Functional Ontogeny of Hypothalamic Agrp Neurons in Neonatal Mouse Behaviors.

Hypothalamic Agrp neurons regulate food ingestion in adult mice. Whether these neurons are functional before animals start to ingest food is unknown. Here, we studied the functional ontogeny of Agrp neurons during breastfeeding using postnatal day 10 mice. In contrast to adult mice, we show that isolation from the nursing nest, not milk deprivation or ingestion, activated Agrp neurons. Non-nutritive suckling and warm temperatures blunted this effect. Using in vivo fiber photometry, neonatal Agrp neurons showed a rapid increase in activity upon isolation from the nest, an effect rapidly diminished following reunion with littermates. Neonates unable to release GABA from Agrp neurons expressed blunted emission of isolation-induced ultrasonic vocalizations. Chemogenetic overactivation of these neurons further increased emission of these ultrasonic vocalizations, but not milk ingestion. We uncovered important functional properties of hypothalamic Agrp neurons during mouse development, suggesting these neurons facilitate offspring-to-caregiver bonding.

Differences in the swallowing process of newborns and healthy preterm infants: first results with a non-invasive bioimpedance and electromyography measurement system.

PURPOSE: Preterm infants (PI) have difficulty coordinating sucking, swallowing and breathing, and there is a risk of aspiration. The causes of this are not yet sufficiently understood. The aim of this study was to test a novel measurement device to measure breathing and pharyngeal processes involved in swallowing externally in everyday life to identify possible differences in neonates (NB) and PI. METHODS: Forty healthy NB were studied at 4-8 weeks of age (mean: 6.7 weeks) and 20 healthy PI (mean gestational age 30.5 weeks) at postmenstrual age (PMA) 34/35 weeks (mean PMA 35.1 weeks) during a single feeding. Surface electrodes were used to measure bioimpedance and electromyography reflecting swallow-related changes in the pharynx and muscle activation of the tongue and submental muscles. A respiratory belt was combined with recording of the depth of chest movements and the occurrence of pauses in breathing. RESULTS: Velocity and extent of pharyngeal closure did not differ significantly across the feeding period (velocity: p=0.09, closure: p=0.17), but during the first two suck-swallow bursts PI had greater velocity (p<0.001*) and extent of pharyngeal closure (p=0.004*) than NB. The duration of swallowing phases was significantly longer in PIs (p<0.001*), their muscle activation decreased faster (p<0.001*), and they had more pauses in breathing than NBs. CONCLUSIONS: The novel measurement device allowed, for the first time in everyday life, the measurement of factors influencing swallowing and breath-swallow coordination in NBs and PIs. PIs showed differences from NBs most likely due to differences in muscle strength and condition.

The effect of early childhood non-nutritive sucking behavior including pacifiers on malocclusion: a randomized controlled trial.

BACKGROUND/RATIONALE: Systematic reviews on the effects of pacifiers on occlusion have highlighted the need for quality RCTs. TRIAL DESIGN: Single region, three parallel-armed, prospective, randomized controlled trial. OBJECTIVES: To investigate the correlations between early childhood non-nutritive sucking habits and malocclusion. Specifically to test whether the use of a study pacifier has differing effects compared to other pacifiers and control, and whether the duration of pacifier use or digit sucking influence the occlusion. PARTICIPANTS: The subjects were firstborn children, born in 2008 in Vantaa, Finland. INTERVENTION: One-third of participants were offered study pacifiers, free of charge, from birth up to 2 years of age. The history of the subjects' sucking habits, including pacifier use was screened in a questionnaire at the age of 2 years, and clinical examinations were performed at the age of 7 years. In addition, the subjects were divided into groups that were equally matched regarding their mother's level of education. OUTCOMES: Posterior crossbite, anterior crossbite, overjet, deep bite, open bite, and crowding. RANDOMIZATION METHOD: Three districts were randomly allocated to three study groups by drawing lots. BLINDING: It was not possible to blind the clinicians or parents from the intervention. Blinding during data analysis was performed. RESULTS: From the original cohort of 2715 children born in the town of Vantaa, 1911 were excluded and 353 were lost to follow-up. The remaining 451 children were divided into three groups according to the use of pacifiers. The prevalence of posterior crossbite at the age of 7 years was higher if a non-study pacifier had been used (P = .005) even when matched for the mother's level of education (P = .029). The prevalence of posterior crossbite was higher if the pacifier habit had continued for 12 months or more compared to 11 months or less, 7% and 1%, respectively, (P = .003). Digit sucking for 12 months or more was associated with crowding (P = .016). The prevalence of crossbite in the study pacifier group was less than in control pacifiers. HARMS: No adverse harms were reported other than effects on the dentition. CONCLUSION: The use of pacifiers is associated with the posterior crossbite, especially if their use continues for a year or more. Parents/guardians should be advised to stop the use or reduce the use of pacifiers to a minimum after their child's first birthday. TRIAL REGISTRATION: ClinicalTrials.gov NCT01854502.

