|Schanler, Richard - Rich|
Submitted to: Acta Paediatrica
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/25/2000
Publication Date: N/A
Citation: Interpretive Summary: Because they are underdeveloped, babies who are born prematurely have a hard time moving from tube feeding to full oral feeding. The babies have to learn how to suck, drink and swallow fluids successfully, without choking. Very little is known about the development of sucking in premature infants. The objective of our study was to show that the bottle-feeding behavior of these infants reflects the stage of development of their sucking capabilities. We followed a group of premature infants from the time they were started on oral feeding until they were able to master total oral feeding. We categorized the developmental process into five primary sucking stages, using a special nipple/bottle system to monitor the process. Although some clinicians think a particular age is the best time to start oral feeding, other factors might be evaluated in individual infants, such as endurance and coordination of sucking, swallowing and breathing. The developmental sucking scale that we created is the first that has been designed and described, to our knowledge, for premature infants. It should prove extremely useful to clinicians in figuring out when to start an infant on oral feeding, as well as gauging and promoting the infant's progress toward full oral feeding. Besides helping the baby gain weight and receive optimal nutrition by mouth, this knowledge is very important because it has many positive ramifications with regard to earlier hospital discharge and associated health-care cost reductions.
Technical Abstract: It is acknowledged that the difficulty many preterm infants have in feeding orally results from their immature sucking skills. However, little is known regarding the development of sucking in these infants. The aim of this study was to demonstrate that the bottle-feeding performance of preterm infants is positively correlated with the developmental stage of their sucking. Infants' oral-motor skills were followed longitudinally using a special nipple/bottle system which monitored the suction and expression/ compression component of sucking. The maturational process was rated into five primary stages based on the presence/absence of suction and the rhythmicity of the two components of sucking, suction and expression/ compression. This five-point scale was used to characterize the developmental stage of sucking of each infant. Outcomes of feeding performance consisted of overall transfer (percent total volume transferred/volume to be taken) and rate of transfer (ml/min). Assessments were conducted when infants were taking 1-2, 3-5 and 6-8 oral feedings per day. Significant positive correlations were observed between the five stages of sucking and postmenstrual age, the defined feeding outcomes, and the number of daily oral feedings. Overall transfer and rate of transfer were enhanced when infants reached the more mature stages of sucking. We have demonstrated that oral feeding performance improves as infants' sucking skills mature. In addition, we propose that the present five-point sucking scale may be used to assess the developmental stages of sucking of preterm infants. Such knowledge would facilitate the management of oral feeding in these infants.