Technological Solutions and Main Indices for the Assessment of Newborns' Nutritive Sucking: A Review

Nutritive Sucking (NS) is a highly organized process that is essential for infants' feeding during the first six months of their life. It requires the complex coordination of sucking, swallowing and breathing. The infant's inability to perform a safe and successful oral feeding can be an early detector of immaturity of the Central Nervous System (CNS). Even though the importance of early sucking measures has been confirmed over the years, the need for standardized instrumental assessment tools still exists. Clinicians would benefit from specifically designed devices to assess oral feeding ability in their routine clinical monitoring and decision-making process. This work is a review of the main instrumental solutions developed to assess an infant's NS behavior, with a detailed survey of the main quantities and indices measured and/or estimated to characterize sucking behavior skills and their development. The adopted sensing measuring systems will be described, and their main advantages and weaknesses will be discussed, taking into account their application to clinical practice, or to at-home monitoring as post-discharge assessment tools. Finally, the study will highlight the most suitable sensing solutions and give some prompts for further research.

[1]  B. Rogers,et al.  Assessment of infant oral sensorimotor and swallowing function. , 2005, Mental retardation and developmental disabilities research reviews.

[2]  D. Skuse,et al.  Prevalence of feeding problems and oral motor dysfunction in children with cerebral palsy: a community survey. , 1996, The Journal of pediatrics.

[3]  V. Bhutani,et al.  Energetics and mechanics of nutritive sucking in the preterm and term neonate. , 1987, The Journal of pediatrics.

[4]  R. Schanler,et al.  Oral feeding in premature infants: advantage of a self‐paced milk flow , 2000, Acta paediatrica.

[5]  F. Flack,et al.  Comparative Review of Techniques for Recording Respiratory Events at Rest and during Deglutition , 1997, Dysphagia.

[6]  Linda Crowe,et al.  Instruments for assessing readiness to commence suck feeds in preterm infants: effects on time to establish full oral feeding and duration of hospitalisation. , 2016, The Cochrane database of systematic reviews.

[7]  P. Dodrill,et al.  Feeding Difficulties in Preterm Infants , 2011 .

[8]  K. Mizuno,et al.  The maturation and coordination of sucking, swallowing, and respiration in preterm infants. , 2003, The Journal of pediatrics.

[9]  K. Mizuno,et al.  Analysis of feeding behavior with direct linear transformation. , 2006, Early human development.

[10]  B. Medoff‐Cooper,et al.  Changes in nutritive sucking patterns with increasing gestational age. , 1991, Nursing research.

[11]  B. Thach,et al.  Ventilatory sparing strategies and swallowing pattern during bottle feeding in human infants. , 1994, Journal of applied physiology.

[12]  W J Logan,et al.  Sonic correlates of human deglutition. , 1967, Journal of applied physiology.

[13]  Mario Enrique Rendón Macías,et al.  Fisiología de la succión nutricia en recién nacidos y lactantes , 2011 .

[14]  R. Schanler,et al.  Maturation of oral feeding skills in preterm infants , 2007, Acta paediatrica.

[15]  R. Pickler,et al.  Relationship of the First Suck Burst to Feeding Outcomes in Preterm Infants , 2006, The Journal of perinatal & neonatal nursing.

[16]  P. Meier,et al.  Concurrent Validity of a New Instrument for Measuring Nutritive Sucking in Preterm Infants , 1992, Nursing research.

[17]  B. Thach,et al.  Coordination of breathing, sucking, and swallowing during bottle feedings in human infants. , 1990, Journal of applied physiology.

[18]  F C Flack,et al.  Coordination of sucking, swallowing and breathing in the newborn: its relationship to infant feeding and normal development. , 1990, The British journal of disorders of communication.

[19]  Justine Slattery,et al.  Early sucking and swallowing problems as predictors of neurodevelopmental outcome in children with neonatal brain injury: a systematic review , 2012, Developmental medicine and child neurology.

[20]  D. Skuse,et al.  CHARACTERISTICS AND MANAGEMENT OF FEEDING PROBLEMS OF YOUNG CHILDREN WITH CEREBRAL PALSY , 1992, Developmental medicine and child neurology.

[21]  J. Heinz,et al.  Cervical Auscultation Of Suckle Feeding In Newborn Infants , 1990, Developmental medicine and child neurology.

[22]  A. Sameroff,et al.  The components of sucking in the human newborn. , 1968, Journal of experimental child psychology.

[23]  H. S. Wolff,et al.  iRun: Horizontal and Vertical Shape of a Region-Based Graph Compression , 2022, Sensors.

[24]  A. Bos,et al.  Uncoordinated sucking patterns in preterm infants are associated with abnormal general movements. , 2012, The Journal of pediatrics.

[25]  A. Stunkard,et al.  Calibrated-orifice nipples for measurement of infant nutritive sucking. , 1998, The Journal of pediatrics.

[26]  Ming-Chih Lin,et al.  Prediction for developmental delay on Neonatal Oral Motor Assessment Scale in preterm infants without brain lesion , 2010, Pediatrics international : official journal of the Japan Pediatric Society.

[27]  Sergio Silvestri,et al.  Ecological Sucking Monitoring of Newborns , 2013, IEEE Sensors Journal.

[28]  K. Mizuno,et al.  Development of sucking behavior in infants with Down's syndrome , 2001, Acta paediatrica.

[29]  J Naish,et al.  Save the children. , 1997, Nursing times.

[30]  David N. Lee,et al.  Detecting motor abnormalities in preterm infants , 2000, Experimental Brain Research.

