Nonnutritive sucking modulates behavioral state for preterm infants before feeding. Effect of Nonnutritive Sucking On Behavioral State In Preterm Infants Before Feeding Facilitating Inactive Awake States In Preterm Infants: A Study of Three Interventions Promotion of preterm infant nipple feeding with nonnutritive sucking. Non‐nutritive sucking does not increase blood levels of gastrin, motilin, insulin and insulin‐like growth factor 1 in premature infants receiving enteral feedings Nonnutritive sucking during tube feedings: effects on preterm neonates in an intensive care unit. Effect of Nonnutritive Sucking on Infant Gastroesophageal Reflux Effects of sweet taste stimulation on growth and sucking in preterm infants. The effect of acoustic stimulation on cessation and initiation of non-nutritive sucking in neonates. The effect of music-reinforced nonnutritive sucking on feeding rate of premature infants. Lack of improved growth outcome related to nonnutritive sucking in very low birth weight premature infants fed a controlled nutrient intake: a randomized prospective study. Nonnutritive sucking and necrotizing enterocolitis. Effect of nonnutritive sucking on nutrient retention in preterm infants. EFFECTS OF NON‐NUTRITIVE SUCKING ON NUTRITIVE SUCKING, BREATHING, AND BEHAVIOR DURING BOTTLE FEEDINGS OF PRETERM INFANTS
Forty-two pre-term infants were studied to determine the effect of nonnutritive sucking pre-feeding on behavioral state .  Infants were r and omly assigned to pacifier or rest groups . Pacifiers or rest were given for 5 minutes following routine caregiving and before each of the first 16 bottle feedings . A 12-category scale was used to measure state immediately before the 5-minutes and after . Frequencies of states that precede optimal feedings changed for infants given pacifiers versus rest : alert inactivity ( + 6 vs. -2 ) , quiet awake ( + 19 vs. -6 ) , and active awake ( -24 vs. + 12 ) ; infants given pacifiers had more sleep and fewer restless states . Group differences were non-significant before nonnutritive sucking ( p = 0.16 ) but significant after ( p = 0.00001 ) . When self-regulatory feeding policies based on early hunger cues are not allowed , nonnutritive sucking for 5 minutes pre-feeding is simple , brief , and appropriate for busy intensive care units . These findings confirm those from earlier less conclusive research and indicate that nonnutritive sucking modulates behavioral state To describe the effect of nonnutritive sucking ( NNS ) on behavioral state ( BSt ) in preterm infants before feedings 24 preterm infants were r and omly assigned and studied before each of their first 16 bottle feedings . Twelve received NNS by pacifier for 5 minutes ; 12 did not receive a pacifier .  BSt was measured with a 12-category scale for 30 seconds before the 5-minute period ( BSt1 ) and for 30 seconds after ( BSt2 ) . Sleep states decreased for both groups . BSts considered more optimal for feeding increased more during NNS ( 86 vs. 46 ) . Restless states were three times less frequent after NNS ( 23 vs. 68 ) . Differences between groups were nonsignificant at BSt1 , but were significant at BSt2 , p < .001 . In the absence of self-regulatory feeding policies based on early hunger cues , NNS for 5 minutes prefeeding is simple , brief , and suitable for implementation in busy neonatal intensive care units . Nonnutritive sucking was an effective modulator of behavioral state for this sample Inactive awake behavioral states have been associated with reduced heart rates and more successful feeding in preterm infants . The purpose of this study was to test the efficacy of three different interventions to facilitate these optimal feeding states . Twenty preterm infants ( gestational ages 27–33 weeks , M = 31.6 , SD = 1.7 ; birth weights 931–2,140 grams , M = 34 , SD = 373 ) serving as their own controls were r and omly administered nonnutritive sucking , nonnutritive sucking plus rocking , and stroking interventions ; and a control condition . There were significantly more inactive awake states with the nonnutritive sucking and nonnutritive sucking plus rocking interventions than with the stroking intervention and the control conditions . The results suggest that there are interventions that can help preterm infants in the transition from gavage to oral feeding and potentially shorten their hospital stays Transition of preterm infants from enteral to nipple feeding is a necessary milestone for hospital discharge . This study tested the efficacy of