Objective assessment of a preterm infant's nutritive sucking from initiation of feeding through hospitalization and discharge

Abstract

Introduction: In 2008, the American Academy of Pediatrics recommended that an infant's ability to feed independently be considered a primary consideration for discharge home. To date, NICU healthcare teams have relied on clinical experience as well as descriptive scales to determine a high risk infant's ability to transition safely from tube feeding to oral feeding. The aim of the current case study was to illustrate the clinical utility of nfant^® Feeding Solution as a noninvasive and objective instrument for determining a neonate's readiness to begin and advance oral feeding.

Materials and methods: We present the case of AC, a female infant born at 28.6 weeks, with an admitting diagnosis of respiratory distress syndrome. Data collection began when AC was declared medical stable by her attending physician and ready to begin oral feedings. Data was captured during hospitalization and at discharge as well as post discharge for a total of eleven (11) data collections.

Results: Results suggested that the subject progressed in all sucking metrics over time. Data analyses revealed three general amplitude and temporal patterns against the nipple: disorganized, hypervigilant, and then organized. Real time data was used to gain immediate feedback on the impact of interventions on sucking performance.

Conclusions: Successful infant feeding is a complex process that requires integration of physiologic function and neurobehavioral ability. To model AC's feeding performance over time, we used nfant Feeding Solution which measures tongue movement against the nipple and streams the data to a mobile tablet so it is displayed in real time. Access to real-time data provides caregivers with objective information that can be used to guide bedside care, help clinicians avoid complications and navigate infants to faster oral feeds and subsequently earlier and safer hospital discharge with lowered expense.

Figure 1

nfant Feeding Solution being used on the subject during the 11th feeding session. Tracings on the mobile app are nipple movement during nutritive suck.

Figure 2

Amplitude traces of nipple movement for sessions 2 to 11 (top to bottom) normalized to the session maximum on a scale from 0 to 1.

Figure 3

a. Movement of the tongue against the nipple in the semi-elevated supine position, session 4 b. Movement of the tongue against the nipple after switching to a semi-elevated side-lying position, session 4

Figure 3

a. Movement of the tongue against the nipple in the semi-elevated supine position, session 4 b. Movement of the tongue against the nipple after switching to a semi-elevated side-lying position, session 4

Figure 4

a. Movement of the tongue against the nipple at the beginning of session 11 b. Movement of the tongue against the nipple following 4a, session 11 c. Movement of the tongue against the nipple following 4b, session 11

Figure 4

a. Movement of the tongue against the nipple at the beginning of session 11 b. Movement of the tongue against the nipple following 4a, session 11 c. Movement of the tongue against the nipple following 4b, session 11

Figure 4

a. Movement of the tongue against the nipple at the beginning of session 11 b. Movement of the tongue against the nipple following 4a, session 11 c. Movement of the tongue against the nipple following 4b, session 11