The effect of oral motor intervention with different initiation times to improve feeding outcomes in preterm infants: protocol for a single-blind, randomized controlled trial.

BACKGROUND: Premature infants commonly encounter difficulties with oral feeding, a complication that extends hospital stays, affects infants' quality of life, and imposes substantial burdens on families and society. Enhancing preterm infants' oral feeding skills and facilitating their transition from parenteral or nasal feeding to full oral feeding pose challenges for neonatal intensive care unit (NICU) healthcare professionals. Research indicates that oral motor interventions (OMIs) can enhance preterm infants' oral feeding capabilities and expedite the transition from feeding initiation to full oral feeding. Nonetheless, the most suitable timing for commencing these interventions remains uncertain. METHODS: This is a single-blind, randomized controlled trial. Preterm with a gestational age between 29+0 to 34+6 weeks will be eligible for the study. These infants will be randomized and allocated to one of two groups, both of which will receive the OMIs. The intervention commences once the infant begins milk intake during the early OMIs. Additionally, in the late OMIs group, the intervention will initiate 48 h after discontinuing nasal continuous positive airway pressure. DISCUSSION: OMIs encompass non-nutritive sucking and artificial oral stimulation techniques. These techniques target the lips, jaw, muscles, or tongue of premature infants, aiming to facilitate the shift from tube feeding to oral feeding. The primary objective is to determine the ideal intervention timing that fosters the development of oral feeding skills and ensures a seamless transition from parenteral or nasal feeding to full oral feeding among preterm infants. Furthermore, this study might yield insights into the long-term effects of OMIs on the growth and neurodevelopmental outcomes of preterm infants. Such insights could bear substantial significance for the quality of survival among preterm infants and the societal burden imposed by preterm birth. TRIAL REGISTRATION: chictr.org.cn ChiCTR2300076721. Registered on October 17, 2023.

Effect of premature infant oral motor intervention [PIOMI] combined with music therapy on feeding progression of preterm infants: a randomized control trial.

Prematurity may produce long-term complications in the physical and cognitive development of infants. There is a need for interventions that can improve feeding and reduce the length of NICU stay and separation time between the infant and mother. This study aimed to explore the clinical effect of premature infant oral motor intervention [PIOMI] combined with music therapy [MT] on feeding progression in premature infants.Premature infants with gestational ages between 26 and 30 weeks were included in the study. Fifty-two participants were randomly divided into intervention and control groups. All infants received PIOMI, and the intervention group received additional MT. The participants of the two groups were compared based on weight gain, feeding progression, Preterm Oral Feeding Readiness Scale [POFRAS], milk volume, and length of hospitalization. The data were analyzed using independent sample t-tests, covariance tests, and repeated measure ANOVA used to compare three group means.The intervention group reached independent oral feeding 8 days earlier [P = .018] than the control group. Length of hospitalization was 6 days shorter [P = .224] for the intervention group, and the mean volume of milk on the 10th day was 215.38 ± 56.4 in the intervention group and 155.69 ± 68.9 in the control group, respectively [P = .001]. The mean score of the POFRAS scale on the 10th day was 28.65 ± 3.0 in the intervention groups and 20.96 ± 3.3 in the control groups, retrospectively [P = .001]. There was no difference in weight gain between the two groups [P = .522].Conclusion: PIOMI combined with MT was effective for the feeding progression of premature infants, and infants who received both these interventions were discharged sooner than control infants. Thus, MT should be considered part of feeding interventions for preterm infants with gestational ages between 26 and 30 weeks.Trial registration: Clinical trial registration number: IRCT20210502051155N1 on 18/9/2021 What is Known -- What is New: • There is numerous study about the eff ect of music therapy or oral motor interventi on. However, premature Infants havenot been yet studied to determine whether music therapy and oral motor interventi ons may synergize to aid their feedingprogression.

Pre-feeding premature infant oral motor intervention (PIOMI) for transition from gavage to oral feeding: A randomised controlled trial.

