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Non-nutritive sucking for gastro-oesophageal reflux disease in preterm and low birth weight infants
Kim Psaila1, Jann P Foster, Robyn Richards
1CHoRUS Project, Family and Community Health Research Group, School of Nursing and Midwifery, University of Western Sydney, College of Health and Science, Locked Bag 1797, Penrith South DC, NSW, Australia, 1797.
Insights
Non-nutritive sucking (NNS) may help calm infants, but no studies show it effectively treats gastro-oesophageal reflux disease (GORD) in preterm or low birth weight infants. More research is needed to confirm its benefits for infant GORD.
Area of Science:
- Neonatal care
- Gastroenterology
- Pediatric clinical trials
Background:
- Gastro-oesophageal reflux (GOR) is common in newborns, but gastro-oesophageal reflux disease (GORD) involves troublesome symptoms.
- Non-nutritive sucking (NNS) is used to calm infants and reduce fussiness during feeds.
- Evidence supporting interventions for infant GORD is lacking.
Purpose of the Study:
- To evaluate the effectiveness of non-nutritive sucking (NNS) in reducing gastro-oesophageal reflux disease (GORD) in preterm and low birth weight infants.
- To assess NNS as an intervention for infants under three months with GORD symptoms or diagnosis.
Main Methods:
- Systematic literature search of major electronic databases (CENTRAL, MEDLINE, CINAHL, EMBASE) up to September 2013.
- Inclusion criteria focused on controlled trials (randomized or quasi-random) of preterm (<37 weeks) or low birth weight (<2500g) infants with GORD.
- Independent review of studies by two authors, including assessment of quality and data extraction.
Main Results:
- No studies were identified that examined the effects of non-nutritive sucking (NNS) for gastro-oesophageal reflux disease (GORD) in preterm and low birth weight infants.
- Initial searches identified two studies, but both were excluded after further review.
Conclusions:
- There is insufficient evidence to determine the effectiveness of non-nutritive sucking (NNS) for treating gastro-oesophageal reflux disease (GORD).
- Further adequately powered randomized controlled trials (RCTs) are required to investigate the effect of NNS in preterm and low birth weight infants diagnosed with GORD.
Background:
Gastro-oesophageal reflux (GOR) is commonly diagnosed in the neonatal population (DiPietro 1994), and generally causes few or no symptoms (Vandenplas 2009). Conversely, gastro-oesophageal reflux disease (GORD) refers to GOR that causes troublesome symptoms with or without complications such as damage to the oesophagus (Vandenplas 2009). Currently there is no evidence to support the range of measures recommended to help alleviate acid reflux experienced by infants. Non-nutritive sucking (NNS) has been used as an intervention to modulate neonatal state behaviours through its pacifying effects such as decrease infant fussiness and crying during feeds (Boiron 2007; Pickler 2004).
Objectives:
To determine if NNS reduces GORD in preterm infants (less than 37 weeks' gestation) and low birth weight (less than 2500 g) infants, three months of age and less, with signs or symptoms suggestive of GORD, or infants with a diagnosis of GORD.
Search Methods:
We performed computerised searches of the electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 9, 2013), MEDLINE (1966 to September 2013), CINAHL (1982 to September 2013), and EMBASE (1988 to September 2013). We applied no language restrictions.
Selection Criteria:
Controlled trials using random or quasi-random allocation of preterm infants (less than 37 weeks' gestation) and low birth weight (less than 2500 g) infants three months of age and less with signs or symptoms suggestive of GORD, or infants with a diagnosis of GORD. We included studies reported only by abstracts, and cluster and cross-over randomised trials.
Data Collection And Analysis:
Two review authors independently reviewed and selected trials from searches, assessed and rated study quality and extracted relevant data. We identified two studies from the initial search. After further review, we excluded both studies.
Main Results:
We identified no studies examining the effects of NNS for GORD in preterm and low birth weight infants
Authors' Conclusions:
There was insufficient evidence to determine the effectiveness of NNS for GORD. Adequately powered RCTs on the effect of NNS in preterm and low birth weight infants diagnosed with GORD are required.
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