The effect of the odor of breast milk on the time needed for transition from gavage to total oral feeding in preterm infants. Prospective study of non-nutritive sucking and feeding skills in premature infants Effects of non-nutritive sucking and oral stimulation on breastfeeding rates for preterm, low birth weight infants: a randomized clinical trial. A Controlled-flow Vacuum-free Bottle System Enhances Preterm Infants’ Nutritive Sucking Skills Cue-based oral feeding clinical pathway results in earlier attainment of full oral feeding in premature infants Oral and non-oral sensorimotor interventions enhance oral feeding performance in preterm infants. The oral motor capacity and feeding performance of preterm newborns at the time of transition to oral feeding. Effect of an oral stimulation program on sucking skill maturation of preterm infants. Oral stimulation accelerates the transition from tube to oral feeding in preterm infants. Identification of neonates at risk of developing feeding problems in infancy Effects of oral stimulation and oral support on non-nutritive sucking and feeding performance in preterm infants. A randomized study of the efficacy of sensory-motor-oral stimulation and non-nutritive sucking in very low birthweight infant. Effect of the Premature Infant Oral Motor Intervention on Feeding Progression and Length of Stay in Preterm Infants Feeding Readiness in Preterm Infants: The Relationship Between Preterm Behavioral State and Feeding Readiness Behaviors and Efficiency During Transition From Gavage to Oral Feeding A feeding protocol for healthy preterm infants that shortens time to oral feeding.
PURPOSE The aim of this study was to investigate the effect of the application of the odor of breast milk in preterm infants during gavage feeding  on the period of transition to total oral feeding . DESIGN This prospect i ve experimental study was performed on a total of 80 preterm infants : 40 infants in the study group and 40 in the control group . METHODS This experimental study was performed in eastern Turkey at the Neonatal Intensive Care and Premature Unit of a university hospital between September 2007 and December 2008 . The demographic data were collected via a question naire , and an intervention and follow-up table was prepared by the research er based on relevant literature . The study was approved by the local institution , and written informed consent was obtained from all parents . FINDINGS The findings of the study indicated that the preterm infants who were stimulated by the odor of breast milk during gavage feeding transitioned to oral feeding 3 days earlier than control subjects . Moreover , the mean hospitalization time of these infants was 4 days shorter . CONCLUSIONS The results show that stimulation with breast milk odor is an effective method for decreasing transition of preterm infants from gavage to oral feeding . CLINICAL RELEVANCE Nurses can train mothers to pump their breast milk , stimulate their infants with the odor of their breast milk , and feed it to their infants in the premature unit . This may lead to a quicker transition to oral feeding Objective The aim of the present work was to assess the value of  non-nutritive sucking ( NNS ) measures as predictors of oral feeding performance in comparison to other putative predictors of feeding skills : respiratory support , post-menstrual age ( PMA ) at birth and the neonatal oral motor assessment score ( NOMAS ) . Methods This was a prospect i ve , observational study . Cox proportional hazards and non-parametric rank sum tests were used to assess the relationship between NNS and feeding outcome measures . The setting was neonatal intensive care units ( NICU ) in rural/academic , urban/tertiary centres in the USA . In all , 51 premature infants born between 25 and 34 weeks ' PMA , birth weight 1512.3±499.4 g , were included in this study . Interventions were measurement of NNS , st and ardised feeding advance schedule , performance of NOMAS , and st and ardised , permissive , oral feeding advance schedule . Main outcome measures were transition time from first to full oral feeding ( FOF ) and gestational age at FOF . Results Higher NNS organisation scores predicted shorter transition to FOF ( p<0.05 ) : infants with a more organised suck pattern reached independent oral feeding 3 days earlier ( 16 vs 13 day transition ) than infants with more chaotic patterns of suck bursts . Consistency of the suck waves also corresponded with feeding milestones : infants with more regular suck wave pressure deflections became competent oral feeders approximately 3 days earlier than those with irregular suck pressure waves . PMA at birth was inversely associated with PMA at FOF . NOMAS measures were not associated with outcome measures . Conclusions Measures of NNS organisation and suck consistency constitute useful c and i date predictors of feeding performance by premature infants . The results accord with previous findings linking PMA at birth with age at independent feeding OBJECTIVE To determine the influence of non-nutritive sucking and oral stimulation programs on breastfeeding rates