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  • Original Article
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Frequency-modulated orocutaneous stimulation promotes non-nutritive suck development in preterm infants with respiratory distress syndrome or chronic lung disease

Journal of Perinatology volume 34, pages 136–142 (2014)Cite this article

Subjects

Abstract

Objective:

For the premature infant, extrauterine life is a pathological condition, which greatly amplifies the challenges to the brain in establishing functional oromotor behaviors. The extent to which suck can be entrained using a synthetically patterned orocutaneous input to promote its development in preterm infants who manifest chronic lung disease (CLD) is unknown. The objective of this study was to evaluate the effects of a frequency-modulated (FM) orocutaneous pulse train delivered through a pneumatically charged pacifier capable of enhancing non-nutritive suck (NNS) activity in tube-fed premature infants.

Study Design:

A randomized trial to evaluate the efficacy of pneumatic orocutaneous stimulation 3 × per day on NNS development and length of stay (LOS) in the neonatal intensive care unit among 160 newborn infants distributed among three sub-populations, including healthy preterm infants, respiratory distress syndrome (RDS) and CLD. Study infants received a regimen of orocutaneous pulse trains through a PULSED pressurized silicone pacifier or a SHAM control (blind pacifier) during gavage feeds for up to 10 days.

Result:

Mixed modeling, adjusted for the infant’s gender, gestational age, postmenstrual age and birth weight, was used to handle interdependency among repeated measures within subjects. A significant main effect for stimulation mode (SHAM pacifier vs PULSED orosensory) was found among preterm infants for NNS bursts per min (P=0.003), NNS events per min (P=0.033) and for total oral compressions per min (NNS+nonNNS) (P=0.016). Pairwise comparison of adjusted means using Bonferroni adjustment indicated RDS and CLD infants showed the most significant gains on these NNS performance indices. CLD infants in the treatment group showed significantly shorter LOS by an average of 2.5 days.

Conclusion:

FM PULSED orocutaneous pulse train stimuli delivered through a silicone pacifier are effective in facilitating NNS burst development in tube-fed RDS and CLD preterm infants, with an added benefit of reduced LOS for CLD infants.

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Acknowledgements

This study was supported by grants NIH R01 DC003311 (SM Barlow), NIH P30 HD02528 and the Sutherland Foundation. We express gratitude to Joy Carlson, NNP and Mimi Burch, MS, for clinical support in patient recruitment and data collection, Drs Meredith P Harold and Emily Zimmerman for experimental support, Kenny Aron for software technical support, and the scores of families who participated in this project. This paper is dedicated to Anna M Dusick, MD (1955 to 2012), an outstanding clinical scientist and neurodevelopmentalist, who encouraged the first author to pursue studies on oral sensorimotor development in the preterm infant.

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Authors and Affiliations

  1. Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, Lawrence, KS, USA

    S M Barlow, J Wang & A Oder

  2. Program in Neuroscience, University of Kansas, Lawrence, KS, USA

    S M Barlow

  3. Program in Human Biology, University of Kansas, Lawrence, KS, USA

    S M Barlow

  4. Program in Bioengineering, University of Kansas, Lawrence, KS, USA

    S M Barlow

  5. Center for Research Methods and Data Analysis, University of Kansas, Lawrence, KS, USA

    J Lee

  6. Stormont-Vail HealthCare, Topeka, KS, USA

    S Hall & K Knox

  7. Overland Park Regional Medical Center, Overland Park, KS, USA

    K Weatherstone & D Thompson

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  1. S M Barlow
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Correspondence to S M Barlow.

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Competing interests

None of the authors have a direct financial relation with the manufacturers of the Soothie pacifier, Honeywell Sensors, nor with the SAS statistical software. Dr Barlow is the inventor of the NTrainer System, which is registered and licensed by the University of Kansas to Innara Health, Incorporated (Olathe, KS, USA).

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Barlow, S., Lee, J., Wang, J. et al. Frequency-modulated orocutaneous stimulation promotes non-nutritive suck development in preterm infants with respiratory distress syndrome or chronic lung disease. J Perinatol 34, 136–142 (2014). https://doi.org/10.1038/jp.2013.149

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