Exploration of the Association Between Sucking Measures and Ability to Attain Independent Oral Feeds Among Infants Who Are Born Preterm.

IMPORTANCE: Infants who are born preterm often experience difficulty transitioning from full tube to independent oral feeds, which often prolongs their hospital stay. No clinical measures associated with attainment of independent oral feeds are currently available. OBJECTIVE: To identify specific nutritive sucking measures associated with time to attainment of independent oral feeds among infants who are born preterm. DESIGN: An observational cohort pilot study was undertaken. SETTING: A Level 2 to Level 3 neonatal intensive care unit. PARTICIPANTS: Fourteen infants (7 male, 7 female) born at or less than 34 wk gestation were enrolled. OUTCOMES AND MEASURES: The monitored suck measures included average suck strength (millimeters of mercury), average sucking burst duration (seconds), average suck count (number of sucks), and average pause duration (seconds). Time to independent oral feeds (days) and baseline characteristics were also monitored. The nutritive sucking measures were recorded once, during the first 5 min of an oral feed, when infants were taking an average of three to four oral feeds per day using a nipple monitoring device. RESULTS: An inverse relation was found among average suck burst duration (p = .04), gestational age (p = .03), and days to attainment of independent oral feeds. CONCLUSIONS AND RELEVANCE: Study results suggest that average sucking burst duration, during the first 5 min of an oral feed, is associated with time to attain independent oral feeds. Plain-Language Summary: Sucking burst duration is a simple measure that may be used clinically to identify early on infants who may have trouble transitioning from full tube to independent oral feedings. The results of this study suggest that a suck burst duration in the first 5 min of an oral feeding is inversely associated with the length of time to achieve independent oral feeding. The results highlight the importance of considering an infant's nutritive sucking ability when evaluating their potential to achieve independent oral feedings.

Association between occlusal features and masticatory function in Hong Kong preschool children: a survey with one-year longitudinal follow-up.

