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Early Intervention to Improve Sucking in Preterm Newborns: A Systematic Review of Quantitative Studies
Angela Grassi1, Giada Sgherri, Olena Chorna
1The BioRobotics Institute, Scuola Superiore Sant'Anna, Polo Sant'Anna Valdera, Pontedera, Pisa, Italy (Drs Grassi, Cecchi, and Laschi); Departments of Translational Research and of New Surgical and Medical Technologies (Dr Sgherri) and Clinical and Experimental Medicine (Dr Guzzetta), University of Pisa, Pisa, Italy; Stella Maris Infant Laboratory for Early Intervention, Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy (Ms Chorna and Drs Marchi and Guzzetta); and Department of Woman and Child Health, Ospedale Versilia AUSL 12, Viareggio, Italy (Dr Gagliardi).
Insights
Nonnutritive sucking (NNS) and oral stimulation interventions improve preterm infant feeding. Most interventions positively influenced sucking efficiency, but NNS alone was less effective.
Area of Science:
- Neonatal development
- Pediatric feeding interventions
- Infant neurodevelopment
Background:
- Premature birth often leads to feeding difficulties due to poor sucking, swallowing, and breathing coordination.
- Nonnutritive sucking (NNS) and oral stimulation show promise for improving oral feeding in preterm infants.
- The precise mechanisms by which these interventions enhance sucking performance require further investigation.
Purpose of the Study:
- To systematically review studies on interventions for preterm infants focusing on quantitative measures of sucking performance.
- To summarize the existing evidence regarding the impact of various interventions on specific components of sucking behavior.
- To provide a foundation for understanding intervention effectiveness in promoting oral feeding skills.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (PubMed, CINAHL, MEDLINE, EMBASE, PSYCOLIST) for English-language studies published up to August 2017.
- Included studies involved preterm infants, experimental interventions aimed at improving sucking or oral feeding, and utilized objective measures of sucking performance.
- Specific Medical Subject Headings (MeSH) terms were employed to ensure thoroughness in the search strategy.
Main Results:
- Nineteen studies (15 randomized controlled trials, 1 quasi-randomized, 3 crossover) met the inclusion criteria.
- Interventions were categorized into six groups: NNS, NNS with auditory reinforcement, sensorimotor stimulation, oral support, combined training, and nutritive sucking.
- Most intervention types positively affected sucking efficiency parameters, with interventions based solely on NNS showing less impact.
Conclusions:
- Findings support the clinical use of NNS and oral stimulation interventions for preterm infants struggling with efficient sucking.
- Further research incorporating quantitative sucking performance measures is essential for developing more personalized and effective interventions.
- Enhanced understanding of intervention mechanisms can lead to improved clinical care for vulnerable preterm infants.
Background:
Premature birth is associated with feeding difficulties due to inadequate coordination of sucking, swallowing, and breathing. Nonnutritive sucking (NNS) and oral stimulation interventions may be effective for oral feeding promotion, but the mechanisms of the intervention effects need further clarifications.
Purpose:
We reviewed preterm infant intervention studies with quantitative outcomes of sucking performance to summarize the evidence of the effect of interventions on specific components of sucking.
Methods:
PubMed, CINAHL, MEDLINE, EMBASE, and PSYCOLIST databases were searched for English language publications through August 2017. Studies were selected if they involved preterm infants, tested experimental interventions to improve sucking or oral feeding skills, and included outcome as an objective measure of sucking performance. Specific Medical Subject Headings (MeSH) terms were utilized.
Results:
Nineteen studies were included in this review: 15 randomized, 1 quasi-randomized, and 3 crossover randomized controlled trials. Intervention types were grouped into 6 categories (i) NNS, (ii) NNS with auditory reinforcement, (iii) sensorimotor stimulation, (iv) oral support, (v) combined training, and (vi) nutritive sucking. Efficiency parameters were positively influenced by most types of interventions, though appear to be less affected by trainings based on NNS alone.
Implications For Practice:
These findings may be useful in the clinical care of infants requiring support to achieve efficient sucking skills through NNS and oral stimulation interventions.
Implications For Research:
Further studies including quantitative measures of sucking performance outcome measures are needed in order to best understand the needs and provide more tailored interventions to preterm infants.
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