Brenda S Lessen1. 1. School of Nursing, Illinois Wesleyan University, Bloomington, IL 61702, USA. blessen@iwu.edu
Abstract
PURPOSE:Preterm infants frequently experience oral feeding difficulties due to underdeveloped oral motor skills and the lack of coordination of sucking, swallowing, and respiration. The infants' ability to consume all feedings orally while maintaining physiologic stability and weight gain is necessary for their discharge. Therefore, difficulty with oral feeding leads to longer hospital stays and higher costs. For example, with more than half a million of premature infants born each year, a 3-day decrease in hospital stay would save more than 2 billion dollars annually. There is a need for evidenced-based interventions that facilitate development of oral-motor skills, leading to improved oral feeding, thus shortening hospital stays and lowering costs. The purpose of this research was to test the newly developed Premature Infant Oral Motor Intervention (PIOMI) beginning at 29 weeks postmenstrual age (PMA), before oral feedings were introduced, to determine whether the prefeeding intervention would result in a shorter transition from gavage to total oral feedings and a shorter length of hospital stay (LOS). The PIOMI is a 5-minute oral motor intervention that provides assisted movement to activate muscle contraction and provides movement against resistance to build strength. The focus of the intervention is to increase functional response to pressure and movement and control of movements for the lips, cheeks, jaw, and tongue. The cheeks (internal and external), lips, gums, tongue, and palate were stimulated per specific protocol with finger stroking. SUBJECTS: A total of 19 infants from 1 level III NICU born between 26 and 29 weeks PMA: 10 in the experimental group and 9 in the control group. DESIGN: A randomized, blinded, clinical trial was conducted to examine outcomes related to the newly developed PIOMI. METHODS: Beginning at 29 weeks PMA (and before the introduction of oral feeding), the experimental group received the PIOMI for 5 minutes per day for 7 consecutive days. The control group received a sham intervention to keep staff and parents blinded to the infants' group assignment. Physiological and behavioral stabilities were continually assessed throughout the intervention. A chart review was then conducted to compare the transition from gavage feeding to total oral feedings between the experimental and control group, as well as LOS. RESULTS: The PIOMI was well tolerated by 29-week PMA infants, as evidenced by physiological and behavioral cues. Infants who received the once-daily PIOMI transitioned from their first oral feeding to total oral feedings 5 days sooner than controls (P = .043) and were discharged 2.6 days sooner than controls. CONCLUSION: This pilot work supports further study on the use of the PIOMI with preterm infants to enhance oral-feeding skills and decrease LOS.
RCT Entities:
PURPOSE: Preterm infants frequently experience oral feeding difficulties due to underdeveloped oral motor skills and the lack of coordination of sucking, swallowing, and respiration. The infants' ability to consume all feedings orally while maintaining physiologic stability and weight gain is necessary for their discharge. Therefore, difficulty with oral feeding leads to longer hospital stays and higher costs. For example, with more than half a million of premature infants born each year, a 3-day decrease in hospital stay would save more than 2 billion dollars annually. There is a need for evidenced-based interventions that facilitate development of oral-motor skills, leading to improved oral feeding, thus shortening hospital stays and lowering costs. The purpose of this research was to test the newly developed Premature Infant Oral Motor Intervention (PIOMI) beginning at 29 weeks postmenstrual age (PMA), before oral feedings were introduced, to determine whether the prefeeding intervention would result in a shorter transition from gavage to total oral feedings and a shorter length of hospital stay (LOS). The PIOMI is a 5-minute oral motor intervention that provides assisted movement to activate muscle contraction and provides movement against resistance to build strength. The focus of the intervention is to increase functional response to pressure and movement and control of movements for the lips, cheeks, jaw, and tongue. The cheeks (internal and external), lips, gums, tongue, and palate were stimulated per specific protocol with finger stroking. SUBJECTS: A total of 19 infants from 1 level III NICU born between 26 and 29 weeks PMA: 10 in the experimental group and 9 in the control group. DESIGN: A randomized, blinded, clinical trial was conducted to examine outcomes related to the newly developed PIOMI. METHODS: Beginning at 29 weeks PMA (and before the introduction of oral feeding), the experimental group received the PIOMI for 5 minutes per day for 7 consecutive days. The control group received a sham intervention to keep staff and parents blinded to the infants' group assignment. Physiological and behavioral stabilities were continually assessed throughout the intervention. A chart review was then conducted to compare the transition from gavage feeding to total oral feedings between the experimental and control group, as well as LOS. RESULTS: The PIOMI was well tolerated by 29-week PMA infants, as evidenced by physiological and behavioral cues. Infants who received the once-daily PIOMI transitioned from their first oral feeding to total oral feedings 5 days sooner than controls (P = .043) and were discharged 2.6 days sooner than controls. CONCLUSION: This pilot work supports further study on the use of the PIOMI with preterm infants to enhance oral-feeding skills and decrease LOS.
Authors: Mollie G Warren; Barbara Do; Abhik Das; P Brian Smith; Ira Adams-Chapman; Sudarshan Jadcherla; Erik A Jensen; Ricki F Goldstein; Ronald N Goldberg; C Michael Cotten; Edward F Bell; William F Malcolm Journal: J Pediatr Date: 2019-08-16 Impact factor: 6.314