BACKGROUND: Mastication is important for breaking down food, aiding swallowing and nutrients absorption, and is therefore fundamental to a child's development. Studies have shown poor masticatory function to be associated with younger age and presence of caries. However, studies of the association between masticatory function and malocclusion yielded contradictory results. The aim of this study is therefore to investigate the association between three-dimensional occlusal features with masticatory function, among preschool children in Hong Kong. METHODS: Self-administered questionnaires on masticatory function in three domains, namely general chewing difficulty, requiring help when eating different food types and increased preference for soft food were completed by parents. Information on non-nutritive sucking habits and basic demographics were also collected in the questionnaire. Clinical examinations were conducted to record three-dimensional occlusal features and presence of caries. Baseline investigations and one-year follow-ups were undertaken for 1,566 and 996 preschool children. Association of poor masticatory function with occlusal features, sucking habits and caries was investigated using chi-squared tests. Binomial logistic regressions were then carried out incorporating any significant factors identified. Longitudinal analysis of the one-year follow-up data was carried out to investigate whether improved occlusal features, sucking habits and caries resulted in better masticatory function. RESULTS: In the cross-sectional study, the first domain of general chewing difficulty was associated with caries and thumb/digit sucking. The second domain of requiring help when eating different food types was associated with the male sex, younger age, caries and pacifier use. The last domain of increased preference for soft foods was associated with caries and thumb/digit sucking. Occlusal features, including abnormal overjet and unilateral permanent molars not in contact, were significantly associated with poor masticatory function in the bivariate analyses, but were not significant in the logistic regressions. In the longitudinal analysis, general chewing difficulty was found to improve in those of older age and those with resolved anterior crossbite. Less help was required to eat meat in those with fewer caries. Similarly, less help was required to eat food containing bones in those with reduced pacifier use. Preferences for eating soft foods was reduced in those who developed a normal overjet. CONCLUSIONS: The study identified significant relationships between masticatory difficulties and factors associated with age, gender, active caries, and non-nutritive oral habits such as thumb/digit sucking and pacifier use. Younger children and males required more assistance with certain food types. Active caries and thumb/digit sucking habits contributed to general masticatory difficulties and preference for soft foods. The one-year follow-up indicated that improvement in masticatory function varies across age cohorts and were associated with improved occlusal features, such as resolution of anterior crossbite and normalized overjet, reduced pacifier use, and a decrease in the number of decayed teeth.

Advancing the assessment of pacifier effects with a novel computational method.

BACKGROUND: Numerous studies have demonstrated a high likelihood of malocclusions resulting from non-nutritive sucking. Consequently, quantifying the impact of pacifiers can potentially aid in preventing the development or exacerbation of malocclusions and guide the design of improved performance pacifiers. METHODS: This work proposes and assesses a computational methodology that can effectively gather crucial information and provide more precise data regarding the consequences of non-nutritive pacifier sucking. The computational framework utilized is based on solids4Foam [1, 2], a collection of numerical solvers developed within the OpenFOAM® computational library [3]. The computational model focuses on the palate of a six-month-old baby and incorporates various components such as palate tissues, pacifier and tongue, and considers the negative intraoral pressure generated and the tongue displacement. Different models were tested, each offering varying levels of detail in representing the palate structure. These models range from a simplified approach, with one tissue, to a more intricate representation, involving up to five different tissues, offering a more comprehensive palate model compared to existing literature. RESULTS: The analysis of results involved examining the distribution of stress on the palate surface, as well as the displacement and forces exerted on the dental crowns. By comparing the obtained results, it was possible to evaluate the precision of the approaches previously described in the literature. The findings revealed that the predictions were less accurate when using the simplified model with a single tissue for the palate, which is the most common approach proposed in the literature. In contrast, the results demonstrated that the palate model with the most intricate structure, incorporating five different tissues, yielded distinct outcomes compared to all other combinations. CONCLUSIONS: The computational methodology proposed, employing the most detailed palate model, has demonstrated its effectiveness and necessity in obtaining accurate data on the impact of non-nutritive sucking habits, which are recognized as a primary contributor to the development of dental malocclusions. In the future, this approach could be extended to conduct similar studies encompassing diverse pacifier designs, sizes, and age groups. This would foster the design of innovative pacifiers that mitigate the adverse effects of non-nutritive sucking on orofacial structures.

Interventions to Enhance Achievement to Independent Oral Feeds in Premature Infants: A Scoping Review.

AIM: To assess the effectiveness of interventions aimed at facilitating the transition from full tube to independent oral feeds in premature infants. METHODS: Scoping review methodology using the Preferred Reporting items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA_ScR). A search of six databases (EMBASE, MEDLINE, CINAHL, Web of Science, COCHRANE, and OT Seeker), using keywords related to oral feeding and premature infants retrieved 11,870 articles. Full-text screening was completed for 36 articles, and 21 articles were included in this review. RESULTS: Review of the 21 articles revealed five intervention types: oral stimulation (n = 14), swallow/gustatory stimulation (n = 3), olfactory stimulation (n = 2), tactile/kinesthetic stimulation (n = 1), and auditory stimulation (n = 1). Oral stimulation had the most studies with consistent evidence supporting its beneficial effect to facilitate achievement to independent oral feeds, swallow/gustatory stimulation appeared to have some benefit, but evidence for olfactory, tactile/kinesthetic, and auditory stimulation was sparse. CONCLUSION: Oral stimulation has the most studies with consistent evidence, and thus is suggested as a suitable early intervention strategy that can be used by health providers to facilitate the achievement to independent oral feeds in premature infants. The alternate forms of stimulation have limited evidence and necessitate further studies to confirm their benefits.