at discharge , at 3 and at 6 months of corrected age in preterm infants with very low birth weight . METHODS Preterm infants were r and omized into experimental and control groups . Ninety-eight preterm infants were r and omized and 96 remained in the study until reaching the corrected age of 6 months . The experimental group received sensory-motor-oral stimulation and non-nutritive sucking , while infants in the control group received a sham stimulation program . Both were administered from reaching enteral feeding ( 100 kcal/kg/day ) until the beginning of oral feeding . RESULTS Fifty-nine infants ( 61.5 % ) were breastfeeding at the time of hospital discharge , 31 ( 36.9 % ) at 3 months , and only 18 ( 20.5 % ) at 6 months of corrected age . At discharge , 46.9 % of the control group and 76.5 % of the experimental group were breastfeeding . There were statistically significant differences between rates of breastfeeding at discharge ( 47 vs. 76 % ) , 3 months ( 18 vs. 47 % ) and 6 months after discharge ( 10 vs. 27 % ) . The experimental group showed significantly higher rates of breastfeeding ( p < 0.05 ) . CONCLUSION Non-nutritive sucking , associated with oral stimulation programs , can contribute to the improvement of breastfeeding rates among preterm infants with very low birth weight We have shown that a controlled-flow vacuum-free bottle system ( CFVFB ) vs. a st and ard bottle ( SB ) facilitates overall transfer and rate of milk transfer , and shortens oral feeding duration in very-low-birth-weight ( VLBW ) infants . We aim ed to underst and the basis by which this occurs . Thirty infants ( 19 males ; 27 ± 1 weeks gestation ) were r and omized to a CFVFB or SB . Outcomes monitored at 1–2 and 6–8 oral feedings/day when infants were around 34 and 36 weeks postmenstrual age , respectively , included : overall transfer ( % volume taken/volume prescribed ) , rate of milk transfer ( ml/min ) , sucking stage , frequency of suction ( # S/s ) and expression ( # E/s ) , suction amplitude ( mmHg ) , and sucking burst duration ( s ) . At both periods we confirmed that infants using a CFVFB vs. SB demonstrated greater overall transfer and rate of milk transfer , along with more mature sucking stages . Suction and expression frequencies were decreased with CFVFB vs. SB at 1–2 oral feeding/day ; only that of suction was reduced at 6–8 oral feedings/day . No group differences in suction amplitude and burst duration were observed . We speculate that oral feeding performance improves without significant change in sucking effort with a CFVFB vs. SB . In addition , we have shown that VLBW infants can tolerate faster milk flow than currently presumed . Finally , the use of a CFVFB may reduce energy expenditure as it enhances feeding performance without increasing sucking effort Objective : To study whether a cue-based clinical pathway for oral feeding initiation and advancement of premature infants would result in earlier achievement of full oral feeding . Study Design : Age of achievement of full oral intake was compared for two groups of preterm infants ; a prospect i ve study group vs historic cohort controls . Study infants had oral feedings managed by nurses using a clinical pathway that relied on infant behavioral readiness signs to initiate and advance oral feedings . Controls had oral feedings managed by physician orders . Result : Fifty-one infants ( n=28 study and n=23 control ) were studied  . Gender distribution , gestational age , birth weight and ventilator days were not different between groups . Study infants reached full oral feedings 6 days earlier than controls ( 36±1 3/7 weeks of postmenstrual age ( PMA ) vs 36 6/7±1 4/7 weeks of PMA , P=0.02 ) . Conclusion : The cue-based clinical pathway for oral feeding initiation and advancement of premature infants result ed in earlier achievement of full oral feeding AIM The aim of this study was to determine whether oral , tactile/kinaesthetic ( T/K ) , or combined ( oral+T/K ) interventions enhance oral feeding performance and whether combined interventions have an additive/synergistic effect . METHOD Seventy-five preterm infants ( mean gestational age 29 wk ; st and ard error of the mean [ SEM ] 0.3 wk ; mean birthweight 1340.3 g ; SEM 52.5 g ; 49 males and 26 females ) were r and omly assigned to one of three intervention groups or a control group . The oral group received sensorimotor input to the oral structures , the T/K group received sensorimotor input to the trunk and limbs , and the combined group received both . The outcomes were time from introduction of nipple feeding to independent oral feeding ( d ) , proficiency ( intake in the first 5 min , % ) , volume transfer ( % ) , rate of transfer ( mL/min ) , volume loss ( % ) , and length of hospital stay ( d ) . RESULTS Infants in the three intervention groups achieved independent oral feeding 9 - 10 days earlier than those in the control group ( p<0.001 ; effect size 1.9 - 2.1 ) . Proficiency ( p ≤ 0.002 ; effect size 0.7 - 1.4 ) at the time of one to two and three to five oral feedings per day , volume transfer ( p ≤ 0.001 ; effect size 0.8 - 1.1 ) at