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Behavioral and physiologic effects of nonnutritive sucking during gavage feeding in preterm infants
J A DiPietro1, R M Cusson, M O Caughy
1Department of Maternal and Child Health, Johns Hopkins University, Baltimore, Maryland 21205.
Insights
Nonnutritive sucking, like using a pacifier, reduces behavioral distress in preterm infants during gavage feeding. However, it does not significantly alter their physiological responses to the feeding procedure.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Infant physiology
Background:
- Nasogastric gavage feeding is a common procedure for preterm infants.
- This feeding method can elicit significant behavioral and physiological stress responses.
- Nonnutritive sucking is a potential intervention to mitigate these stressors.
Purpose of the Study:
- To assess the impact of nonnutritive sucking via pacifier on behavioral and physiological responses during nasogastric gavage feeding in preterm infants.
- To determine if pacifier use alters infant stress indicators during a standardized feeding protocol.
Main Methods:
- A standardized protocol including baseline, handling, pregavage, gavage, and postgavage periods was used.
- Thirty-six stable preterm infants were studied over two consecutive days.
- On one day, a pacifier was provided during and after the gavage feeding; physiological (heart period, vagal tone, oxygen saturation) and behavioral states were quantified.
Main Results:
- Preterm infants showed reduced heart period, vagal tone, and oxygen saturation in response to handling and gavage feeding.
- Pacifier use did not significantly alter these physiological responses, though a trend towards fewer bradycardia and desaturation episodes was observed.
- Nonnutritive sucking significantly improved behavioral state, reducing fussiness, active awake states, and accelerating return to sleep.
Conclusions:
- Nonnutritive sucking effectively lessens behavioral distress experienced by preterm infants during nasogastric gavage feeding.
- Physiological responsivity to gavage feeding in stable preterm infants is not significantly altered by the provision of a pacifier.
- Pacifier use may be a valuable tool for managing behavioral distress in preterm infants undergoing iatrogenic procedures.
Abstract:
Behavioral and physiologic responsivity to nasogastric gavage feeding was assessed in 36 preterm infants on 2 consecutive d. On one of these days, a pacifier was provided during and after the gavage segment of the standardized protocol. The protocol was divided into segments that included baseline, preparatory handling, pregavage, gavage, and postgavage periods. Patterns of cardiac (heart period and vagal tone), oxygen saturation, behavioral state, and defensive behavioral responses to gavage were quantified. These stable preterm infants responded to handling and gavage feeding with reduction in heart period, vagal tone, and oxygen saturation. These responses were not altered by provision of a pacifier, although there was a tendency for fewer episodes of bradycardia and oxygen desaturation. Conversely, behavioral state was affected significantly by nonnutritive sucking: when provided with a pacifier, infants exhibited less behavioral distress, spent less time in fussy and active awake states during and after feeding, and returned to a sleep state significantly faster. There is converging evidence to suggest that nonnutritive sucking lessens behavioral distress to iatrogenic stressors but does not alter physiologic responsiveness.