Effects of an Oral Stimulation Program on Feeding Outcomes in Preterm Infants: A Systematic Review and Meta-Analysis.

AIMS: To review the literature on the effects of unimodal sensorimotor stimulation protocols on feeding outcomes in very preterm and moderate to late preterm infants (PIs). METHODS: Five databases were searched up to April 2022. Studies comparing unimodal sensorimotor stimulation protocols based on the combination of manual oral stimulation with NNS against usual care in PIs, on-time transition to full oral feeding (FOF), feeding efficacy, length of hospital stay, and/or body weight gain. RESULTS: Eleven studies were included. Compared to usual care, unimodal sensorimotor stimulation protocols based on manual oral stimulation combined with NNS demonstrated to be more effective in decreasing time transition to FOF (standardized mean difference [95%CI] - 1.08 [-1.74, -0.41]), improving feeding efficacy (2.15 [1.18, 3.13]) and shortening length of hospital stay (-0.35 [-0.68, -0.03]). However, the proposed intervention was not effective in improving weight gain (0.27 [-0.40, 0.95]). There were no significant differences according to gestational age (p > .05). CONCLUSIONS: Based on fair-to-high quality evidence, unimodal sensorimotor stimulation protocols combined with NNS reduce time transition to FOF, improve feeding efficacy, and shorten the length of hospital stay; yet the proposed intervention yielded no significant effects on body weight gain when compared to usual care in PIs.

[Oral Feeding Readiness Assessment Tools for Preterm Infants].

Due to their underdeveloped physiological maturity, preterm infants often face challenges related to sucking, breathing, and swallowing coordination during initial feeding. This lack of coordination may lead to episodes of apnea and choking, resulting in unstable vital signs. Preterm infants with this issue must gradually learn oral feeding skills appropriate to their developmental stage. Registered nurses play a critical role in assessing the right time to transition from tube to oral feeding and in providing a safe and positive oral feeding experience. In this article, three validated assessment tools for feeding premature infants are introduced, accompanied by clinical research data demonstrating their use in clinical practice. These three tools include: (1) the Neonatal Oral Motor Assessment Scale, which is applied to evaluate oral motor skills using observations of nonnutritive sucking and the sucking state during the two minutes before feeding; (2) the Premature Oral Feeding Readiness Assessment Scale, which is used to assess readiness for oral feeding in preterm infants; and (3) the Early Feeding Skills assessment, which is used to evaluate the oral feeding skills of preterm infants. These tools aid nurses in helping preterm infants achieve independent oral feeding, facilitating earlier discharge and return to home. The clinical implications and effectiveness of these tools are also discussed to provide to nurses the means and confidence necessary to apply them appropriately in clinical settings.

Effects of non-nutritive sucking habits on malocclusions: a systematic review.

The development of the craniomandibular system is guided by genetic interactions and environmental factors, including specific habits such as breastfeeding, bottle feeding, thumb sucking and the use of pacifiers. These habits can have a considerable impact on the growth of the developing jaws and can lead to malocclusion in children. This review aims to investigate potential associations between non-nutritive sucking habits (NNSHs) and malocclusions compared to the presence of nutritive sucking habits (NSHs). To carry out this systematic review, we followed the PRISMA protocol and performed a bibliographic search of the existing literature until April 2023 in the following electronic databases: Medline, PubMed, The Cochrane Library and Embase. Out of a total of 153 records, we included 21 studies. We found that the chances of diagnosing a malocclusion were higher for children with bottle nutrition when compared to breast-fed children. Breastfeeding provides protection against malocclusions. In the same manner, persistent NNSH habits appeared to be associated with increased chances of having malocclusions. The longer the child was breastfed, the shorter the duration of the pacifier habit and the lower the risk of developing moderate/severe malocclusions. The duration of the habits has a positive influence on the appearance of occlusion defects.

