Baylor

It is well recognized that preterm infants have difficulty transitioning from tube to oral feeding (bottle/breast). Such difficulty frequently leads to prolonged hospitalization, delayed mother-infant reunion, and increased medical cost. Poor oral feeding may result from immature oral-motor skills, disorganized or delayed swallowing, and/or in-coordination of sucking, swallowing, and respiration. The latter is essential if these infants are to feed safely, i.e., with no aspiration, and successfully, i.e., capable of finishing all their feedings by mouth with adequate daily weight gain. Developmental care consists of a broad category of interventions designed to improve the developmental outcome of preterm infants. Its approach is based on the concept that environmental inputs can influence infants? development through their various senses, ie, visual, auditory, tactile, kinesthetic, vestibular, olfactory and gustatory. A premature birth not only places infants in a highly technological environment, but importantly disrupts the in utero environment that provides the necessary sensory stimulation for optimizing infants? developmental outcome. Although this specialized environment is necessary for their survival, it exposes these infants to an excess of negative sensory stimuli, eg, bright lights and loud noises. It is speculated that such mismatch between the actual sensory input and the one the developing infants? would have received in utero may lead to impaired developmental outcomes. Oral feeding is an area that is compromised by prematurity and exposure to the NICU environment. The difficulties experienced by preterm infants in oral feeding may be due to their immature physiological functions and exposure to negative environmental stimuli. As such, a developmental care approach, using appropriate sensory stimulation, may enhance the development of appropriate oral feeding skills in preterm infants. We have developed a nipple device that allows for the simultaneous monitoring of sucking, swallowing, and breathing. With this tool, we have gained an understanding of the development of sucking in infants and established a 5-stage scale that assesses the level of infant sucking skills. In an earlier study, we have observed that the use of a non-nutritive stimulation program prior to the introduction of oral feeding (H# 7469), accelerated the transition of these infants from tube to oral feeding. It was speculated that such early experience prepared the neural and muscular structures implicated in sucking, swallowing and/or respiration to the function of oral feeding.Tactile/kinesthetic stimulation consisting of stroking the head, limbs, and torso, along with passive range of motion of the limbs leads to more alert states, higher scores on the Brazelton Neurological Behavioural Assessment Scale that evaluates infants habituation, motor maturity and range of states at term age, and increases weight gain. Since these factors are also part of the oral feeding process, it is postulated that tactile/kinesthetic stimulation may have beneficial effects on preterm infants? oral feeding performances.Specific sensory stimulation interventions may have beneficial effects on preterm infants? development beyond their targeted area. For instance, oral stimulation aimed at improving preterm infants? sucking skill also enhances their behavioural state organization. In turn, tactile/kinesthetic stimulation not only improves infants? motor development, but also increases their behavioural state organization. Therefore, the simultaneous provision of multiple forms of sensory stimulations, eg, oral + tactile/kinesthetic may have an additive or synergistic effect on infants? oral feeding skills.

Objective I: To demonstrate that 1. preterm infants who receive an oral and/or tactile/kinesthetic stimulation program, prior to the introduction of oral feeding, will achieve better oral feeding performance than their control counterparts. More specifically, when compared to control counterparts, they will: a. attain independent oral feeding sooner; b. demonstrate better overall transfer and rate of transfer; c. have developed more mature sucking skills, i.e., more advanced stage of sucking, greater suction and expression amplitudes, and longer sucking burst duration; d. display more advanced motor function, i.e., postural alignment, head and trunk control, and limb movements; 2. preterm infants who receive a combined oral + tactile/kinesthetic stimulation program, prior to the start of oral feeding, will demonstrate enhanced oral feeding performance over that of infants who received either one of the above interventions singly.

Objective 2: To assess the long-term effect of these interventions on the oral feeding performance of these infants during their first 2 years of life. The primary outcome will be the number of subjects requiring more than 1 visit to a feeding specialist/feeding disorder clinic for feeding problems. Secondary outcomes will consist of age(s) of attainment of specific feeding milestones.

Other

An experienced occupational therapist will perform all the interventions. Bottle feeding will be offered by the regular caretaker or the occupational therapist when mother is not present so as to insure that breastfeeding will not be disrupted. These evaluations will be conducted so as not to interfere with any other procedures. These studies are not intensive nor invasive to the subjects. If indication of overstimulation is observed during the interventions, they will be halted.

The tests used following hospital discharge are routine tests administered to infants to follow growth and development

The subjects may not benefit from this study. However, potential benefits of the proposed interventions may include earlier attainment of independent oral feeding and earlier hospital discharge.