Angela Regina Maciel Weinmann

The oral motor capacity and feeding performance of preterm newborns at the time of transition to oral feeding

The objective of the present study was to determine the oral motor capacity and the feeding performance of preterm newborn infants when they were permitted to start oral feeding. This was an observational and prospective study conducted on 43 preterm newborns admitted to the Neonatal Intensive Care Unit of UFSM, RS, Brazil. Exclusion criteria were the presence of head and neck malformations, genetic disease, neonatal asphyxia, intracranial hemorrhage, and kernicterus. When the infants were permitted to start oral feeding, non-nutritive sucking was evaluated by a speech therapist regarding force (strong vs weak), rhythm (rapid vs slow), presence of adaptive oral reflexes (searching, sucking and swallowing) and coordination between sucking, swallowing and respiration. Feeding performance was evaluated on the basis of competence (defined by rate of milk intake, mL/min) and overall transfer (percent ingested volume/total volume ordered). The speech therapists evaluation showed that 33% of the newborns presented weak sucking, 23% slow rhythm, 30% absence of at least one adaptive oral reflex, and 14% with no coordination between sucking, swallowing and respiration. Mean feeding competence was greater in infants with strong sucking fast rhythm. The presence of sucking-swallowing-respiration coordination decreased the days for an overall transfer of 100%. Evaluation by a speech therapist proved to be a useful tool for the safe indication of the beginning of oral feeding for premature infants.

Influência do estado comportamental nos padrões de sucção de recém-nascidos pré-termo

Purpose: To verify the influence of preterm infants’ behavioral states in non-nutritive sucking, nutritive sucking and feeding performance at the moment of oral feeding release. Methods: Thirty-two preterm infants participated in the study. They were hospitalized in a Neonatal Intensive Care Unit and presented stable clinical conditions. After medical release for oral feeding, the following aspects of infants were observed by the same speech therapist: behavioral state, postural pattern, oral reflexes, phono-articulatory organs’ characteristics, non-nutritive and nutritive sucking, number of sucks per block, rate of milk transfer and oral feeding performance. Results: No relationship was found between the infants’ behavioral states and non-nutritive sucking. In nutritive sucking it was verified the influence of behavioral states on the number of sucks in the three first blocks intervals sucking/pause. This means that at the moment of oral feeding start infants in the alertness state presented a higher number of sucks than those in the sleep state. Consequently an impact on feeding performance was verified, with a higher rate of milk transfer and an increased oral feeding performance. Nonetheless no statistical significance was found in regards to these aspects. Conclusion: This research’s findings show that behavioral states did not influence on non-nutritive sucking aspects. But in nutritive sucking, infants in the alertness state presented a higher number of sucks per block than those in the sleep state.

