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Updated: Aug 2, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Nutritive sucking and neurobehavioral development in preterm infants from 34 weeks PCA to term
B Medoff-Cooper1, J M McGrath, W Bilker
1University of Pennsylvania, School of Nursing, Philadelphia. medoff@nursing.upenn.edu
Insights
Preterm infants show significant improvements in nutritive sucking and alertness from 34 weeks postconceptional age (PCA) to term. However, alertness doesn't always enhance sucking skills in preterm infants at 34 weeks PCA.
Area of Science:
- Neonatology
- Developmental Pediatrics
- Infant Nutrition
Background:
- Preterm infants exhibit unique developmental trajectories compared to full-term infants.
- Nutritive sucking and behavioral state are critical indicators of infant development and feeding readiness.
- Understanding neurobehavioral development in preterm infants is crucial for optimizing care and interventions.
Purpose of the Study:
- To examine the maturation of nutritive sucking patterns and behavioral states in preterm infants.
- To assess neurobehavioral development in preterm infants from 34 weeks postconceptional age (PCA) to term.
- To investigate the relationship between sucking parameters, behavioral state, and neurobehavioral outcomes.
Main Methods:
- A descriptive correlational study design was employed.
- 66 preterm infants (gestational age 24-34 weeks) were assessed at 34 and 40 weeks PCA.
- Data collected using the Kron Nutritive Sucking Apparatus, Anderson Behavioral State Scale (ABSS), and Brazelton Neonatal Behavioral Assessment Scale (BNBAS).
Main Results:
- Significant improvements in sucking number, intensity, and timing were observed from 34 weeks PCA to term (p < 0.001).
- Preterm infants demonstrated increased alertness during sucking protocols with maturation (p < 0.001).
- Sucking parameters at 34 weeks PCA and term were not significantly correlated with BNBAS scores or infant state.
Conclusions:
- High-risk preterm infants show significant maturation in sucking behaviors and alertness by term.
- Unlike full-term infants, preterm infant alertness may not directly enhance sucking skills at 34 weeks PCA due to stress.
- The relationship between alertness and feeding success appears to evolve by 40 weeks PCA in preterm infants.
Purpose:
To investigate changes in nutritive sucking patterns, behavioral state, and neurobehavioral development of preterm infants from the 34 weeks postconceptional age (PCA) to term.
Design:
Nonexperimental descriptive correlational design was used.
Methods:
A convenience sample included 66 preterm infants with a gestational age between 24 and 34 weeks at birth. Mean gestational age was 29.7 weeks, with a mean birthweight of 1379 grams. Instruments included the Kron Nutritive Sucking Apparatus, the Anderson Behavioral State Scale (ABSS), and the Brazelton Neonatal Behavioral Assessment Scale (BNBAS). A feeding procedure was administered at 34 and 40 weeks PCA with BNBAS administered at 40 weeks PCA. Data analysis strategies included t-tests, Spearman rho correlations, Wilcoxon matched-pairs signed-ranks test, and a Random Coefficients Model.
Results:
There were significant differences in number of sucks (p < 0.001), intensity of sucking pressures (p < 0.001), average time between sucks (p < 0.001), and average time between bursts (p < 0.001) from 34 weeks PCA to term. With maturation, it was noted that the preterm infants were significantly more alert during the sucking protocol from 34 weeks to term (p < 0.001). Yet, infant sucking parameters at 34 weeks PCA and term were not significantly related to the BNBAS or to the infant's state.
Clinical Implications:
These results demonstrate that high risk preterm infants mature significantly in their sucking behaviors and in their ability to maintain a more alert behavioral state from 34 weeks PCA to term. However, unlike full term infants--where state is positively correlated to feeding (sucking) success--the preterm infant state of alertness may not enhance sucking skills at 34 weeks PCA. These infants may be too stressed to manage both feeding and stimulation from the environment that is unavoidable when alert. However, this relationship does appear to change by 40 weeks PCA.