one potential intervention to facilitate the transition process . Ten minutes of nonnutritive sucking ( NNS ) and a control condition were administered r and omly before first nipple feedings . The sample consisted of 20 preterm infants ( gestational ages 27 - 33 weeks , M = 31.6 , SD = 1.7 ; birth weights 931 - 2 , 140 g , M = 1,649 , SD = 373 ) who served as their own controls . NNS result ed in fewer behavioral state changes during feedings and produced quiet , awake states more frequently during feedings . Heart rates did not differ between feedings following NNS compared with those in the control condition Non‐nutritive sucking in premature infants accelerates weight gain for unclear reasons . The effects of non‐nutritive sucking on enteral hormone secretion may augment digestion and /or absorption of nutrients . Blood concentrations of gastrin , motilin , insulin and insulin‐like growth factor‐1 were measured before and 72 h after the initiation of nasogastric feedings in 21 premature infants r and omly assigned to either a non‐nutritive suckling or control group . Gastrin and motilin concentrations increased significantly after feedings in all infants ( mean ± SEM ) ( gastrin , 4 ± 4 to 73 ± 9 pg/ml , p<0.01 ; motilin , 141 ± 5 to 181 ± 3 pg/ml , p<0.01 ) Pre‐ and post‐feed insulin concentrations were greater in the non‐nutritive sucking group receiving bolus feeds than in control infants who were bolusfed ( P<0.01 ) . Non‐nutritive sucking in premature infants does not appear to alter blood concentrations of motilin , gastrin , insulin or insuline‐like growth factor‐1 three days after initiation of feedings . If changes in the secretion of these hormones are induced by non‐nutritive sucking , they may be at a local paracrine level Preterm neonates ( mean 32 weeks ' gestation , 1,300 gm birth weight ) were provided a pacifier for nonnutritive sucking during tube feedings in the intensive care nursery . Their clinical course , subsequent bottle feeding behavior , and performance on the Brazelton Neonatal Behavior Assessment scale were compared with those of control group infants . The infants provided with pacifiers averaged 27 fewer tube feedings , started bottle feeding three days earlier , averaged a greater weight gain per day , and were discharged eight days earlier for an average hospital cost savings of approximately $ 3,500 . Formula intake was similar for the two groups , although nurses appeared to provide more feeding stimulation for the control infants . On the Brazelton scale , the infants provided with pacifiers showed weak reflexes more frequently . Increased restfulness and diminished activity level in these infants may have contributed to the appearance of weak reflexes . The consistency between these findings and those of previous investigators suggests that the provision of a pacifier for nonnutritive sucking during tube feedings may be a cost-effective form of intervention ABSTRACT : To evaluate the effect of pacifier use ( non-nutritive sucking ) on  gastroesophageal reflux in infants , 48 infants younger than 6 months of age with pathologic reflux were prospect ively evaluated with pH probe . In each infant , parameters of reflux were blindly quantified during paired periods in a cross-over design when pacifier use was either encouraged or prohibited . To determine whether positioning was a factor in the effect of nonnutritive sucking on reflux , 24 of the infants were studied seated and 24 studied prone . Pacifier use significantly affected only the frequency of reflux episodes , increasing it in prone infants from 7.2 ± 1.1 to 12.8 ± 2.3 episodes/120 min postpr and ially ( p = 0.040 ) and decreasing it in seated infants , from 21.1 ± 3.1 to 14.8 ± 2.6 postpr and ially ( p = 0.003 ) and from 17.3 ± 4.8 to 5.9 ± 0.9 in the fasting period ( p = 0.035 ) . It did not significantly affect the clearance of reflux episodes or the total reflux time . These results suggest that infants with pathologic reflux frequency might best avoid pacifier use while in the beneficial prone position . When seated position is necessary , the pacifying effects of nonnutritive sucking may be useful in decreasing reflux events as well as in reducing crying behavior OBJECTIVE To evaluate the effect of sweet taste stimulation in augmenting the reported growth-enhancing effects of nonnutritive sucking in preterm infants who are gavage-fed . DESIGN R and om assignment of preterm infants to receive stimulation by one of three methods during each feeding until