Aleitamento materno e sua influência nas habilidades orais de crianças

OBJECTIVE The objective of this study was to investigate the influence of oral habits and breastfeeding on the oral skills of children. METHODS Cross-sectional study evaluated the oral skills of 125 nine-month-old-children born at term, belonging to Macro-Midwest region of Rio Grande do Sul between August 2010 and March 2011. Variables included evaluating oral skills and information on breastfeeding and weaning. The results were analyzed using simple and multiple logistic regression. RESULTS Breastfeeding positively influenced the acquisition of oral skills sucking at nine months of age (OR 3.1, 95%CI 1.2;8.3) and using a pacifier had a negative effect (OR 0.1, 95%CI 0.03;0.6). CONCLUSIONS It was found that breastfeeding contributed to mature orofacial as it improved the ability of oral suction. Pacifier use was shown to affect the functioning of the stomatognathic system. This should be made clear to parents and the use of pacifiers during infancy should be avoided.OBJETIVO: Avaliar a influencia de habitos orais e do aleitamento materno sobre as habilidades orais de criancas. METODOS: Estudo transversal que avaliou as habilidades orais de 125 criancas nascidas a termo, aos nove meses de idade, pertencentes a macrorregiao centro-oeste do estado do Rio Grande do Sul, no periodo de agosto de 2010 a marco de 2011. As variaveis estudadas incluiram avaliacao das habilidades orais e informacoes sobre o aleitamento materno e a introducao da alimentacao complementar. Analise de regressao logistica simples e multipla foi utilizada na analise dos resultados. RESULTADOS: O aleitamento materno influenciou positivamente a aquisicao das habilidades orais de succao das criancas aos nove meses de idade (OR 3,1; IC95% 1,2;8,3) e o habito de usar a chupeta influenciou negativamente tais habilidades (OR 0,1; IC95% 0,03;0,6). CONCLUSOES: O aleitamento materno contribuiu para o amadurecimento orofacial, pois melhorou a habilidade oral de succao. O uso da chupeta mostrou alterar o funcionamento do sistema estomatognatico. Os pais devem ser esclarecidos e recomendados a evitar o uso de chupetas durante a infância.OBJETIVO: Evaluar la influencia de habitos orales y de la lactanciamaterna sobre las habilidades orales de los ninos METODOS: Estudio transversal que evaluo las habilidades orales de 125 ninos nacidos a termino, a los nueve meses de edad, pertenecientes a la macro region centro oeste del Estado de Rio Grande do Sul, Brasil, en el periodo de agosto de 2010 a marzo de 2011. Las variables estudiadas incluyeron evaluacion de las habilidades orales e informaciones sobre la lactancia materna y la introduccion de la alimentacion complementaria. Los resultados se analizaron utilizando regresion logistica simple y multiple. RESULTADOS: La lactancia materna influencio positivamente en la adquisicion de habilidades orales de succion de los ninos a los nueve meses de edad (OR=3,1; IC95% 1,2;8,3), mientras que el habito de usar el chupete influencio negativamente tales habilidades (OR=0,1; IC95% 0,03;0,6). CONCLUSIONES: La lactancia materna contribuyo para la maduracion orofacial, ya que mejoro la habilidad oral de succion. El uso del chupete mostro alterar el funcionamiento del sistema estomatognatico. Los padres deben ser informados y recomendados para que eviten el uso de chupetes durante la infancia.

Avaliação de habilidades orais de crianças nascidas pré-termo

PURPOSE: to evaluate the oral skills of preterm infants at 4 and 6 months of corrected age. METHODS: 14 preterm infants born between 29 and 35 weeks of gestational age were evaluated during their follow-up at the University Hospital of Santa Maria, state of Rio Grande do Sul. Assessment at 4 and 6 months of corrected age included movements of the tongue, lips and jaw during bottle or breastfeeding, and at 6 months, we also assessed their ability to remove the pasty food from the spoon, the use of the cup, and with munching biscuits. All assessments were recorded and analyzed by 3 speech therapists. The parents answered a questionnaire on the dietary habits of their children. RESULTS: at 4 and 6 months of corrected age an appropriate lip sealing was observed in 71.4% and 85.7% of the infants, respectively. At 6 months, in 78.6% of them the upper lip removed efficiently the pasty food from the spoon, 42.9% were able to absorb the liquid from the cup and 57.1% had difficulties to do this well. CONCLUSION: in this study, infants born preterm at 4 and 6 months of corrected age showed the development of oral skills in a progressive sequence, although they showed a compromised lip sealing during sucking and difficulties in using spoon and cup for their feeding.

Avaliação da estimulação sensório-motora-oral na transição da alimentação enteral para a via oral plena em recém-nascidos pré-termo

OBJECTIVES: to evaluate the influence of sensory-motor-oral (SMO) stimulation on weight gain, the time taken to make the transition from tube-to oral feeding and, indirectly, on the duration of hospitalization of preterm infants. METHODS: a controlled clinical intervention study was carried out with 24 preterm infants hospitalized in the Neonatal ICU of the Santa Maria University Hospital in the State of Rio Grande do Sul, Brazil, between May 2007 and March 2008, divided randomly into a treatment (TG) and control group (CG). The analysis of the differences between the groups was tested using Students independent t-test and Fishers exact test (with a p value <0.05). RESULTS: there was no statistical difference in terms of anthropometrical measurements, although the daily weight gain was higher in the TG (p=0.16). The TG group made a full transition from tube-to oral feeding on average 1.6 days earlier than the CG, 83.3% of the children in the TG making the transition within seven days, compared to only 38.9% of the control group. There was no difference in terms of the length of stay in hospital between the two groups (p=0.48). CONCLUSIONS: SMO stimulation was likely to lead to a swifter transition from tube-to oral feeding, without any adverse effect on weight gain in preterm newborns. No influence on the length of stay in hospital was observed.

