (Geddes et al, ).…”

Section: Discussionmentioning

confidence: 99%

Defining the anatomy of the neonatal lingual frenulum

et al. 2019

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The lingual frenulum is recognized as having the potential to limit tongue mobility, which may lead to difficulties with breastfeeding in some infants. There is extensive variation between individuals in the appearance of the lingual frenulum but an ambiguous relationship between frenulum appearance and functional limitation. An increasing number of infants are being diagnosed with ankyloglossia, with growing uncertainty regarding what can be considered "normal" lingual frenulum anatomy. In this study, microdissection of four fresh tissue premature infant cadavers shows that the lingual frenulum is a dynamic, layered structure formed by oral mucosa and the underlying floor of mouth fascia, which is mobilized into a midline fold with tongue elevation and/or retraction. Genioglossus is suspended from the floor of mouth fascia, and in some individuals can be drawn up into the fold of the frenulum. Branches of the lingual nerve are located superficially on the ventral surface of the tongue, immediately beneath the fascia, making them vulnerable to injury during frenotomy procedures. This research challenges the longstanding belief that the lingual frenulum is a midline structure formed by a submucosal "band" or "string" and confirms that the neonatal lingual frenulum structure replicates that recently described in the adult. This article provides an anatomical construct for understanding and describing variability in lingual frenulum morphology and lays the foundation for future research to assess the impact of specific anatomic variants of lingual frenulum morphology on tongue mobility. Clin. Anat. 32:824-835, 2019.

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“…GE time was determined as the time from the start of F1 to the start of F2 and included the time between two feeds and feed duration. Feed duration was included as up to 80% of HM consumed by term healthy breastfed infants in the first 4–5 min [ 68 ]. GE during breastfeeding was defined as the volume of milk to have left the stomach, calculated as the difference between the immediate post-feed stomach volumes and the sum of R1 and FV.…”

Section: Methodsmentioning

confidence: 99%

Effect of Human Milk Appetite Hormones, Macronutrients, and Infant Characteristics on Gastric Emptying and Breastfeeding Patterns of Term Fully Breastfed Infants

et al. 2016

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Human milk (HM) components influence infant feeding patterns and nutrient intake, yet it is unclear how they influence gastric emptying (GE), a key component of appetite regulation. This study analyzed GE of a single breastfeed, HM appetite hormones/macronutrients and demographics/anthropometrics/body composition of term fully breastfed infants (n = 41, 2 and/or 5 mo). Stomach volumes (SV) were calculated from pre-/post-feed ultrasound scans, then repeatedly until the next feed. Feed volume (FV) was measured by the test-weigh method. HM samples were analyzed for adiponectin, leptin, fat, lactose, total carbohydrate, lysozyme, and total/whey/casein protein. Linear regression/mixed effect models were used to determine associations between GE/feed variables and HM components/infant anthropometrics/adiposity. Higher FVs were associated with faster (−0.07 [−0.10, −0.03], p < 0.001) GE rate, higher post-feed SVs (0.82 [0.53, 1.12], p < 0.001), and longer GE times (0.24 [0.03, 0.46], p = 0.033). Higher whey protein concentration was associated with higher post-feed SVs (4.99 [0.84, 9.13], p = 0.023). Longer GE time was associated with higher adiponectin concentration (2.29 [0.92, 3.66], p = 0.002) and dose (0.02 [0.01, 0.03], p = 0.005), and lower casein:whey ratio (−65.89 [−107.13, −2.66], p = 0.003). FV and HM composition influence GE and breastfeeding patterns in term breastfed infants.

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Vacuum characteristics of the sucking cycle and relationships with milk removal from the breast in term infants

Cited by 19 publications

References 29 publications

Characterisation of sucking dynamics of breastfeeding preterm infants: a cross sectional study

Characterisation of sucking dynamics of breastfeeding preterm infants: a cross sectional study

Defining the anatomy of the neonatal lingual frenulum

Effect of Human Milk Appetite Hormones, Macronutrients, and Infant Characteristics on Gastric Emptying and Breastfeeding Patterns of Term Fully Breastfed Infants

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