one to two , three to five , and six to eight oral feedings per day , and overall rate of transfer ( p ≤ 0.018 ; effect size 0.8 - 1.1 ) were greater , and overall volume losses were less ( p ≤ 0.007 ; effect size 0.9 - 1.1 ) , than in the control group ( p ≤ 0.042 ) . The combined group attained independent oral feeding at a significantly younger postmenstrual age than controls ( p=0.020 ) and had clinical ly greater proficiency than the T/K group ( p=0.020 ; effect size 0.7 ) and oral group ( p=0.109 ; effect size 0.5 ) . Length of hospital stay was not significantly different between groups ( p=0.792 ; effect size 0.02 - 0.3 ) . INTERPRETATION Oral and T/K interventions accelerated the transition from introduction to independent oral feeding and enhanced oral feeding skills . T/K has beneficial effects beyond the specific targeted system . The combined sensorimotor intervention led to an additive/synergistic effect for proficiency , further benefiting this population The objective of the present study was to determine the  oral motor capacity  and the feeding performance of preterm newborn infants when they were permitted to start oral feeding . This was an observational and prospect i ve study conducted on 43 preterm newborns admitted to the Neonatal Intensive Care Unit of UFSM , RS , Brazil . Exclusion criteria were the presence of head and neck malformations , genetic disease , neonatal asphyxia , intracranial hemorrhage , and kernicterus . When the infants were permitted to start oral feeding , non-nutritive sucking was evaluated by a speech therapist regarding force ( strong vs weak ) , rhythm ( rapid vs slow ) , presence of adaptive oral reflexes ( search ing , sucking and swallowing ) and coordination between sucking , swallowing and respiration . Feeding performance was evaluated on the basis of competence ( defined by rate of milk intake , mL/min ) and overall transfer ( percent ingested volume/total volume ordered ) . The speech therapist 's evaluation showed that 33 % of the newborns presented weak sucking , 23 % slow rhythm , 30 % absence of at least one adaptive oral reflex , and 14 % with no coordination between sucking , swallowing and respiration . Mean feeding competence was greater in infants with strong sucking fast rhythm . The presence of sucking-swallowing-respiration coordination decreased the days for an overall transfer of 100 % . Evaluation by a speech therapist proved to be a useful tool for the safe indication of the beginning of oral feeding for premature infants This study assessed the effect of an oral stimulation program on the maturation of sucking skills of preterm infants . Thirty-two preterm infants ( 13 males , 19 females ) , appropriate size for gestational age ( gestational age at birth 28 wks , SD 1.2wks ; birthweight 1002 g , SD 251 g ) , were r and omly placed into experimental and control groups . The experimental group received a daily 15-minute oral stimulation program , consisting of stroking the peri- and intra-oral structures , for 10 days before the start of oral feedings .  Sucking measures were monitored with a specially- design ed nipple-bottle apparatus . Results indicate that the experimental group achieved full oral feedings 7 days sooner than the control group , and demonstrated greater overall intake ( % ) , rate of milk transfer ( mL/min ) , and amplitude of the expression component of sucking ( mmHg ) . There was no difference in sucking stage maturation , sucking frequency , and amplitude of the suction component of sucking . Endurance , defined as ability to sustain the same sucking stage , sucking burst duration , and suction and expression amplitudes throughout a feeding session , was not significantly different between the two groups . The stimulation program enhanced the expression component of sucking , result ing in better oral feeding performance OBJECTIVE To assess whether an oral stimulation program , before the introduction of oral feeding , enhances the oral feeding performance of preterm infants born between 26 and 29 weeks ' gestational age . STUDY DESIGN Preterm infants ( n = 32 ) were r and omized into an experimental and control group . Infants in the experimental group received an oral stimulation program consisting of stimulation of the oral structures for 15 minutes . Infants in the control group received a sham stimulation program . Both were administered once per day for 10 consecutive days , 48 hours after discontinuation of nasal continuous positive air pressure . RESULTS Independent oral feeding was attained significantly earlier in the experimental group than the control group , 11 + /- 4 days ( mean + /- SD ) versus 18 + /- 7 days , respectively ( P = .005 ) . Overall intake and rate of milk transfer were significantly greater over time in the experimental group than the control group ( P = .0002 and .046 , respectively ) . There was no difference in length of hospital stay between the 2 groups . CONCLUSION An early oral stimulation program accelerates the transition to full oral feedings in preterm infants . This was associated with greater overall intake and rate of milk