Examining the association between prenatal maternal stress and infant non-nutritive suck.

BACKGROUND: This study examined the relationship between prenatal maternal stress (PREMS) and non-nutritive suck (NNS) and tested its robustness across 2 demographically diverse populations. METHODS: The study involved 2 prospective birth cohorts participating in the national Environmental influences on Child Health Outcomes (ECHO) Program: Illinois Kids Development Study (IKIDS) and ECHO Puerto Rico (ECHO-PROTECT). PREMS was measured during late pregnancy via the 10-item Perceived Stress Scale (PSS-10). NNS was sampled from 1- to 8-week-olds using a custom pacifier for ~5 min. RESULTS: Overall, 237 mother-infant dyads completed this study. Despite several significant differences, including race/ethnicity, income, education, and PREMS levels, significant PREMS-NNS associations were found in the 2 cohorts. In adjusted linear regression models, higher PREMS, measured through PSS-10 total scores, related to fewer but longer NNS bursts per minute. CONCLUSIONS: A significant association was observed between PREMS and NNS across two diverse cohorts. This finding is important as it may enable the earlier detection of exposure-related deficits and, as a result, earlier intervention, which potentially can optimize outcomes. More research is needed to understand how NNS affects children's neurofunction and development. IMPACT: In this double-cohort study, we found that higher maternal perceived stress assessed in late pregnancy was significantly associated with fewer but longer sucking bursts in 1- to 8-week-old infants. This is the first study investigating the association between prenatal maternal stress (PREMS) and infant non-nutritive suck (NNS), an early indicator of central nervous system integrity. Non-nutritive suck is a potential marker of increased prenatal stress in diverse populations. Non-nutritive suck can potentially serve as an early indicator of exposure-related neuropsychological deficits allowing for earlier interventions and thus better prognoses.

The clinical experience of early skin-to-skin contact combined with non-nutritive comfort sucking in mothers of preterm infants: a qualitative study.

BACKGROUND: In most areas of China, mothers typically do not participate in early care of preterm infants in NICU. This study aims to examine the early experience of mothers of preterm infants participating in skin-to-skin contact combined with non-nutritive comfort sucking in China. METHODS: This qualitative research study used one-on-one, face-to-face, semi-structured in-depth interviews. Eighteen mothers who participated in early skin-to-skin contact combined with non-nutritive comfort sucking were interviewed in the NICU of a tertiary children's hospital in Shanghai between July and December 2020. Their experiences were analyzed using the inductive topic analysis method. RESULTS: Five themes about skin-to-skin contact combined with non-nutritive comfort sucking were identified, including alleviation of maternal anxiety and fear during mother infant separation, reshaping the maternal role, promotion of active breast pumping, enhances the mother's willingness to actively breast feed and building the maternal confidence in baby care. CONCLUSION: Skin-to-skin contact combined with non-nutritive comfort sucking in the NICU can not only enhance the identity and responsibility of the mother's role, but also provide non-nutritive sucking experience for promoting the establishment of oral feeding in preterm infants.

Effects of Swaddling During Bottle Feeding in Preterm Infants.