CONCORDÂNCIA ENTRE MÉTODO ANTROPOMÉTRICO E CEFALOMÉTRICO NA CLASSIFICAÇÃO DO TIPO FACIAL

Objetivo: verificar a correspondencia entre os tipos faciais de criancas, obtidos por meio do indice morfologico da face e com o indice VERT da analise cefalometrica de Ricketts.Metodos: 57 criancas entre 7 e 12 anos foram avaliadas por meio de avaliacao antropometrica orofacial, em que foram consideradas as medidas de altura e largura facial para obtencao do indice e tipo facial, e pela cefalometria, na qual foi observada a quantidade de crescimento vertical da face. Os resultados foram analisados estatisticamente por meio do coeficiente Kappa ponderado.Resultados: houve uma concordância fraca entre os tipos faciais obtidos por meio dos dois metodos.Conclusao: a antropometria e considerada um importante recurso no exame de motricidade orofacial, entretanto o indice facial nao substitui o indice VERT da analise cefalometrica de Ricketts para determinacao do tipo facial.

Influence of breastfeeding on children's oral skills

OBJECTIVE The objective of this study was to investigate the influence of oral habits and breastfeeding on the oral skills of children. METHODS Cross-sectional study evaluated the oral skills of 125 nine-month-old-children born at term, belonging to Macro-Midwest region of Rio Grande do Sul between August 2010 and March 2011. Variables included evaluating oral skills and information on breastfeeding and weaning. The results were analyzed using simple and multiple logistic regression. RESULTS Breastfeeding positively influenced the acquisition of oral skills sucking at nine months of age (OR 3.1, 95%CI 1.2;8.3) and using a pacifier had a negative effect (OR 0.1, 95%CI 0.03;0.6). CONCLUSIONS It was found that breastfeeding contributed to mature orofacial as it improved the ability of oral suction. Pacifier use was shown to affect the functioning of the stomatognathic system. This should be made clear to parents and the use of pacifiers during infancy should be avoided.OBJETIVO: Avaliar a influencia de habitos orais e do aleitamento materno sobre as habilidades orais de criancas. METODOS: Estudo transversal que avaliou as habilidades orais de 125 criancas nascidas a termo, aos nove meses de idade, pertencentes a macrorregiao centro-oeste do estado do Rio Grande do Sul, no periodo de agosto de 2010 a marco de 2011. As variaveis estudadas incluiram avaliacao das habilidades orais e informacoes sobre o aleitamento materno e a introducao da alimentacao complementar. Analise de regressao logistica simples e multipla foi utilizada na analise dos resultados. RESULTADOS: O aleitamento materno influenciou positivamente a aquisicao das habilidades orais de succao das criancas aos nove meses de idade (OR 3,1; IC95% 1,2;8,3) e o habito de usar a chupeta influenciou negativamente tais habilidades (OR 0,1; IC95% 0,03;0,6). CONCLUSOES: O aleitamento materno contribuiu para o amadurecimento orofacial, pois melhorou a habilidade oral de succao. O uso da chupeta mostrou alterar o funcionamento do sistema estomatognatico. Os pais devem ser esclarecidos e recomendados a evitar o uso de chupetas durante a infância.OBJETIVO: Evaluar la influencia de habitos orales y de la lactanciamaterna sobre las habilidades orales de los ninos METODOS: Estudio transversal que evaluo las habilidades orales de 125 ninos nacidos a termino, a los nueve meses de edad, pertenecientes a la macro region centro oeste del Estado de Rio Grande do Sul, Brasil, en el periodo de agosto de 2010 a marzo de 2011. Las variables estudiadas incluyeron evaluacion de las habilidades orales e informaciones sobre la lactancia materna y la introduccion de la alimentacion complementaria. Los resultados se analizaron utilizando regresion logistica simple y multiple. RESULTADOS: La lactancia materna influencio positivamente en la adquisicion de habilidades orales de succion de los ninos a los nueve meses de edad (OR=3,1; IC95% 1,2;8,3), mientras que el habito de usar el chupete influencio negativamente tales habilidades (OR=0,1; IC95% 0,03;0,6). CONCLUSIONES: La lactancia materna contribuyo para la maduracion orofacial, ya que mejoro la habilidad oral de succion. El uso del chupete mostro alterar el funcionamiento del sistema estomatognatico. Los padres deben ser informados y recomendados para que eviten el uso de chupetes durante la infancia.