[31]  P. de Cock,et al.  Feeding behaviour in preterm neonates. , 1982, Early human development.

[32]  Steven M. Barlow,et al.  Suck Predicts Neuromotor Integrity and Developmental Outcomes , 2009 .

[33]  C. Lau,et al.  Characterization of the developmental stages of sucking in preterm infants during bottle feeding , 2000, Acta paediatrica.

[34]  A. Bos,et al.  Sucking and swallowing in infants and diagnostic tools , 2008, Journal of Perinatology.

[35]  B Medoff-Cooper,et al.  Neonatal Sucking As A Clinical Assessment Tool: Preliminary Findings , 1989, Nursing research.

[36]  J. Bosma,et al.  An electromyographic analysis of reflex deglutition. , 1956, Journal of neurophysiology.

[37]  Edward F. Bell,et al.  Hospital Discharge of the High-Risk Neonate , 2008, Pediatrics.

[38]  P. Wolff,et al.  The serial organization of sucking in the young infant. , 1968, Pediatrics.

[39]  C. Lau,et al.  Coordination of suck‐swallow and swallow respiration in preterm infants , 2003, Acta paediatrica.

[40]  M. Mcbride,et al.  Sucking disorders in neurologically impaired infants: assessment and facilitation of breastfeeding. , 1987, Clinics in perinatology.

[41]  I. Gewolb,et al.  Maturational changes in the rhythms, patterning, and coordination of respiration and swallow during feeding in preterm and term infants. , 2006, Developmental medicine and child neurology.

[42]  W. Bilker,et al.  Sucking patterns and behavioral state in 1- and 2-day-old full-term infants. , 2010, Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.

[43]  Joy E. Lawn,et al.  Born too soon: the global action report on preterm birth , 2012 .

[44]  Elizabeth Adams,et al.  Quantification of Intraoral Pressures During Nutritive Sucking: Methods with Normal Infants , 2011, Dysphagia.

[45]  R. Pickler,et al.  Bottle-feeding histories of preterm infants. , 1997, Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.

[46]  J. McGrath,et al.  State of the Science: Feeding Readiness in the Preterm Infant , 2004, The Journal of perinatal & neonatal nursing.

[47]  K. Pridham,et al.  Oral feeding in low birth weight infants. , 1998, The Journal of pediatrics.

[48]  Katsumi Mizuno,et al.  Neonatal feeding performance as a predictor of neurodevelopmental outcome at 18 months , 2005, Developmental medicine and child neurology.

[49]  O P Mathew,et al.  Breathing patterns of preterm infants during bottle feeding: role of milk flow. , 1991, The Journal of pediatrics.

[50]  F C Flack,et al.  Deglutition apnoea as indicator of maturation of suckle feeding in bottle‐fed preterm infants , 1997, Developmental medicine and child neurology.

[51]  Tsu-Hsin Howe,et al.  A review of psychometric properties of feeding assessment tools used in neonates. , 2008, Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.

[52]  Y. Mukai,et al.  Maturational changes in the feeding behaviour of infants – a comparison between breast‐feeding and bottle‐feeding , 2009, Acta paediatrica.

[53]  K. Mizuno,et al.  Perioral movements and sucking pattern during bottle feeding with a novel, experimental teat are similar to breastfeeding , 2013, Journal of Perinatology.

[54]  Michèle Boiron,et al.  Acoustic study of swallowing behaviour in premature infants during tube-bottle feeding and bottle feeding period. , 2004, Early human development.

[55]  R. Pickler,et al.  EFFECTS OF NON‐NUTRITIVE SUCKING ON NUTRITIVE SUCKING, BREATHING, AND BEHAVIOR DURING BOTTLE FEEDINGS OF PRETERM INFANTS , 2004, Advances in neonatal care : official journal of the National Association of Neonatal Nurses.

[56]  R. Kron,et al.  A Method of Measuring Sucking Behavior of Newborn Infants , 1963, Psychosomatic medicine.

[57]  J. Bosma,et al.  Developmental patterns of rhythmic suck and swallow in preterm infants. , 2001 .

[58]  S. Zarbock,et al.  Hospital discharge of the high-risk neonate. , 1998, Home care provider.

[59]  Emiliano Schena,et al.  A new ecological method for the estimation of Nutritive Sucking Efficiency in newborns: Measurement principle and experimental assessment , 2013, 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[60]  Eugene C. Goldfield,et al.  A Dynamical Systems Approach to Infant Oral Feeding and Dysphagia: From Model System to Therapeutic Medical Device , 2007 .

[61]  S. Levy,et al.  DEVELOPMENTAL PATTERNS OF NORMAL NUTRITIVE SUCKING IN INFANTS , 1991, Developmental medicine and child neurology.

[62]  D. N. Lee,et al.  Neonatal control of nutritive sucking pressure: evidence for an intrinsic τ-guide , 1999, Experimental Brain Research.

[63]  J. Bosma,et al.  Changes in rhythmic suckle feeding patterns in term infants in the first month of life. , 2002, Developmental medicine and child neurology.

[64]  Justine Shults,et al.  Sucking Behavior of Preterm Neonates As a Predictor of Developmental Outcomes , 2009, Journal of developmental and behavioral pediatrics : JDBP.

[65]  D. Vidyasagar,et al.  Mechanics and energetics of nutritive sucking: a functional comparison of commercially available nipples. , 1997, The Journal of pediatrics.

[66]  S. Morris,et al.  Pre-feeding skills , 2000 .