BACKGROUND: Preterm infants have immature oral feeding skills, affecting length of hospital stay and long-term feeding outcomes. Swaddling has positive effects on pain and stress responses, state regulation, and physiological stability in preterm infants in the neonatal intensive care unit (NICU). Swaddling during bottle feeding may support preterm infant behavioral organization and oral feeding skills. Swaddling is used inconsistently during feeding in the NICU and has not been critically examined for effects on bottle feeding performance in preterm infants. PURPOSE: To examine the effects of swaddling on bottle feeding quality and efficiency in preterm infants. METHODS: A convenience sample of 30 infants born before 34 weeks of gestation was selected in an urban level IV NICU. Using an experimental, randomized crossover design, each infant was swaddled for one feeding and unswaddled for one feeding. Feeding efficiency was measured by rate and volume consumed. Feeding quality was examined by the Early Feeding Skills Assessment and frequency of physiological changes. Data were analyzed using dependent t tests and Wilcoxon signed rank test. RESULTS: When swaddled, participants demonstrated significantly better scores on all related subtests of the Early Feeding Skills Assessment ( P ≤ .001). Infants demonstrated no difference in frequency of bradycardia or oxygen desaturations greater than 4 seconds. No significant differences were found in feeding efficiency outcomes. IMPLICATIONS FOR PRACTICE AND RESEARCH: Swaddling can be used in the NICU to improve bottle feeding quality in preterm infants. Future investigation is needed on long-term effects of swaddling during bottle feeding on feeding performance, weight gain, and length of stay.

Anterior open bite self-correction after cessation of non-nutritive sucking habits: a systematic review.

BACKGROUND: Non-nutritive sucking habits likely may cause occlusal changes such as anterior open bite (AOB) if they persist over extended time. OBJECTIVES: To assess if there is self-correction of AOB after cessation of non-nutritive sucking habits in children older than 4 years old, through a systematic review. SEARCH METHODS: Data sources included PubMed, Scopus, Web of Science and Latin American and Caribbean Health Sciences (LILACS) databases, gray literature as Google Scholar, the database System for Information on Gray Literature in Europe (OpenGrey) and ProQuest Dissertations and Theses Database, also hand searches of the included studies references. SELECTION CRITERIA: Studies assessing occlusal changes in children aged 4-12 years with AOB traits and non-nutritive sucking habits after the discontinuation of the habit were included. DATA COLLECTION AND ANALYSIS: Two authors independently assessed eligibility and extracted data. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale and the Joanna Briggs Critical Appraisal Checklist for quasi-experimental studies. The confidence in cumulative evidence was assessed using the GRADE criteria. RESULTS: Over 3100 studies, only 5 met the inclusion criteria. There is often self-correction of AOB after discontinuing the non-nutritive sucking habit, even in cases older than 4 years old. The improvement ranged between 50 and 100%. The overall quality of evidence was very low. CONCLUSIONS: AOB self-correction after discontinuing a non-nutritive sucking habit is possible, even after 4 years old, although with very low certainty in the body of evidence. It is not clear after what age the removal from the habit is unlikely to facilitate AOB self-correction. REGISTRATION AND CONFLICT OF INTEREST: International Prospective Register of Systematic Reviews code: CRD42016052171. There was no conflicting interest from the review authors.

A brief gestalt intervention changes ultrasound measures of tongue movement during breastfeeding: case series.

BACKGROUND: Lactation consultants frequently advise adjustments to fit and hold (or positioning and attachment) with the aim of optimising intra-oral nipple placement. However, approaches to fit and hold vary widely, with limited evidence of benefits, and effects of fit and hold on infant tongue movement have not been examined. The aim of this preliminary study was to investigate whether a gestalt breastfeeding intervention alters tongue movement, using measurements from ultrasound imaging to determine nipple placement and intra-oral nipple and breast tissue dimensions. METHODS: Ultrasound measurements were conducted in five breastfeeding dyads, infants aged 4-20 weeks, while feeding in their usual or 'standard' position and again after brief application of gestalt principles of fit and hold. Four of the mother-baby pairs, who had received comprehensive lactation support, reported persisting nipple pain. Three of these infants had difficulty latching and fussed at the breast; three had been diagnosed with oral ties. A fifth pair was breastfeeding successfully. RESULTS: Ultrasound demonstrated that the distance from nipple tip to junction of the hard and soft palate decreased, intra-oral nipple and breast tissue dimensions increased, and nipple slide decreased after a brief gestalt intervention. CONCLUSION: These preliminary findings suggest that changes in fit and hold impact on infant tongue movement and contour. Further research investigating short- and long-term outcomes of a gestalt breastfeeding intervention in larger cohorts is required.

Comparison of the effect of two methods of sucking on pacifier and mother's finger on oral feeding behavior in preterm infants: a randomized clinical trial.

