Oral and nonoral sensorimotor interventions facilitate suck-swallow-respiration functions and their coordination in preterm infants

Abstract

Background: Preterm infants are at high risk of encountering oral feeding difficulties. Early sensorimotor interventions may improve oral feeding skills in preterm infants.

Aim: To further explore the effects of an oral (O), tactile/kinesthetic (T/K), and combined (O+T/K) sensorimotor intervention on preterm infants' nutritive sucking, swallowing and their coordination with respiration.

Study design: Seventy-five infants (29 [0.3, standard error of mean, SEM] weeks gestation, 49 males/26 females) were randomly assigned to an O group involving sensorimotor input to the oral structures; a T/K group involving sensorimotor input to the trunk and limbs; a combined (O+T/K) group; and a control group.

Outcome measures: Stage of sucking, suction and expression amplitudes (mmHg), suck-swallow ratio, stability of suck-swallow interval, and swallow-respiration patterns.

Results: The O group had significantly more advanced sucking stages, and greater suction and expression amplitudes than controls [p≤0.035, effect size (ES) >0.6]. The suck-swallow ratio and stability of suck-swallow intervals did not significantly differ among groups (p≥0.181, ES≤0.3). The three interventions led to fewer swallows bracketed by prolonged respiratory pauses compared to controls (pause-swallow-pause, p≤0.044, ES≥0.7). The T/K and combined (O+T/K) groups had greater occurrence of swallows bracketed by expiration than the control and O groups (expiration-swallow-expiration, p≤0.039, ES≥0.3).

Conclusion: The O intervention enhanced specific components of nutritive sucking. All three interventions resulted in improved swallow-respiration coordination. Sensorimotor interventions have distributed beneficial effects that go beyond the specific target of input.

Conflict of interest statement

Conflict of Interest

The authors do not have any conflict of interest to disclose.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1

Swallow-respiration patterns. Pattern 1 - start inspiration-swallow-end expiration (start I-Sw-end E); pattern 2 - inspiration-swallow-inspiration (I-Sw-I); pattern 3 - end inspiration-swallow-start expiration (end I-Sw-start E); pattern 4 - expiration-swallow-expiration (E-Sw-E); pattern 5i - swallow interrupts inspiration (Sw-interrupt I); pattern 5e - swallow interrupts expiration (Sw-interrupt E); and pattern 6 - pause-swallow-pause (P-Sw-P, swallows occurring at cessation of respiration ≥ 2 seconds).

Figure 2

Sample tracing of swallow-respiratory movements (pressure changes during respiration) recorded from one infant during oral feeding, demonstrating, the pause-swallow-pause pattern (P-Sw-P), and expiration-swallow-expiration pattern (E-Sw-E).