Oral and non-oral sensorimotor interventions enhance oral feeding performance in preterm infants

Abstract

Aim: The aim of this study was to determine whether oral, tactile/kinaesthetic (T/K), or combined (oral+T/K) interventions enhance oral feeding performance and whether combined interventions have an additive/synergistic effect.

Method: Seventy-five preterm infants (mean gestational age 29 wk; standard error of the mean [SEM] 0.3 wk; mean birthweight 1340.3g; SEM 52.5 g; 49 males and 26 females) were randomly assigned to one of three intervention groups or a control group. The oral group received sensorimotor input to the oral structures, the T/K group received sensorimotor input to the trunk and limbs, and the combined group received both. The outcomes were time from introduction of nipple feeding to independent oral feeding (d), proficiency (intake in the first 5 min, %), volume transfer (%), rate of transfer (mL/min), volume loss (%), and length of hospital stay (d).

Results: Infants in the three intervention groups achieved independent oral feeding 9-10 days earlier than those in the control group (p<0.001; effect size 1.9-2.1). Proficiency (p ≤ 0.002; effect size 0.7-1.4) at the time of one to two and three to five oral feedings per day, volume transfer (p ≤ 0.001; effect size 0.8-1.1) at one to two, three to five, and six to eight oral feedings per day, and overall rate of transfer (p ≤ 0.018; effect size 0.8-1.1) were greater, and overall volume losses were less (p ≤ 0.007; effect size 0.9-1.1), than in the control group (p ≤ 0.042). The combined group attained independent oral feeding at a significantly younger postmenstrual age than controls (p=0.020) and had clinically greater proficiency than the T/K group (p=0.020; effect size 0.7) and oral group (p=0.109; effect size 0.5). Length of hospital stay was not significantly different between groups (p=0.792; effect size 0.02-0.3).

Interpretation: Oral and T/K interventions accelerated the transition from introduction to independent oral feeding and enhanced oral feeding skills. T/K has beneficial effects beyond the specific targeted system. The combined sensorimotor intervention led to an additive/synergistic effect for proficiency, further benefiting this population.

Figure 1

(a) Proficiency (%) at the three oral feeding sessions. Data presented as means±(standard error of the mean, SEM). At one to two oral feedings a day, the three intervention groups had significantly greater proficiency than controls, and at three to five oral feedings a day the O and combined (O+T/K) groups had significantly greater proficiency than controls (p≤0.022, ES≥0.7). (b) Volume transfer (%) at the three oral feeding sessions. Data presented as means±(SEM). At one to two and six to eight oral feedings a day, the three intervention groups had significantly greater volume transfer than controls (p≤0.040, ES O≥0.7), and at three to five oral feedings a day only the O group demonstrated marginally greater volume transfer than controls (p=0.07, ES≥0.6). (c) Rate of transfer (ml/min) at the three oral feeding sessions. Data presented as means±(SEM). All three interventions had significantly faster rate of transfer than controls (p≤0.018, ES≥1.0). (d) Volume loss (%) at the three oral feeding sessions. Data presented as means±(SEM). All three interventions had significantly less volume loss than controls (p≤0.007, ES≥1.0).