BACKGROUND: Oral feeding problems will cause long-term hospitalization of the infant and increase the cost of hospitalization. This study aimed to compare the effect of two methods of sucking on pacifier and mother's finger on oral feeding behavior in preterm infants. METHODS: This single-blind randomized controlled clinical trial was performed in the neonatal intensive care unit of Babol Rouhani Hospital, Iran. 150 preterm infants with the gestational age of 31 to 33 weeks were selected and were divided into three groups of 50 samples using randomized block method, including non-nutritive sucking on mother's finger (A), pacifier (B) and control (C). Infants in groups A and B were stimulated with mother's finger or pacifier three times a day for five minutes before gavage, for ten days exactly. For data collection, demographic characteristics questionnaire and preterm infant breastfeeding behavior scale were used. RESULTS: The mean score of breastfeeding behavior in preterm infants in the three groups of A,B,C was 12.34 ± 3.37, 11.00 ± 3.55, 10.40 ± 4.29 respectively, which had a significant difference between the three groups (p = 0.03). The mean rooting score between three groups of A, B, and C was 1.76 ± 0.47, 1.64 ± 0.48, and 1.40 ± 0.90 (p < 0.001) respectively. Also, the mean sucking score in groups of A, B and C was 2.52 ± 0.76, 2.28 ± 0.64 and 2.02 ± 0.74 respectively, which had a significant difference (p = 0.003), but other scales had no significant difference between the three groups (P > 0.05). The mean time to achieve independent oral feeding between the three groups of A, B, C was 22.12 ± 8.15, 22.54 ± 7.54 and 25.86 ± 7.93 days respectively (p = 0.03), and duration of hospitalization was 25.98 ± 6.78, 27.28 ± 6.20, and 29.36 ± 5.97 days (p = 0.02), which had a significant difference. But there was no significant difference between the two groups of A and B in terms of rooting, sucking, the total score of breastfeeding behavior and time of achieving independent oral feeding (P > 0.05). CONCLUSION: Considering the positive effect of these two methods, especially non-nutritive sucking on mother's finger, on increasing oral feeding behaviors, it is recommended to implement these low-cost methods for preterm infants admitted to neonatal intensive care unit. TRIAL REGISTRATION: Trial Registration: IRCT, IRCT20191116045460N1 . Registered 11 January 2020- prospective registered.

Effects of oral stimulation with breast milk in preterm infants oral feeding: a randomized clinical trial.

OBJECTIVES: This study was performed to evaluate the effect of oral stimulation with breast milk for preterm infants. METHODS: A total of 68 subjects form neonatal intensive care unit were randomly assigned into control group (n=20), premature infant oral motor intervention (PIOMI) group (n=25) and premature infant oral motor intervention with breast milk (BM-PIOMI) group (n=23). RESULTS: BM-PIOMI group had significant shorter initiation of oral feeding (IOF) time compared to PIOMI group (2.95 days, 95% CI [0.42-5.48]) or control group (9.79 days, 95% CI [7.07-12.51]). BM-PIOMI group had significant sooner transition time from IOF to full oral feeding (FOF) compared to control group (6.68 days, 95% CI [2.2-11.16]), but not to PIOMI group (2.09 days, 95% CI [-2.07 to 6.25]). Length of hospital stay (LOS) did not show statistical different between three groups (control 38.85 ± 14.40 vs. PIOMI 38.48 ± 11.76 vs. BM-PIOMI 38.04 ± 12.2). Growth mixture model identified improvement in non-nutritive sucking (NNS) score in BM-PIOMI group compared to control and PIOMI group (0.8293, p<0.0001, and 0.8296, p<0.0001, respectively). CONCLUSIONS: Oral stimulation with breast milk can better promotes the oral feeding process of premature infants than the simple oral stimulation, by shorten IOF time and improve early NNS score, but does not shorten transition time from IOF to FOF and LOS.

Variability in Swallowing Biomechanics in Infants with Feeding Difficulties: A Videofluoroscopic Analysis.

