Katsumi Mizuno

Neonatal feeding performance as a predictor of neurodevelopmental outcome at 18 months

This study aimed to determine whether neonatal feeding performance can predict the neurodevelopmental outcome of infants at 18 months of age. We measured the expression and sucking pressures of 65 infants (32 males and 33 females, mean gestational age 37.8 weeks [SD 0.5]; range 35.1 to 42.7 weeks and mean birth weight 2722g [SD 92]) with feeding problems and assessed their neurodevelopmental outcome at 18 months of age. Their diagnoses varied from mild asphyxia and transient tachypnea to Chiari malformation. A neurological examination was performed at 40 to 42 weeks postmenstrual age by means of an Amiel‐Tison examination. Feeding performance at 1 and 2 weeks after initiation of oral feeding was divided into four classes: class 1, no suction and weak expression; class 2, arrhythmic alternation of expression/suction and weak pressures; class 3, rhythmic alternation, but weak pressures; and class 4, rhythmic alternation with normal pressures. Neurodevelopmental outcome was evaluated with the Bayley Scales of Infant Development‐II and was divided into four categories: severe disability, moderate delay, minor delay, and normal. We examined the brain ultrasound on the day of feeding assessment, and compared the prognostic value of ultrasound and feeding performance. There was a significant correlation between feeding assessment and neurodevelopmental outcome at 18 months (p<0.001). Improvements of feeding pattern at the second evaluation resulted in better neurodevelopmental outcome. The sensitivity and specificity of feeding assessment were higher than those of ultrasound assessment. Neonatal feeding performance is, therefore, of prognostic value in detecting future developmental problems.

Mother‐infant skin‐to‐skin contact after delivery results in early recognition of own mother's milk odour

Aim: To determine the effects of mother‐infant skin‐to‐skin contact immediately after birth on infant recognition of their own mothers milk odour and breastfeeding duration until 1 y of age. Methods: Sixty healthy, full‐term neonates were randomly assigned to group A with skin‐to‐skin contact and group B without. One and 4d after birth, infant responses to the following odour stimuli were observed: own mothers milk, another mothers milk, formula, orange juice and distilled water. Infant facial action was videotaped and the frequency of mouthing movements was evaluated for each stimulus. Nutritional assessment, focused particularly on breastfeeding, was performed every 3 mo on participating infants. Statistical analysis comparing the frequency of mouthing movements with the aforementioned five different odour exposures was performed by ANOVA with Fishers PLSD. Kaplan‐Meier analysis with a log‐rank test was used to compare breastfeeding rates between groups. Results: Infants in both groups responded differently to mothers milk odour (either their own or another mothers milk) compared to the other stimuli on days 1 and 4. However, infants in group A demonstrated a larger difference in mouthing movements between their own and another mothers milk odour at 4 d of age (2.6 ±; 1.6) compared to infants in group B (0.9 ±; 2.0, p= 0.01). Infants in group A were breastfed an average of 1.9 mo longer than the others.

Feeding behaviour of infants with cleft lip and palate.

Aim: To determine whether the feeding behaviour of infants with cleft lip and palate is improved with a type‐P teat, which is widely used in Japan by such infants, compared with a standard teat. The difference in intra‐oral movements between the type‐P teat, modified for the evaluation of feeding behaviour, and an unmodified type‐P teat was also compared using ultrasonography. Methods: In part 1 of the study, 15 infants aged 2 to 3 mo and 7 infants aged 2 wk were evaluated for sucking pressure, expression pressure, frequency and duration of sucking. All the infants had a complete unilateral cleft lip and palate without any other abnormalities. In part 2, an ultrasonographic analysis of intra‐oral movement was done for 5 infants enrolled in part 1 of the study. Results: Sucking pressure did not occur in all infants. It was found that feeding efficiency improved with the type‐P teat compared with the standard teat. The expression pressure with the type‐P teat was significantly higher than that with the standard teat, and the feeding frequency with the type‐P teat was lower than that with the standard teat.

Effects of Different Fluids on the Relationship between Swallowing and Breathing during Nutritive Sucking in Neonates

This study in 10 term infants investigated the effects of different fluids on the coordination between swallowing and breathing during bottle feedings. Sucking pressure, swallowing, breathing and O2 saturation were examined in each infant during bottle feedings with breast milk, formula and distilled water. When receiving breast milk, the infants showed a significantly higher breathing rate than with the other liquids. Swallows followed by inspiration were demonstrated less often with breast milk compared with formula or distilled water. In conclusion, expressed breast milk is suitable for neonates because better coordination between swallowing and breathing could be obtained and subclinical aspiration could be prevented.