PURPOSE: To assess the performance of premature infant oral motor intervention for transition from gavage to full spoon feeding in preterm infants. METHODS: Preterm neonates born between 28 + 0-32 + 6 weeks gestation (n = 32) were randomised into an intervention group (premature infant oral motor intervention) for five minutes twice a day along with routine care (n = 16) and a control group (routine care, n = 16) once they reached a feed volume of at least 150 ml/kg/day administered by gavage method. The primary outcome measure was time (in days) to transition from gavage to full spoon feeds. RESULTS: The mean (SD) time to transition from gavage to full spoon feeds was attained significantly earlier in the intervention group than the control group (9.93 [5.83] vs 16.43 [10.46] days; mean difference, -6.5 days; 95% CI, -12.58 to -0.41). There was no significant difference between the two groups in terms of the duration of hospital stay, rates of physiological stability, and culture positive sepsis. CONCLUSION: Premature infant oral motor intervention, as used in this specific population, significantly reduces the time to transition to full spoon feeds without increasing culture positive sepsis and physiological instability.

Effects of Complete Oral Motor Intervention and Nonnutritive Sucking Alone on the Feeding Performance of Premature Infants: A Systematic Review and Meta-Analysis.

We explore the effect of complete oral motor intervention (OMI) and nonnutritive sucking (NNS) alone on oral feeding in preterm infants through a meta-analysis. We searched the Embased, Medline, Cochrane Library, and Web of Science databases for randomized controlled trials up to 8 August 2023, based on established selection criteria. Quality evaluations of the studies were carried out by applying both the Cochrane risk of bias assessment tool and the Jadad scale. The outcome measures of three clinical indicators included transition time to oral feeding, weight gain, and hospitalization duration. We conducted a meta-analysis using a random-effects model to determine the pooled effect sizes, expressed as standardized mean differences (SMDs) and their corresponding confidence intervals (CIs). Additionally, we undertook a subgroup analysis and meta-regression to investigate any potential moderating factors. Eight randomized controlled trials with 419 participants were selected. Meta-analysis revealed that receiving a complete OMI had significantly reduced transition time compared with those receiving NNS alone in preterm newborns (SMD, -1.186; 95% CI, -2.160 to -0.212, p = 0.017). However, complete OMI had no significant effect on shortened hospitalization duration (SMD, -0.394; 95% CI, -0.979 to 0.192, p = 0.188) and increased weight gain (SMD, 0.346; 95% CI, -0.147 to 0.838, p = 0.169) compared with NNS alone. In brief, a complete OMI should not be replaced by NNS alone. However, we were unable to draw decisive conclusions because of the limitations of our meta-analysis. Future well-designed randomized controlled trials are necessary to confirm our conclusion.

The Effects of Neurodevelopmental Therapy on Feeding and Swallowing Activities in Children with Cerebral Palsy.

This study investigated the effect of the structured Neurodevelopmental Therapy Method-Bobath (NDT-B) approach on the feeding and swallowing activity of patients with cerebral palsy (CP) and feeding difficulties. In addition to feeding and oral motor intervention strategies (OMIS), and nutrition-related caregiver training (NRCT), and the NDT-B, which was structured to increase trunk and postural control, was added to the therapy program. Forty patients with CP, with a mean age of 3.25 ± 0.927 years, were classified using the Gross Motor Function Classification System, Eating and Drinking Ability Classification System, and Mini-Manual Ability Classification System. The patients were randomly assigned into two groups as OMIS + NRCT (n = 20) and OMIS + NRCT + NDT-B (n = 20). The program was applied for 6 weeks, 2 days/week, for 45 min. The patients were evaluated using the Trunk Impairment Scale, Schedule for Oral Motor Assessment, and the Pediatric Quality of Life Inventory before and after 6 weeks. The trunk control of the OMIS + NRCT + NDT-B group was superior to the other group (P = 0.026). Although there was an improvement in the groups according to the subcategories of SOMA, the OMIS + NRCT + NDT-B group was superior in the trainer cup and puree subcategories of SOMA (P = 0.05). A significant correlation was observed between trunk control and oral motor functions in children with CP, and the eating function of children in the OMIS + NRCT + NDT-B group further improved. NDT-B-based neck and trunk stabilization exercises should be added to the treatment programs.Trial Registration NCT04403113.

The effects of premature infant oral motor intervention (PIOMI) on oral feeding of preterm infants: A randomized clinical trial.

