Oral Motor Intervention Improved the Oral Feeding in Preterm Infants: Evidence Based on a Meta-Analysis With Trial Sequential Analysis

Xu Tian, Li-Juan Yi, Lei Zhang, Jian-Guo Zhou, Li Ma, Yang-Xiang Ou, Ting Shuai, Zi Zeng, Guo-Min Song, Xu Tian, Li-Juan Yi, Lei Zhang, Jian-Guo Zhou, Li Ma, Yang-Xiang Ou, Ting Shuai, Zi Zeng, Guo-Min Song

Abstract

Oral feeding for preterm infants has been a thorny problem worldwide. To improve the efficacy of oral feeding in preterm infants, oral motor intervention (OMI), which consists of nonnutritive sucking, oral stimulation, and oral support, was developed. Published studies demonstrated that OMI may be as an alternative treatment to solve this problem; however, these results remain controversial. We conducted a meta-analysis with trial sequential analysis (TSA) to objectively evaluate the potential of OMI for improving the current status of oral feeding in preterm infants.A search of PubMed, EMBASE, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure was performed to capture relevant citations until at the end of October, 2014. Lists of references of eligible studies and reviews were also hand-checked to include any latent studies. Two independent investigators screened literature, extracted data, and assessed the methodology, and then a meta-analysis and TSA was performed by using Reviewer Manager (RevMan) 5.3 and TSA 0.9 beta, respectively.A total of 11 randomized controlled trials (RCTs), which included 855 participants, were incorporated into our meta-analysis. The meta-analyses suggested that OMI is associated with the reduced transition time (ie, the time needed from tube feeding to totally oral feeding) (mean difference [MD], -4.03; 95% confidence interval [CI], -5.22 to -2.84), shorten hospital stays (MD, -3.64; 95% CI, -5.57 to -1.71), increased feeding efficiency (MD, 0.08; 95% CI, 0.36-1.27), and intake of milk (MD, 0.14; 95% CI, 0.06-0.21) rather than weight gain. Results of TSA for each outcomes of interest confirmed these pooled results.With present evidences, OMI can be as an alternative to improve the condition of transition time, length of hospital stays, feeding efficiency, and intake of milk in preterm infants. However, the pooled results may be impaired due to low quality included, and thus, well-designed and large RCTs were needed to further established effects.

Conflict of interest statement

All authors have reviewed carefully the author guide and declared no conflicts of interests existed in this work.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram of search and selection of literature. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analysis.
FIGURE 2
FIGURE 2
Assessment of risk of bias: (A) risk of bias graph and (B) risk of bias summary.
FIGURE 3
FIGURE 3
Meta-analysis on transition time: OMI effectively reduced the time needed from bottle feeding to total oral feeding compared to route NICU care, random-effect model. OMI = oral motor intervention.
FIGURE 4
FIGURE 4
TSA on pooled result of transition time: the cumulative sample size over the RIS of 273 and the Z-curve across the adjusted monitor boundary. RIS = required information size, TSA = trial sequential analysis.
FIGURE 5
FIGURE 5
Meta-analysis on length of hospital stays: the length of hospitalization of preterm infants in OMI group was reduced by approximately 3.64 days relative to that of route care group, fixed-effect model. OMI = oral motor intervention.
FIGURE 6
FIGURE 6
TSA on pooled result of length of hospital stays: although cumulative sample size less than RIS, the Z-curve across the adjusted monitor boundary. RIS = required information size, TSA = trial sequential analysis.
FIGURE 7
FIGURE 7
Meta-analysis on feeding efficiency: the feeding efficiency of preterm infants has been slightly improved after received the OMI approach, fixed-effect model. OMI = oral motor intervention.
FIGURE 8
FIGURE 8
TSA on summarized result of feeding efficiency: although cumulative sample size less than RIS, the Z-curve across the adjusted monitor boundary. RIS = required information size, TSA = trial sequential analysis.
FIGURE 9
FIGURE 9
Meta-analysis on intake of milk: OMI approach mildly increased the intake of milk of preterm infants compared to route NICU care regime, fixed-effect model. OMI = oral motor intervention.
FIGURE 10
FIGURE 10
TSA on summarized result of intake of milk: although cumulative sample size less than RIS of 527, the Z-curve across the adjusted monitor boundary. RIS = required information size, TSA = trial sequential analysis.
FIGURE 11
FIGURE 11
Meta-analysis on weight gain: no significant difference was detected between OMI and route NICU care regime in terms of weight gain, random-effect model. OMI = oral motor intervention.
FIGURE 12
FIGURE 12
Funnel plot of publication bias.

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