totally orally fed . SETTING Hospital intensive-care and infant transitional units . PATIENTS Eligibility criteria included body weight greater than or equal to 1,250 g , gestational age younger than 34 weeks , growth parameters appropriate for gestational age , tolerating at least 100 kcals/kg/day by gavage feeding with evidence of weight gain , and no clinical evidence of health complications . Data are presented for 42 infants who completed 14 days of treatment . INTERVENTIONS Exposure to a sweet pacifier , a latex pacifier , or maternal heartbeat sounds during gavage feedings . MAIN OUTCOME MEASURES Growth , time to total oral feeding , and sucking responses . RESULTS No significant differences in sucking measures were noted among treatment groups . Differences in progression time to total oral feedings and weight gain favored the sweet-pacifier group but were not statistically significant . CONCLUSIONS Oral stimulation of gavage-fed , preterm infants during a 2-week hospitalization was not sufficient to elicit a significant improvement in growth efficiency , progression to total oral feedings , or sucking maturation . Additional studies may show a beneficial effect of chemosensory stimulation in preterm infants Discrete changes in the human newborn 's sucking behavior in response to acoustic stimulation was studied . In order to obtain a sensitive comparison measure for stimulus conditions , control trials were r and omly interspersed with stimulus trials . To prevent temporal biasing effects , variable interstimulus intervals were used , and stimuli were presented contingent on the infant 's sucking state on each trial . Results from 30 Ss clearly demonstrate the presence of two dichotomous responses : ( 1 ) response initiation to the stimulus in the presence of non-sucking ; and ( 2 ) response cessation to the stimulus in the presence of active-sucking . No differences were found among three groups exposed to qualitatively different stimuli of the same intensity , and there was no evidence of habituation of either response Premature infants are fed by gavage tube before 34 weeks adjusted gestational age and when nipple feeding results in detrimental changes in respiration and heart rate . Nipple feeding skill must be developed and correlates with length of hospitalization and neurobehavioral development . This study provided music reinforcement for nonnutritive sucking and assessed nipple feeding rates pre- and posttreatment for 32 infants referred as poor feeders . A pacifier fitted with a pressure transducer activated 10 seconds of recorded music in a one-trial , 15-minute intervention given to experimental infants ( n = 16 ) 30 to 60 minutes before the late afternoon bottle feeding . Feeding rates were collected for bottle feedings pre- and postintervention and for a similar interval for a no-contact control group ( n = 16 ) . Results showed that the intervention significantly increased feeding rates . Music functioned as reinforcement and the sucking behavior transferred from a nonnutritive to a nutritive event The effect of nonnutritive sucking during gavage feeding on nutritional outcome and gastrointestinal transit time was evaluated in 18 premature appropriate for gestational age infants whose birth weights were less than or equal to 1,400 g and gestational ages were less than or equal to 30 weeks . Infants were r and omized to a treatment ( nonnutritive sucking infants received a pacifier for 30 minutes with each feeding , 12 times per day until they reached a weight of 1,500 g , eight times per day thereafter ) or control ( no pacifier ) group . The nine nonnutritive sucking ( five girls , four boys ) and nine control ( five girls , four boys ) infants were treated for 14 days . Infants were without medical complications and were fed a single premature formula by intermittent gastric gavage at exactly 120 kcal/kg/d throughout the study period . Weight gain , linear growth , subscapular and triceps skinfold , and arm circumference accretions were assessed weekly . Serum proteins ( albumin , prealbumin , retinol-binding protein , and transferrin ) were measured weekly . Gastrointestinal transit times were measured weekly using carmine red markers . In contrast to previous studies , these data indicate no apparent effect of nonnutritive sucking on growth outcome , serum proteins , or gastrointestinal transit time in growing , very low birth weight infants when nutrient intake was controlled . In a subgroup of eight boys ( four nonnutritive sucking , four control ) , energy and fat excretions were determined from 72-hour fecal collection s and energy expenditure was estimated from six-hour cumulative heart rate measurements . Neither excretion of fat and calories nor estimated energy expenditure was affected significantly by nonnutritive sucking in this subgroup of baby boys .  