transfer observed in the experimental group when compared with the control group The increased survival of sick and preterm neonates may be associated with long‐term problems which must be recognised and managed if outcome is to be optimised . In a prospect i ve study of 35 neonates ( median gestational age at birth 34 weeks ) admitted to a neonatal intensive care unit over a 3‐month period , we have documented a high incidence ( 14 of 35 ) of immature or abnormal feeding patterns when infants were assessed at 36 to 40 weeks postmenstrual age . Neonates with  prolonged respiratory support and delayed enteral and oral feeding were most affected . Compared with neonates who have normal initial feeding assessment s , neonates with disorganised or dysfunctional feeding were six times more likely to vomit and three times more likely to cough when offered solid food at 6 months of age . At 12 months of age significant differences were also found in tolerating lumpy food and enjoying mealtimes . We hypothesise that these feeding problems contribute to failure to thrive and psychosocial distress after discharge from the neonatal unit and propose potential neonatal measures to reduce their incidence This study compared the effects of oral stimulation with those of oral support on non-nutritive sucking and feeding parameters in preterm infants . Preterm infants ( 23 males , 20 females ) born between 29 and less than 34 weeks ' gestational age ( GA ; mean GA 31.2wks [ st and ard error of mean{SEM } 0.39 ] ; mean birth-weight 1580 g [ SEM 120 ] ) were allocated to one of three experimental groups : ( Stimulation+support [ five males , four females ] ; Stimulation [ four males , seven females ] ; and Support [ seven males , five females ] ) or a control group .  Non-nutritive sucking pressure and sucking activity were quantified in the gavage and transition periods . Oral support minimizes fluid loss , stabilizes the jaw , and organizes deglutition . The time of transition , the quantity of milk ingested per day , and the number of bottle feeds per day were recorded . Variables were analyzed by repeated- measures analysis of variance , with birth-weight as covariate ( ANCOVA ) . Transition time was reduced ( p<0.0001 ) for the Stimulation+support and Support groups . ANCOVA computed during gavage showed increased non-nutritive sucking pressure and sucking activity ( p<0.001 ) for the Stimulation and Stimulation+support groups . ANCOVA computed during transition revealed increases in non-nutritive sucking pressure and daily bottle feeds ( p<0.001 ) for the three experimental groups and in daily milk ingested ( p=0.002 ) for the Stimulation+support and Support groups . We demonstrated that oral support is the result of both the action of chin and cheek support , and the aid to deglutition . An analysis of the organization of sucking patterns should be undertaken to provide better underst and ing of the mechanisms involved in oral support UNLABELLED To assess if sensory-motor-oral stimulation and non-nutritive sucking gavage feeding enhances the oral feeding performance of preterm infants born between 26 and 32 weeks of gestational age . STUDY DESIGN Very low birthweight infants ( n=98 ) were r and omized into a experimental and control group . Preterm infants in the experimental group received sensory-motor-oral stimulation and non-nutritive sucking and infants in the control group received a sham stimulation program . Both were administered from when they reached enteral diet ( 100 kcal/kg/day ) until the beginning of oral diet . Primary outcome was length of hospital stay . RESULTS Independent oral feeding was attained significantly earlier in the experimental group than the control group , 38+/-16 days of life ( mean+/-S.D. ) versus 47+/-17 days of life , respectively ( P<0.001 ) There was significant difference in length of hospital stay between the two groups ( 41.9+/-17 ( mean+/-S.D. ) versus 52.3+/-19 days ( P<0.01 ) ) . CONCLUSION Sensory-motor-oral stimulation , together with early  non-nutritive sucking  ( as soon as the newborn reaches full diet and is clinical ly stable ) in very low birthweight preterm infants , as long as they are clinical ly stable , in this study , earlier initiation of oral feeding and earlier hospital discharge Purpose : Preterm infants frequently experience oral feeding difficulties due to underdeveloped oral motor skills and the lack of coordination of sucking , swallowing , and respiration . The infants ’ ability to consume all feedings orally while maintaining physiologic stability and weight gain is necessary for their discharge . Therefore , difficulty with oral feeding leads to longer hospital stays and higher costs . For example , with more than half a million of premature infants born each year , a 3-day decrease in hospital stay would save more than 2 billion dollars annually . There is a need for evidence d-based interventions that facilitate development of oral-motor skills , leading to improved oral feeding , thus shortening hospital stays and lowering costs . The purpose of this research was to test the newly developed Premature Infant