Clinicians performing feeding evaluations in infants often report swallow variability or inconsistency as concerning. However, little is known about whether this represents pathological incoordination or normal physiologic variance in a developing child. Our retrospective study explored quantitative videofluoroscopic measures in 50 bottle-fed infants (0-9 months) referred with feeding concerns. Our research questions were as follows: Is it possible to assess swallow to swallow variability in an infant with feeding concerns, is there variability in pharyngeal timing and displacement in infants referred for videofluoroscopy, and is variability associated with aspiration risk? Measures were taken from a mid-feed, 20-s loop recorded at 30 frames per second. Each swallow within the 20-s loop (n = 349 swallows) was analysed using quantitative digital measures of timing, displacement and coordination (Swallowtail™). Two blinded raters measured all swallows with strong inter-rater reliability (ICC .78). Swallow frequency, suck-swallow ratio, residue and aspiration were also rated. Variability in timing and displacement was identified across all infants but did not correlate with aspiration (p > .05). Sixteen infants (32%) aspirated. Across the cohort, swallow frequency varied from 1 to 15 within the 20-s loops; suck-swallow ratios varied from 1:1 to 6:1. Within-infant variability in suck-swallow ratios was associated with higher penetration-aspiration scores (p < .001). In conclusion, pharyngeal timing and displacement variability is present in infants referred with feeding difficulties but does not correlate with aspiration. Suck-swallow ratio variability, however, is an important risk factor for aspiration that can be observed at bedside without radiation. These objective measures provide insight into infant swallowing biomechanics and deserve further exploration for their clinical applicability.

Effect of the Premature Infant Oral Motor Intervention on Sucking Capacity in Preterm Infants in Turkey: A Randomized Controlled Trial.

BACKGROUND: Preterm infants have oral feeding difficulty that often delays discharge, indicating a need for evidence-based interventions for oral-motor development. PURPOSE: To test the Premature Infant Oral Motor Intervention (PIOMI) on the development of oral-motor function, feeding, and anthropometric outcomes using sucking manometry. METHODS: A single-blind randomized experimental design was conducted with a sample of 60 preterm infants from 2 neonatal intensive care units between May 2019 and March 2020. The experimental group received PIOMI for 5 min/d for 14 consecutive days. Sucking capacity, anthropometrics (weight and head circumference), bottle feeding, breast/chest feeding initiation, and length of hospital stay were measured. The Yakut Sucking Manometer (PCT/TR2019/050678) was developed specifically for this study and tested for the first time. RESULTS: The experimental group had a statistically significant percent increase over controls in sucking power (69%), continuous sucking before releasing the bottle (16%), sucking time (13%), and sucking amount (12%) with partial η 2 values of interaction between the groups of 0.692, 0.164, 0.136, and 0.121, respectively. The experimental group had a higher increase in weight (89%) and head circumference (81%) over controls ( F = 485.130, P < .001; F = 254.754, P < .001, respectively). The experimental group transitioned to oral feeding 9.9 days earlier than controls ( t = -2.822; P = .007), started breast/chest feeding 10.8 days earlier ( t = 3.016; P = .004), and were discharged 3.0 days earlier. IMPLICATIONS FOR RESEARCH/PRACTICE: The PIOMI had a significant positive effect on anthropometrics, sucking capacity, readiness to initiate bottle and breast/chest feeding, and a 3-day reduction in length of hospital stay.

Infants can breathe and swallow at the same time?

The concept that infants can breathe and swallow simultaneously due to distinct breathing and swallowing channels was propagated primarily by Edmund Crelin and his student, Jeffrey Laitman. Our evaluation of the primary research article that supported this concept found the article to be unconvincing due to numerous misrepresentations of prior data as well as those presented in the article. Despite clear evidence that newborns cannot breathe and swallow simultaneously, Crelin and Laitman continued to support this concept well into the 21st century, which resulted in the concept becoming imbedded in popular literature and the internet, with potentially significant negative clinical consequences. We suggest that a partial explanation why this anatomically and physiologically illogical concept was able to propagate is the paucity of the teaching of newborn anatomy to medical professionals.