Sucking Patterns in Infants with Down Syndrome admitted to a Level 4 Neonatal Intensive Care Unit

Infants with Down syndrome present multiple challenges that can affect growth and development, among them feeding, difficulties that arise in the early days after birth. We aimed to describe the sucking patterns of infants with Down syndrome in the neonatal intensive care unit (NICU).

We reviewed the medical records of infants with Down syndrome admitted (2012-2022) to the University Pediatric Hospital NICU in San Juan, Puerto Rico, who were evaluated with a clinical swallow examination and the Neonatal Oral-Motor Assessment Scale (NOMAS).

The study included 29 infants. The median gestational age was 38 weeks, and the median birth weight was 2650 grams. Generalized low muscle tone was identified in 81% of the infants. Sucking patterns were classified as disorganized (41%), dysfunctional (52%), and mature (7%). Only 8% of term infants had mature sucking. The clinical signs of swallow dysfunction included reduced oxygen saturation (20%), mottling (50%), interference with the gag reflex (31%), stridor (40%), and wet or gurgly breathing (75%).

Mature sucking skills are expected in term infants. However, our sample of term infants with Down syndrome had a high prevalence of dysfunctional sucking. Neonates with congenital anomalies associated with hypotonia require a formal assessment with a clinical tool to determine their readiness for oral feeding and may require a complete evaluation of feeding and swallowing for the diagnosis and monitoring of swallowing dysfunction. These assessments will form the basis for the design of evidence-based interventions and may yield valuable information regarding neurodevelopmental outcomes.