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Impact of a pre-feeding oral stimulation program on first feed attempt in preterm infants: Double-blind controlled
Karine da Rosa Pereira1, Deborah Salle Levy1,2, Renato S Procianoy3,4
1Department of Speech-Language Pathology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
Insights
An oral stimulation program significantly improved feeding skills in preterm infants, reducing the time to transition from tube feeding to oral intake. Breastfeeding also positively impacted this transition time.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Clinical nutrition
Background:
- Preterm infants often require specialized feeding support due to immature oral motor skills.
- Transitioning from tube feeding to full oral intake is a critical developmental milestone.
- Oral stimulation may enhance oral motor function and feeding performance.
Purpose of the Study:
- To assess the efficacy of an oral stimulation program on the initial oral feeding performance of preterm infants.
- To evaluate the impact of oral stimulation on oral feeding skills (OFS).
- To determine the effect on the time required to transition from tube feeding to total oral intake.
Main Methods:
- A double-blind randomized clinical trial was conducted with very preterm newborns.
- The intervention group received a 10-day daily oral stimulation program; the control group received a sham procedure.
- Oral feeding ability was assessed by a blinded speech-language pathologist using Oral Feeding Skills (OFS).
Main Results:
- Infants in the intervention group showed significantly higher proficiency (41.5% vs. 19.9%), transfer rates (2.3 vs. 1.1 mL/min), and overall transfer (57.2% vs. 35.0%) compared to controls (p<0.001).
- Median transition time from tube to oral feeding was significantly shorter in the intervention group (4 days vs. 8 days, p=0.003).
- Breast milk intake was associated with reduced transition time, and the oral stimulation program's effect remained significant (p=0.007).
Conclusions:
- An oral stimulation program is beneficial for improving oral feeding performance in preterm infants.
- The intervention significantly reduced the time needed to transition from tube to oral feeding.
- Both oral stimulation and breastfeeding support a timely transition to oral feeding in this population.
Objective:
To evaluate the effect of an oral stimulation program in preterm on the performance in the first oral feeding, oral feeding skills and transition time from tube to total oral intake.
Study Designer:
Double-blind randomized clinical trial including very preterm newborns. Congenital malformations, intracranial hemorrhage grade III or IV, bronchopulmonary dysplasia, and necrotizing enterocolitis were excluded. Intervention group (GI) received an oral stimulation program of tactile extra-, peri-, and intraoral tactile manipulation once a day for 15 minutes, during a 10-day period. Control group (GII) received sham procedure with same duration of time. Feeding ability was assessed by a speech-language pathologist blinded to group assignment. The classification of infants' oral performance was determined by Oral Feeding Skills (OFS). Neonates were monitored until hospital discharge.
Results:
Seventy-four (37 in each group) were randomized. Mean gestational ages and birth weights were 30±1.4 and 30±1.5 weeks, and 1,452±330g and 1,457±353g for intervention and control groups, respectively. Infants in the intervention group had significantly better rates than infants in the control group on: mean proficiency (PRO) (41.5%±18.3 vs. 19.9%±11.6 (p<0.001)), transfer rate (RT) (2.3 mL/min and 1.1 mL/min (p<0.001)) and overall transfer (OT) (57.2%±19.7 and 35.0%±15.7 (p<0.001)). Median transition time from tube to oral feeding was 4 (3-11) and 8 (7-13) days in intervention and control groups, respectively (p = 0.003). Intake of breast milk was found to reduce transition time from tube feeds to exclusive oral feeding (p<0.001, HR 1.01, 95%CI 1.005-1.019), but the impact of the study intervention remained significant (p = 0.007, HR 1.97, 95%CI 1.2-3.2).
Conclusion:
Infants who were breast-fed and an oral stimulation program proved beneficial in reducing transition time from tube feeding to oral feeding.
Trial Registration:
ClinicalTrials.gov number NCT03025815.
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