OBJECTIVE: Given the increase in the birth and survival rate of the premature infants, a need for supportive health care services becomes more evident. The goal of the present study was to examine the effectiveness of the Premature Infant Oral Motor Intervention (PIOMI) in the feeding progression and early intervention. This study was a double-blind randomized clinical trial. METHODS: This clinical trial included premature infants in the neonatal intensive care units (NICUs) of two hospitals in Tehran, who were randomly assigned into intervention and control group, each containing 15 infants. The PIOMI was administered to the intervention group in the course of 10 days. The infants in the control group received routine nursing services. Repeated measures ANOVA (RMA) were analyzed. The postmenstrual age and weight of the participants were examined at the time points of accomplishing one, four, and eight oral feedings a day and at the time of hospital discharge. RESULTS: The intervention group reached the first oral feeding (with a mean of 7.2 days) and eight oral feeding (with a mean of 13.47 days) earlier than the control group. The length of hospital stay in intervention group was significantly shorter (P = 0.03). RMA wasn't statistically significant between groups for weight (F: 0.76, P: 0.39, ŋ: 0.03); but within-subjects test showed that change of the weight over time and for interaction of time and group was significant (F: 74.437, P < 0.001, ŋ: 0.727). The effect size of infants' age in the measurement times was 91%. CONCLUSION: the results revealed that PIOMI is a fruitful method for premature infants. We suggest that PIOMI can be integrated in feeding rehabilitation programs of the premature infants born with gestational age of as young as 26-29 weeks, and applied at 29 weeks postmenstrual age (PMA). THE CLINICAL TRIAL REGISTRATION NUMBER: IRCT20180410039260N1.

Randomized Controlled Trial of a Prefeeding Oral Motor Therapy and Its Effect on Feeding Improvement in a Thai NICU.

OBJECTIVE: To evaluate the effect of the Premature Infant Oral Motor Intervention (PIOMI) on preterm newborns' feeding efficiency and rates of improvement across Days 1, 3, and 5 of oral feeding in a Thai NICU. DESIGN: Randomized controlled trial. SETTING: A 20-bed special neonatal ward and 8-bed NICU in urban Thailand. PARTICIPANTS: Stable newborns (N = 30) born between 26 and 34 weeks postmenstrual age (PMA) without comorbidities. METHODS: After they reached 32 to 34 weeks PMA, participants were randomly assigned to groups. The experimental group (n = 15) received the PIOMI once daily for 7 consecutive days, and the control group (n = 15) received routine care only. After oral feedings were initiated, the mean volume (MV) of oral intake of two consecutive oral feedings was calculated on Days 1, 3, and 5 to assess feeding efficiency and compare the groups. RESULTS: The MV of oral intake (percentage of prescribed feeding) was significantly greater in the experimental group versus the control group on all days of measurement. The MV consumed on Day 1 of oral feeding was 44.9% ± 7.33% in the experimental group versus 29.7% ± 9.55% in the control group (P < .001), 53.9% ± 8.01% versus 30.4% ± 11.07% on Day 3 (P < .001), and 61.7% ± 7.44% versus 34.8% ± 8.76 on Day 5 (P < .001). The rate of improvement was also accelerated in the intervention group. CONCLUSION: The improved feeding efficiency that we found in our participants is consistent with results from other published studies and supports the use of the PIOMI as an effective oral motor therapy for newborns ages 32 to 34 weeks PMA.

Clinical significance of oral motor intervention on the prognosis of early premature infant / 中华危重病急救医学

