Non-nutritive sucking milestones of preterm infants in Indonesia: a descriptive study

  • Luh Karunia Wahyuni FKUI-RSCM
  • Irawan Mangunatmadja
  • Risma Kerina Kaban
  • Elvie Zulka Kautzia Rachmawati
  • Melinda Harini
  • Budiati Laksmitasari
  • Agatha Geraldyne
  • Inez Ayuwibowo Sangwidjojo
  • Dini Prima Utami
  • Victor Prasetyo Poernomo
  • Adrian Prasetya Sudjono
Keywords: preterm infants, non-nutritive sucking milestone, gestational age

Abstract

Background Non-nutritive sucking (NNS) maturity has been used as one of the markers of oral feeding readiness in infants. Prematurity may hinder the attainment of NNS milestones. Depending on gestational age (GA) at birth, preterm infants may display various degrees of immaturity, potentially affecting the strength, coordination, and efficiency of skills required for NNS.

Objective To identify the progression of NNS patterns across gestational age groups of preterm infants in Indonesia by comparing NNS parameters between moderate-to-late preterm and very preterm infants.

Methods NNS evaluation was conducted in 120 preterm infants born at 28-34 weeks gestational age in five tertiary hospitals in Jakarta, Indonesia. Three aspects of NNS (suction pressure, number of suctions per burst, and time between bursts) were documented and arranged to present a descriptive overview. A suction pressure measurement device was used to record, identify, and analyze NNS parameters. We hypothesize that maturity, as determined by GA, positively affected the attainment of NNS milestones.

Results Moderate-to-late preterm infants (GA 32 to <37 weeks), compared to very preterm infants (GA 28 to <32 weeks), had higher mean NNS pressure (-79.8 vs. -72.7 mmHg, respectively, P=0.041) and shorter mean time between bursts (6.63 vs. 7.36 s, respectively, P=0.030). Mean number of suctions per burst were also significantly different between the two GA groups (8.90 vs. 8.99 sucks/burst, respectively, P=0.048).

Conclusion Maturity, as reflected by GA, had a positive effect on the attainment of NNS milestones in preterm infants in Indonesia. Significant differences in the three NNS parameters: number of suctions per burst, time between bursts, and suction pressure were found between moderate-to-late preterm and very preterm infants.

