Background: Premature infants born prior to 34 weeks gestation have difficulty with immature suck- swallow-breath reflex, and thus gavage feeding is the most common method of delivering adequate nutrition.
Objective/aims: The aim of this study was to investigate the current research and determine if non-nutritive suck (NNS) as part of sensory motor oral-facial stimulation (SMOS) is an appropriate early intervention and to identify whether this intervention facilitates transition to oral feeding in premature babies.
Methods: A literature search was undertaken from 2000 to May 2020 to identify articles that assess this area. A variety of terms were used including MeSH Terms “enteric nutrition” “gavage tube feeding’, “breastfeeding”, ‘‘premature infants’’ ‘‘oral-motor stimulation’’, ‘non-nutritional sucking’.
Inclusion criteria: Articles in English language; population of preterm infants less than 34 weeks; articles that looked at non-nutritive suck and its effects.
Exclusion criteria: any other feeding devices than gavage feeding/naso-gastric tube used, premature infant with congenital anomalies, or ventilation support, older than 34 weeks gestation.
Results: Eleven studies in total were identified as relevant: 3 systematic reviews, 5 RCTs, 2 cohort studies, 1 observational cross sectional study. Pacifiers (non-nutritive suck) along with sensory motor oral stimulation were found to improve coordination of suck-swallow-respiration and breastfeeding and earlier release from hospital in multiple cases. However, the research is heterogenous and overall, inconclusive.
Conclusion: The research demonstrated mixed outcomes for the effectiveness of pacifiers and the use of NNS. No clear guidelines exist to facilitate smooth transition to oral feeding in the NICU. Given the lack of negative outcome with the use of NNS as well as understanding the effect of NNS on the activation of vagal tone and the benefits this has on the gut motility and overall health of preterm infants, it appears to be a viable tool to help reduce hospital stay and facilitate infants toward oral feeding.
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