A randomized study of the efficacy of sensory-motor-oral stimulation and non-nutritive sucking in very low birthweight infant

https://doi.org/10.1016/j.earlhumdev.2006.08.003Get rights and content

Abstract

To assess if sensory-motor-oral stimulation and non-nutritive sucking gavage feeding enhances the oral feeding performance of preterm infants born between 26 and 32 weeks of gestational age.

Study design:

Very low birthweight infants (n = 98) were randomized into a experimental and control group. Preterm infants in the experimental group received sensory-motor-oral stimulation and non-nutritive sucking and infants in the control group received a sham stimulation program. Both were administered from when they reached enteral diet (100 kcal/kg/day) until the beginning of oral diet. Primary outcome was length of hospital stay.

Results:

Independent oral feeding was attained significantly earlier in the experimental group than the control group, 38 ± 16 days of life (mean ± S.D.) versus 47 ± 17 days of life, respectively (P < 0.001) There was significant difference in length of hospital stay between the two groups (41.9 ± 17 (mean ± S.D.) versus 52.3 ± 19 days (P < 0.01)).

Conclusion:

Sensory-motor-oral stimulation, together with early non-nutritive sucking (as soon as the newborn reaches full diet and is clinically stable) in very low birthweight preterm infants, as long as they are clinically stable, in this study, earlier initiation of oral feeding and earlier hospital discharge.

Section snippets

Methodology

A double-blind, randomized, clinical trial was performed. The sample size was calculated considering a 20% reduction in length of stay, statistical power of 80% two-tailed type 1 error of 0.05. Randomization was stratified based on gestational age ranges (26–28, 28.1–30, 30.1–32). A total of 98 newborns were admitted to the study, from the neonatal intensive care unit at the Fernandes Figueira Institute, FIOCRUZ, Rio de Janeiro, Brazil. These preterm infants met the following inclusion

Results

Of the 241 very low birthweight infants who were screened for enrollment, 103 (42%) were ineligible (40% succumbing to death; 22% presented with congenital malformations such as esophageal atresia, gastroschisis, omphalocele or another genetic problems; 10% the parents refused or were unavailable; others presented with asphyxia or convulsions). Among the remaining 138 infants, we studied 98. The remaining 40 eligible infants were not enrolled because of sepsis, intraventricular haemorrhage

Discussion

Preterm infants present with significant difficulties during the post-natal period, such as infections, respiratory problems, hypoglycemia, asphyxia and others. In addition, nutritional issues are a major challenge, especially considering nutritional requirements to maintain vital capacity, the growth and development of these infants. The nutritional challenges include the difficulty newborns less than 34 weeks of gestational age have in coordinating sucking, breathing and swallowing. Preterm

Conclusion

Based on our study, sensory-motor-oral stimulation, together with early non-nutritive sucking (as soon as the newborn reaches full diet) in low birthweight infants as long as they are clinically stable, should be implemented to promote earlier initiation of oral feeding and earlier hospital discharge, but we cannot recommend this practice against non-nutritive sucking alone. Further studies are required to address this issue.

Acknowledgments

This study was supported by PAPES III-FIOCRUZ and FAPERJ. Special thanks to Nadia Rodrigues Mallet.

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This study was approved by the Fernandes Figueiras Institutional Review Board/Research Ethics Committee and by neonatal unit where the research was conducted. Prior informed consent was obtained from parents/guardians of the newborns for their participation in the study.

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