Development of sucking behavior in infants with Down's syndrome

The aim of this study was to gain a better understanding of the development of sucking behavior in infants with Downs syndrome. The sucking behavior of 14 infants with Downs syndrome was consecutively studied at 1, 4, 8 and 12 mo of age. They were free from complications that may cause sucking difficulty. The sucking pressure, expression pressure, frequency and duration were measured. In addition, an ultrasound study during sucking was performed in sagittal planes. Although levels of the sucking pressure and duration were in the normal range, significant development occurred with time. Ultrasonographic images showed deficiency in the smooth peristaltic tongue movement.

The effects of body positioning on sucking behaviour in sick neonates.

Abstract Some infants show better oxygenation in the prone position compared to the supine position while they are bottle-fed; however, the reason for this phenomenon is not clear. The purpose of this study was to obtain a better understanding of the effects of body position on the oral feeding performance, i.e. the sucking pressure, frequency, efficiency, and ventilation. A total of 14 infants (12 full-term, 2 preterm), who often showed O2 desaturation (SpO2u2009<u200990) during oral feeding, were enrolled in the study. The infants were fed either in the supine position or in the prone position throughout feeding. Oxygen saturation was recorded with a pulse oxymeter. The sucking pressure was measured with a 1u2009mm I.D. silicone tube inserted into the artificial nipple. The ventilation volume during bottle feeding was measured with a pneumotachograph. The prone position resulted in better oxygenation (97.2u2009±u20090.6% prone, 92.5u2009±u20090.9% supine, Pu2009<u20090.05) and larger tidal volume (6.4u2009±u20090.8u2009ml/kg prone and 4.9u2009±u20090.6u2009ml/kg supine, Pu2009<u20090.05), although the minute ventilation during bottle-feeding was not different from that in the supine position. In the prone position, the sucking pressure and frequency were higher and the duration of each suck was shorter.nConclusion Sucking in the prone position may to some extent reduce disadvantages of oral feeding on ventilation.

Effects of body position on blood gases and lung mechanics of infants with chronic lung disease during tube feeding

Abstract Background: The effects of body position and feeding on lung mechanics and blood gases in very low birthweight infants with chronic lung disease (CLD) is not fully elucidated.

Transient abnormal myelopoiesis complicated by tumor lysis syndrome

Transient abnormal myelopoiesis (TAM) is a well-described hematological problem in neonates with Down syndrome, which occasionally presents with transient proliferation of blasts. 1 There is still controversy as to whether TAM should be classifi ed as a true malignancy, because the disease regresses spontaneously. 1,2 However, several complications, including hyperviscosity syndrome, hemorrhage, and liver fi brosis have been described and prognosis is not always favorable. 2,3

Sipping/lapping is a safe alternative feeding method to suckling for preterm infants

AIMnTo determine whether sipping/lapping is a safe alternative to suckle bottle-feeding without any hydrostatic pressure, in terms of physiological stability and the relationship between swallowing and respiration. In addition, tongue movement was compared between sipping/lapping and suckling (bottle- and breastfeeding).nnnMETHODSnEighteen infants (30-35?wk of gestation at birth) were studied while sipping/lapping and suckling a bottle without any hydrostatic pressure at different feeding sessions on the same day of the first oral feeding. The postmenstrual age at the time of study was 34.6+/-0.2 wk. We evaluated the amounts ingested and administration times. The heart rate, O(2) saturation (SpO(2)), and relationship between swallowing and respiration were examined while feeding. Tongue movements were also observed by ultrasonography. Statistical analysis was performed by a paired t-test.nnnRESULTSnThe amounts ingested and intake volume per minute were lower while sipping/lapping compared to suckling. The overall heart rate and SpO(2) showed no statistically significant difference. The frequency of swallows followed by inspiration (27.6+/-0.8% and 31.0+/-1.3%) and swallows followed by expiration (46.4+/-0.9% and 45.4+/-1.4%, sipping and suckling, respectively) also showed no difference. Tongue movements while sipping/lapping differed from those while suckling a bottle or breast.nnnCONCLUSIONnBecause physiological parameters and the relationship between swallowing and respiration while sipping/lapping are comparable to those while suckle bottle-feeding without any hydrostatic pressure, sipping/lapping is a safe alternative feeding method to suckle bottle-feeding, even in preterm infants.