Fat excretion correlated well ( r = .987 ) with energy excretion The purpose of this study was to explore the possible protective effect of nonnutritive sucking ( NNS ) against the development of necrotizing enterocolitis ( NEC ) . A retrospective chart review was conducted to examine the histories of 12 preterm infants who were enrolled in a longitudinal study of the effects of NNS on energy expenditure , weight gain , and feeding readiness . Six infants were enrolled in the control group ;  they did not receive NNS but did develop NEC .  Six infants were in the experimental group and did not develop NEC . The groups were compared on the basis of clinical correlates associated with NEC . These included race , gender , birth weight , five-minute Apgar , maternal bleeding , maternal age , and length of ruptured membranes . For infants who developed NEC , the number of clinical correlates ranged from one to four . For infants who received NNS , the range of clinical correlates was from one to five . It is not possible to conclude from this study that NNS protects preterm infants from NEC . Prospect i ve studies of larger sample sizes that involve examination of the effect of NNS on gastric motility and enzyme and hormone secretion are needed Cette etude des  balances energetique , azotee et lipidique  et du  temps de transit du carmin chez 10 prematures nes en moyenne a 1111 g± 189 et âges de 28± 24 jours au debut de l'etude , ne montre aucun effet immediat de la stimulation de la succion non nutritive au cours de l'alimentation par sonde , sur des differents PURPOSE The purpose of this study was to examine the effect of prefeeding non-nutritive sucking ( NNS ) on breathing , nutritive sucking ( NS ) , and behavioral characteristics of bottle feeding . SUBJECTSThe convenience sample was composed of 10 preterm infants who were 33 to 40 weeks postconceptual age ( PCA ) at the time of the observation . DESIGN R and omized , crossover ; each infant was observed twice during the first 48 hours of bottle feeding . METHODS Ten preterm infants received NNS before 1 bottle feeding and served as their own control at a second bottle feeding . Sucking  was measured using a chin strain gauge and breathing was measured with a nasal thermistor . Behavioral characteristics included behavior state , measured using the Neonatal Individualized Developmental Care and Assessment Program ( NIDCAP ) behavior state scale , and feeding efficiency . MAIN OUTCOME MEASURES Characteristics of NS ( number of suck bursts , sucks/burst , suck burst length ) and breathing ( number of breath bursts , breaths/burst , breath burst length ) , as well as behavior state during bottle feedings and feeding efficiency ( percent of prescribed formula consumed , formula consumed/minute of feeding ) . PRINCIPAL RESULTS NS waves were smoother and more regular than NNS waves . Time to onset and duration of the first non-nutritive suck burst were positively correlated with time to onset for the first nutritive suck burst . Prefeeding NNS had no statistically significant effect on characteristics of breathing or on any other characteristics of NS . Behavioral state during feedings and feeding efficiency were not affected by prefeeding NNS . CONCLUSIONS In this sample , the use of prefeeding NNS did not affect NS , breathing during feeding , or select behavioral characteristics of feeding
BACKGROUND Non-nutritive sucking is used during gavage feeding and in the transition from gavage to breast/bottle feeding in preterm infants .
The rationale for this intervention is that non-nutritive sucking facilitates the development of sucking behaviour and improves digestion of enteral feedings .
Non-nutritive sucking has been considered to be a benign intervention , although it has the potential to have a negative effect on breastfeeding or on the incidence of later oral aversion .
OBJECTIVES To determine whether non-nutritive sucking ( NNS ) in preterm infants influences : a ) weight gain , b ) energy intake , c ) heart rate , d ) oxygen saturation , e ) length of hospital stay , f ) intestinal transit time , g ) age at full oral feeds , or h ) any other clinical ly relevant outcomes .