References

1. da Costa SP, Engel-Hoek LVD, Bos AF. Sucking and swallowing in infants and diagnostic tools. J Perinatol. 2008;28:247–57. DOI: https://doi.org/10.1038/sj.jp.7211924.
2. Wolf LS, Glass RP. Feeding and swallowing disorder in infancy?: assessment and management. Pennsylvania State University: Therapy Skill Builders; 1992.
3. Nijhuis JG. Fetal behavior. Neurobiol Aging. 2003;24:S41-6. DOI: https://doi.org/10.1016/S0197-4580(03)00054-X.
4. Hack M, Estabrook MM, Robertson SS. Development of sucking rhythm in preterm infants. Early Hum Dev. 1985;11:133–40. DOI: https://doi.org/10.1016/0378-3782(85)90100-8.
5. Hafstrom M, Kjellmer I. Non-nutritive sucking in the healthy pre-term infant. Early Hum Dev. 2000;60:13–24. DOI: https://doi.org/10.1016/s0378-3782(00)00091-8.
6. Kish MZ. Improving preterm infant outcomes: Implementing an evidence-based oral feeding advancement protocol in the neonatal intensive care unit. Adv Neonatal Care. 2014;14:346–53. DOI: https://doi.org/10.1016/s0378-3782(00)00091-8.
7. Wolff PH. The serial organization of sucking in the young infant. Pediatrics. 1968;42:943–56. PMID: 4235770.
8. Hafström M, Lundquist C, Lindecrantz K, Larsson K, Kjellmer I. Recording non-nutritive sucking in the neonate. Description of an automatized system for analysis. Acta Paediatr. 1997;86:82–90. DOI: https://doi.org/10.1111/j.1651-2227.1997.tb08838.x.
9. Kenner C, McGrath J. Developmental care of newborns and neonates: a guide for health professionals. St. Louis: Mosby; 2004.
10. Lau C, Alagugurusamy R, Schanler RJ, Smith EO, Shulman RJ. Characterization of the developmental stages of sucking in preterm infants during bottle feeding. Acta Paediatr. 2000;89:846–52. PMID: 10943969.
11. Medoff-Cooper B, McGrath J, Bilker W. Nutritive sucking and neurobehavioral development in preterm infants from 34 weeks PCA to term. MCN Am J Matern Child Nurs. 2000;25:64–70. DOI: https://doi.org/10.1097/00005721-200003000-00004.
12. Martell M, Martinez G, Gonzalez M, Diaz Rossello JL. Suction patterns in preterm infants. J Perinat Med. 1993;21:363–9. DOI: https://doi.org/10.1515/jpme.1993.21.5.363 .
13. Eishima K. The analysis of sucking behaviour infants. Early Hum Dev. 1991;27:163–73. DOI: https://doi.org/10.1016/0378-3782(91)90192-6 .
14. Shandley S, Capilouto G, Tamilia E, Riley DM, Johnson YR, Papadelis C. Abnormal nutritive sucking as an indicator of neonatal brain injury. Front Pediatr. 2021;8:599633. DOI: https://doi.org/10.3389/fped.2020.599633.
15. Wahyuni LK, Mangunatmadja I, Kaban RK, Rachmawati EZK, Harini M, Laksmitasari B, et al. A comparison of objective and subjective measurements of non-nutritive sucking in preterm infants. Paediatr Indones. 2022;62:276-83. DOI: https://doi.org/10.14238/pi62.4.2022.276-83.
16. Medoff-Cooper B, Verklan T, Carlson S. The development of sucking patterns and physiologic correlates in very-low-birth-weight infants. Nurs Res. 1993;42:100–5. PMID: 8455984
17. Lau C, Kusnierczyk I. Quantitative evaluation of infant’s nonnutritive and nutritive sucking. Dysphagia. 2001;16:58–67. DOI: https://doi.org/10.1007/s004550000043.
18. Howson CP, Kinney MV, Lawn JE. March of Dimes, PMNCH, Save the children, WHO. Born too soon: the global action report on preterm birth. Geneva: World Health Organization. 2012.
19. World Health Organization. ICD-10: International statistical classification of diseases and related health problems : tenth revision, 2nd ed. World Health Organization; 2004.
20. Gouna G, Rakza T, Kuissi E, Pennaforte T, Mur S, Storme L. Positioning effects on lung function and breathing pattern in premature newborns. J Pediatr. 2013;162:1133–7.e1. DOI: https://doi.org/10.1016/j.jpeds.2012.11.036.
21. Mizuno K, Ueda A. The maturation and coordination of sucking, swallowing, and respiration in preterm infants. J Pediatr. 2003;142:36–40. DOI: https://doi.org/10.1067/mpd.2003.12.
22. Pineda R, Dewey K, Jacobsen A, Smith J. Non-nutritive sucking in the preterm infant. Am J Perinatol. 2019;36:268-276. DOI: https://doi.org/10.1055/s-0038-1667289 .
23. Mizuno K, Ueda A. Neonatal feeding performance as a predictor of neurodevelopmental outcome at 18 months. Dev Med Child Neurol. 2005;47:299–304. DOI: https://doi.org/10.1017/s0012162205000587.
24. Lau C. Development of suck and swallow mechanism in infants. Ann Nutr Metab. 2015;66(suppl 5):7–14. DOI: https://doi.org/10.1159/000381361.
25. McGrath JM, Braescu AV. State of the science: feeding readiness in the preterm infant. J Perinat Neonatal Nurs. 2004;18(4):353–68. DOI: https://doi.org/10.1097/00005237-200410000-00006.
26. Barlow SM, Burch M, Venkatesan L, Harold M, Zimmerman E. Frequency modulation and spatiotemporal stability of the sCPG in preterm infants with RDS. Int J Pediatr. 2012;2012;581538. DOI: https://doi.org/10.1155/2012/581538..
27. Sidell EP, Froman RD. A national survey of neonatal intensive-care units: criteria used to determine readiness for oral feedings. J Obstet Gynecol Neonatal Nurs. 1994;23:783–9. DOI: https://doi.org/10.1111/j.1552-6909.1994.tb01953.x.
28. Eichenwald EC, Blackwell M, Lloyd JS, Tran T, Wilker RE, Richardson DK. Inter-neonatal intensive care unit variation in discharge timing: influence of apnea and feeding management. Pediatrics. 2001;108:928–33. DOI: https://doi.org/10.1111/j.1552-6909.1994.tb01953.x.
29. Blackwell MT, Eichenwald EC, McAlmon K, Petit K, Linton PT, McCormick MC, et al. Interneonatal intensive care unit variation in growth rates and feeding practices in healthy moderately premature infants. J Perinatol. 2005;25:478–85. DOI: https://doi.org/10.1038/sj.jp.7211302.
30. Pickler RH, Best AM, Reyna BA, Gutcher G, Wetzel PA. Predictors of nutritive sucking in preterm infants. J Perinatol. 2006;26:693–9. DOI: https://doi.org/10.1038/sj.jp.7211590
31. Medoff-Cooper B. Changes in nutritive sucking patterns with increasing gestational age. Nurs Res. 1991;40:235-7. PMID: 1857653.
Published
2022-10-28
How to Cite
1.
Wahyuni L, Mangunatmadja I, Kaban R, Rachmawati E, Harini M, Laksmitasari B, Geraldyne A, Sangwidjojo I, Utami D, Poernomo V, Sudjono A. Non-nutritive sucking milestones of preterm infants in Indonesia: a descriptive study. PI [Internet]. 28Oct.2022 [cited 30Nov.2022];62(5):311-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2952
Section
Neonatology
Received 2022-01-14
Accepted 2022-10-28
Published 2022-10-28