| Research backgroundWith the development of neonatal-perinatal medicine, the survival rate of the preterm infants has remarkably increased. However, the physiological immaturity of preterm infants can cause various types and degrees of brain injuries, influencing the future survival quality. Sucking is one basic activity of newborn, successful and safe oral feeding depends upon the coordination of suck-swallow-breath. Studies have been showed that sucking disorder serves as a potential marker of neurodevelopmental problems in infants, and abnormal sucking patterns are related to feeding difficulties of preterm infants. So recognition of abnormal sucking patterns in preterm infants without brain injury and timely intervention are especially important. Previous researches have demonstrated early sucking behavior assessment offers predictive value in neurodevelopment and feeding difficulties, but relative researches are few and there is limited evidence to support this predictive value. At present, multiple tools have been developed over the years to evaluate neonate sucking behaviors. The Neonatal Oral-Motor Assessment Scale(NOMAS) is one of non-invasive neonatal feeding assessment tools that could be used in either bottle-feeding or breastfeeding and either preterm or full-term infants. In china, the translation, revision and psychometrics work of the NOMAS have been completed. ObjectivesWe apply the Chinese version of the NOMAS to assess the sucking pattern in preterm infants, investigating the relationship between abnormal sucking patterns in preterm infants without obvious brain injury and neurodevelopmental outcomes and feeding difficulties and whether oral motor assessment in preterm infants without obvious brain injury provides predictive value for neurodevelopmental outcomes and feeding difficulties. Methods1. Sucking behaviors of 128 preterm infants during October 2013 to April 2015 were videotaped weekly before discharge. The Chinese version of the NOMAS was used to assess the initial 2 min sucking behavior of the video. The preterm infants were divided into normal sucking pattern group and abnormal sucking pattern group by NOMAS scores at 36~37 weeks postmenstrual age.2. Infants returned for the Bayley Scales of Infant Development(BSID) test and growth at 6 months and 12 months corrected age, anthropometry measurements including weight, supine length, and head circumference were recorded by professional nurses of child health care, and doctor finished regular physical examination and the feeding guide. The BSID tests of the infants were completed by a researcher. Parents of subjects written Chinese revision of the Montreal Children’s Hospital Feeding Scale after BSID test. Results1. At 6 months corrected age, the average of MDI and PDI were 107.4±7.7 and 100.8±8.7 in normal group, the average of MDI and PDI were 102.3±10.1 and 97.4±8.9 in abnormal group. The infants in abnormal sucking pattern group had a significantly lower MDI and PDI than normal group(P<0.05). The infants with abnormal sucking patterns showed a higher rate of below average scores(P<0.05), abnormal group had 11 infants, normal group had 5 infants.2. At 12 months corrected age, the average of MDI and PDI were 118.9±13.7 and 104.3±9.3 in normal group, the average of MDI and PDI were 113.0±9.9 and 102.2±10.8 in abnormal sucking pattern group, the infants in abnormal sucking pattern group had a significantly lower MDI than normal group(P<0.05), there was no significant difference in PDI between the groups.3. The NOMAS scores of abnormal sucking pattern group showed negative correlation with PDI at 6 months and 12 months corrected age(r=﹣0.093, r=﹣0.279), at 12 months it reached significance( P<0.05).4. The incoordination of sucking, swallowing, and breathing significantly increased the odds of adverse neurodevelopmental outcomes at 6 month corrected age(RR=3.53, 95%CI: 1.48-8.42). The RR of incoordination of sucking, swallowing, and breathing were high shortly, but failed to reach significance(RR=3.45, 95%CI: 0.47-25.35).5. At 6 months and 12 months corrected age, the PDI of normal sucking pattern group showed negative correlation with scores of Chinese revision of the Montreal Children’s Hospital Feeding Scale(r=﹣0.279, r=﹣0.263), at 6 months it reached significance( P<0.05). ConclusionsSucking patterns in preterm infants without obvious brain injury are associated with adverse neurodevelopmental outcomes. Incoordination of sucking, swallowing, and breathing may be an early signal of adverse neurodevelopmental outcomes. The association between abnormal sucking patterns and feeding difficulties is not significant, and neurodevelopmental outcomes are related to feeding difficulties. These results indicate that abnormal sucking patterns show some predictive value on neurodevelopment, but do not for feeding difficulties. |
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