Oral Motor Intervention ( PIOMI ) beginning at 29 weeks postmenstrual age ( PMA ) , before oral feedings were introduced , to determine whether the prefeeding intervention would result in a shorter transition from gavage to total oral feedings and a shorter length of hospital stay ( LOS ) . The PIOMI is a 5-minute oral motor intervention that provides assisted movement to activate muscle contraction and provides movement against resistance to build strength . The focus of the intervention is to increase functional response to pressure and movement and control of movements for the lips , cheeks , jaw , and tongue . The cheeks ( internal and external ) , lips , gums , tongue , and palate were stimulated per specific protocol with finger stroking . Subjects : A total of 19 infants from 1 level III NICU born between 26 and 29 weeks PMA : 10 in the experimental group and 9 in the control group . Design : A r and omized , blinded , clinical trial was conducted to examine outcomes related to the newly developed PIOMI . Methods : Beginning at 29 weeks PMA ( and before the introduction of oral feeding ) , the experimental group received the PIOMI for 5 minutes per day for 7 consecutive days . The control group received a sham intervention to keep staff and parents blinded to the infants ’ group assignment . Physiological and behavioral stabilities were continually assessed throughout the intervention . A chart review was then conducted to compare the transition from gavage feeding to total oral feedings between the experimental and control group , as well as LOS . Results : The PIOMI was well tolerated by 29-week PMA infants , as evidence d by physiological and behavioral cues . Infants who received the once-daily PIOMI transitioned from their first oral feeding to total oral feedings 5 days sooner than controls ( P = .043 ) and were discharged 2.6 days sooner than controls . Conclusion : This pilot work supports further study on the use of the PIOMI with preterm infants to enhance oral-feeding skills and decrease LOS Purpose : The purpose of this secondary analysis was to assess whether alert behavioral states were associated with an increased number of feeding readiness behaviors ( FRBs ) and whether the number of FRBs were associated with subsequent feeding efficiency in healthy premature infants born between 29 to 35 weeks gestation . Study Design and Methods : The data were collected as part of a larger study design ed to compare the frequency of  FRBs  and feeding efficiency between control and experimental groups . Data from 21 stable premature infants were included in this secondary analysis . Infants were videotaped immediately prior to each of the first three oral feedings , from which infant behavioral state ( IBS ) and FRBs were assessed . Feeding efficiency was determined by calculating the ratio of feeding intake to feeding duration . Results : IBS was not a significant predictor of the number of FRBs . The number of FRBs was predictive of feeding efficiency ( p < .05 ) . Group assignment was a marginally significant predictor of feeding efficiency ( p < .10 ) . Infant sex ( p < .05 ) , birthweight ( p < .01 ) , gestational age at birth ( p < .01 ) , and gestational age at entry ( p < .05 ) were identified as significant predictors of the number of FRBs . Group assignment was marginally significant ( p < .10 ) . Clinical Implication s : Feeding efficiency may be predicted by the increased number of FRBs immediately prior to feeding . An infant ’s attributes ( sex , birth-weight , and gestational age ) may relate to feeding efficiency and should be assessed when instituting oral feeding . Assessment of FRBs can be easily incorporated into routine clinical practice OBJECTIVE To test the hypothesis that healthy preterm infants r and omly assigned to a semi-dem and feeding protocol would require fewer days to attain oral feeding and have a satisfactory weight gain compared with control infants receiving st and ard care . STUDY DESIGN In 2 neonatal intensive care nurseries , 81 infants 32 to < or = 34 weeks ' postconceptional age were r and omly assigned to the control ( n = 41 ) or experimental ( n = 40 ) protocol for transition from gavage to oral feedings . The control protocol followed the st and ard practice of gradually increasing scheduled oral feedings , whereas the experimental protocol used a semi-dem and feeding method contingent on infant behavior . Analysis of variance techniques were used to compare the study groups for number of days to attain oral feeding and weight gain . RESULTS The semi-dem and method shortened the time for infants to achieve oral feeding by 5 days ( P < .001 ) . There were no differences in weight gain between the study groups , and both groups had satisfactory weight gain . CONCLUSION The semi-dem and method for the transition from gavage to oral feeding in healthy , preterm infants 32 to < or = 34 weeks postconceptional age promotes faster attainment of oral feeding and does not compromise their weight gain
PURPOSE To identify and systematize the main studies on the transition from enteral to oral feeding in preterm infants .