Premature: growth and its relation to oral skills

OBJECTIVE To evaluate the influence of oral motor skills of premature infants on their oral feeding performance and growth, during neonatal hospitalization. METHODS Fifty-one newborns hospitalized in the neonatal intensive care unit of a hospital in Southern Brazil, between July 2012 and March 2013, were evaluated. The evaluation of oral feeding skills, according to Lau and Smith, was applied after prescription for starting oral feeding. The oral feeding performance was analyzed using the following variables: days taken to start independent oral feeding and hospital discharge. Growth was measured by weight, length, and head circumference, using the curves of Fenton, at birth, first and independent oral feeding, and hospital discharge. RESULTS At birth, 71% preterm infants were proper for gestational age, most of them were males (53%), with average of 33.6 (±1.5) weeks of gestational age. The gestational age in the assessment did not influence the oral feeding performance of the premature infant and did not differ between levels. Time of transition from tube feeding to oral feeding and hospital stay was shorter when the oral skills were higher. At birth, there was a tendency of low weight and low oral feeding performance. Level IV premature infants in the release of oral feeding presented higher weights. CONCLUSION The level of oral skills of the premature infant interfered positively on time of feeding transition from tube to independent oral feeding and hospital stay. Growth, represented by weight gain, was not affected by the level of oral skill.

Readiness for oral feeding and oral motor function in preterm infants

Mailing adress: Raquel Coube de Carvalho Yamamoto Rua Rubem Martins Berta, 103 Camobi, Santa Maria, RS, Brasil CEP: 97105-350 E-mail: raquelcoube@yahoo.com.br ABSTRACT Objective: this study aimed at investigating the Schedule Oral Motor Assessment (SOMA) tool to be used with preterm infants and to compare its results with the Preterm Oral Feeding Readiness Assessment Scale (POFRAS) to start oral feeding. Methods: a cross-sectional and quantitative study, consisting in a sample of 45 healthy and clinically stable preterm infants, assessed at their first oral feeding with two tools: the Schedule Oral Motor Assessment and Preterm Oral Feeding Readiness Assessment Scale. Stata 10.0 software was used for data analysis. Results: 10 preterm infants with readiness for oral feeding showed normal oral motor function, and 16, presented with oral motor dysfunction, did not show readiness for feeding (p <0.05). The time of transition for full oral feeding was 13.5 (± 8.1) days for preterm infants with better results in both assessment tools, and 17.7 (± 10.9) days for those who did not show readiness for oral feeding and had oral motor dysfunction to initiate oral feeding, resulting in a given clinical relevance, even showing no significance (p> 0.05). Conclusion: these results suggest that the Schedule Oral Motor Assessment can be an adjunctive method for evaluation of the oral motor function at the first oral feeding in preterm infants.

A relação entre saturação de oxigênio, idade gestacional e nível de habilidade de alimentação oral de recém-nascido pré-termo

Purpose To correlate the peripheral oxygen saturation with gestational age and the level of oral feeding skills in the introduction of oral feeding in preterm infants. Methods This is a cross-sectional, quantitative study whose sample was composed of 169 clinically stable preterm infants. Peripheral oxygen saturation was assessed before and after introduction of oral feeding. The preterm infants were stratified into three groups based on their gestational age at birth: 26-29, 30-33, and 34-36 weeks. The preterm infants were classified into four levels according to their oral feeding skill and resistance. Results No differences in oxygen saturation were observed between the strata of gestational age and between the levels of oral feeding skill. Differences were observed in the groups of preterm infants aged 30-33 weeks (p=0.04) and 34-36 weeks (p=0.02) and on the level I of oral feeding skills (p=0.04) when oxygen saturation was compared at pre- and post-first oral feeding. Significant correlations (p<0.001) were found between gestational age and the levels of oral feeding skills (r=0.38); in Group A, between gestational age and oxygen saturation before the first oral feeding (r=0.83); in Group B, between the level of oral feeding skill and oxygen saturation before the first oral feeding (r=0.26) and between level of oral feeding skill and gestational age (r=0.26). Conclusion Correlation was found for peripheral oxygen saturation when compared with gestational age and with the level of oral feeding skills.