Objective? To? explore? the? clinical? significance? of? early? oral? intervention? measures? in? the?prognosis?of?premature?infants.? Methods? 151?preterm?infants?admitted?to?neonatal?intensive?care?unit?(NICU)?of?Liaocheng?People's?Hospital?from?January?2015?to?January?2017?were?enrolled.?Premature?infants?were?divided?into?intervention?group?and?control?group?according?to?random?number?table?method?and?with?the?consent?of?legal?guardian.?Both?groups?received?routine?treatment?of?preterm?infants?after?stable?vital?signs.?The?intervention?group?received?the?oral?massage?method?adopted?by?none-nutritive?sucking,?stimulating?swallowing?function?and?SandraFucile?on?the?basis?of?routine?treatment,?once?a?day?for?14?consecutive?days.?Both?groups?were?followed?up?for?6?months.?The?oral?feeding?ability?of?premature?infants?was?evaluated?by?the?proficiency?(PRO),?rate?of?transfer?(RT),?feeding?process?and??non-nutritive?suction?(NNS).?At?40?weeks?of?postmenstrual?age?(PMA),?neonatal?behavioral?neurological?(NBNA)?was?used?to?assess?neonatal?brain?development;?Infanib?was?used?for?early?motor?development?evaluation?at?3?months?and??6?months?after?birth.? Results? Finally,?151?premature?infants?were?enrolled,?including?78?in?the?intervention?group?and?73?in?the?control?group.?The?time?to?complete?oral?feeding?of?the?intervention?group?was?significantly?shorter?than?that?of?the?control?group?(days:?18.1±3.7?vs.?23.4±5.8,?P?<?0.05).?Compared?with?the?control?group,?at?the?time?of?complete?oral?feeding,?the?PMA?of?the?intervention?group?was?significantly?decreased?(weeks:?33.4±0.9?vs.?35.9±1.9,?P <?0.05),?the?feeding?efficiency?was?significantly?increased?(mL/min:?10.6±5.1?vs.?8.1±4.7,?P?<?0.05),?and?PRO?was?significantly?increased?[(95±8)%?vs.?(72±28)%,?P <?0.05],?and?the?body?weight?was?significantly?decreased?(g:?1?836.0±193.0?vs.?2?000.8±204.5,?P?<?0.05).?The?NNS?scores?of?the?intervention?group?and?the?control?group?were?increased?gradually?with?time?(F?values?were?86.21?and?75.23,?respectively,?both?P?<?0.01),?and?the?NNS?scores?of?the?intervention?group?at??10?days?and?14?days?were?significantly?higher?than?those?of?the?control?group?(52.89±6.26?vs.?46.74±6.24,?73.90±7.01? vs.?63.53±6.80,?both?P?<?0.01).?The?NBNA?scores?of?the?two?groups?were?lower,?but?there?was?no?significant?difference?between?the?intervention?group?and?the?control?group?(32.7±3.6?vs.?32.0±4.1,?P?>?0.05).?Infanib?evaluation?at?3?months?of?age?showed?that?the?proportion?of?normal?children?in?the?intervention?group?was?significantly?higher?than?that?in?the?control?group?[67.95%?(53/78)?vs.?49.31%?(36/73),?P?<?0.05],?and?at?6?months?of?age,?the?proportion?of?normal?children?in?the?intervention?group?was?significantly?higher?than?that?in?the?control?group?[84.62%?(66/78)?vs.?58.90%?(43/73),??P <?0.01].? Conclusion? Early?oral?exercise?intervention?can?shorten?the?transition?time?from?tube?feeding?to?full?oral?feeding?in?NICU?premature?infants?and?improve?the?performance?of?infants?during?feeding.

Identification of Risk Factors for Poor Feeding in Infants with Congenital Heart Disease and a Novel Approach to Improve Oral Feeding.

Many infants with complex congenital heart disease (CHD) do not develop the skills to feed orally and are discharged home on gastrostomy tube or nasogastric feeds. We aimed to identify risk factors for failure to achieve full oral feeding and evaluate the efficacy of oral motor intervention for increasing the rate of discharge on full oral feeds by performing a prospective study in the neonatal and cardiac intensive care units of a tertiary children's hospital. 23 neonates born at ≥37weeks gestation and diagnosed with single-ventricle physiology requiring a surgical shunt were prospectively enrolled and received oral motor intervention therapy. 40 historical controls were identified. Mean length of stay was 53.7days for the control group and 40.9days for the study group (p=0.668). 13/23 patients who received oral motor intervention therapy (56.5%) and 18/40 (45.0%) controls were on full oral feeds at discharge, a difference of 11.5% (95% CI -13.9% to 37.0%, p=0.378). Diagnosis of hypoplastic left heart syndrome, longer intubation and duration of withholding enteral feeds, and presence of gastroesophageal reflux disease were predictors of poor oral feeding on univariate analysis. Although we did not detect a statistically significant impact of oral motor intervention, we found clinically meaningful differences in hospital length of stay and feeding tube requirement. Further research should be undertaken to evaluate methods for improving oral feeding in these at-risk infants.