Rita H. Pickler

EFFECTS OF NONNUTRITIVE SUCKING ON BEHAVIORAL ORGANIZATION AND FEEDING PERFORMANCE IN PRETERM INFANTS

The purpose of this study was to examine the effects of nonnutritive sucking (NNS) on behavioral organization and feeding performance in preterm infants. Thirteen preterm infants were observed at four bottle-feedings, two of which involved treatment with prefeeding NNS. NNS had a positive effect on oxygen saturation and behavior state, as well as on the initiation and duration of the first nutritive suck burst.

Effects of non-nutritive sucking on nutritive sucking, breathing, and behavior during bottle feedings of preterm infants.

PURPOSEThe purpose of this study was to examine the effect of prefeeding non-nutritive sucking (NNS) on breathing, nutritive sucking (NS), and behavioral characteristics of bottle feeding. SUBJECTSThe convenience sample was composed of 10 preterm infants who were 33 to 40 weeks postconceptual age (PCA) at the time of the observation. DESIGNRandomized, crossover; each infant was observed twice during the first 48 hours of bottle feeding. METHODSTen preterm infants received NNS before 1 bottle feeding and served as their own control at a second bottle feeding. Sucking was measured using a chin strain gauge and breathing was measured with a nasal thermistor. Behavioral characteristics included behavior state, measured using the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) behavior state scale, and feeding efficiency. MAIN OUTCOME MEASURESCharacteristics of NS (number of suck bursts, sucks/burst, suck burst length) and breathing (number of breath bursts, breaths/burst, breath burst length), as well as behavior state during bottle feedings and feeding efficiency (percent of prescribed formula consumed, formula consumed/minute of feeding). PRINCIPAL RESULTSNS waves were smoother and more regular than NNS waves. Time to onset and duration of the first non-nutritive suck burst were positively correlated with time to onset for the first nutritive suck burst. Prefeeding NNS had no statistically significant effect on characteristics of breathing or on any other characteristics of NS. Behavioral state during feedings and feeding efficiency were not affected by prefeeding NNS. CONCLUSIONSIn this sample, the use of prefeeding NNS did not affect NS, breathing during feeding, or select behavioral characteristics of feeding.

Mother-Infant Synchrony

Synchrony is an essential component of the interaction between a mother and her infant and is characterized by adaptive and reciprocal behaviors that promote a mutually rewarding interaction. It is an antecedent for the emergence of self-regulatory function in infants and influences current and future interactions. Understanding the dynamics of the mother-infant dyad and identifying synchronous patterns are important for promoting a healthy relationship. Approaches to measurement and challenges to model development are described.

Comparison of Biomarkers in Blood and Saliva in Healthy Adults

Researchers measure biomarkers as a reflection of patient health status or intervention outcomes. While blood is generally regarded as the best body fluid for evaluation of systemic processes, substitution of saliva samples for blood would be less invasive and more convenient. The concentration of specific biomarkers may differ between blood and saliva. The objective of this study was to compare multiple biomarkers (27 cytokines) in plasma samples, passive drool saliva samples, and filter paper saliva samples in 50 healthy adults. Demographic data and three samples were obtained from each subject: saliva collected on filter paper over 1 minute, saliva collected by passive drool over 30 seconds, and venous blood (3 mL) collected by venipuncture. Cytokines were assayed using Bio-Rad multiplex suspension array technology. Descriptive statistics and pairwise correlations were used for data analysis. The sample was 52% male and 74% white. Mean age was 26 (range = 19–63 years, sd = 9.7). The most consistent and highest correlations were between the passive drool and filter paper saliva samples, although relationships were dependent on the specific biomarker. Correlations were not robust enough to support substitution of one collection method for another. There was little correlation between the plasma and passive drool saliva samples. Caution should be used in substituting saliva for blood, and relationships differ by biomarker.

Integrated Review of Cytokines in Maternal, Cord, and Newborn Blood: Part I—Associations With Preterm Birth

Preterm birth (PTB; spontaneous delivery prior to 37 weeks gestation) affects one out of eight infants born in the United States and is the most common cause of neonatal morbidity and mortality. Although the pathogenesis of PTB is multifactorial, a growing body of literature supports the hypothesis that one cause of PTB is inflammation in pregnancy. Investigators have implicated mediators of inflammation, most notably proinflammatory cytokines, as being associated with and perhaps a playing a causal role in the pathogenesis of preterm labor and adverse early fetal outcomes. Though researchers have pursued the association of cytokines with preterm labor and subsequent early adverse fetal outcomes as a line of research, there has been little integration of diverse findings across studies. This systematic review appraises the empirical evidence from human studies for the association of levels of cytokines in blood with preterm labor and adverse early fetal outcome to examine the current state of the science in this important area of biobehavioral research. The most consistent finding is that increased levels of proinflammatory cytokines, particularly interleukin (IL) 6, IL-β1, and tumor necrosis factor α (TNF-α), are associated with PTB as compared to levels found at term birth. However, there have been relatively few studies and results have not been consistent. Therefore, further research is needed to elucidate the association of these inflammatory mediators with adverse pregnancy outcomes.

Predictors of nutritive sucking in preterm infants

Objective:The purposes of this analysis were to determine how select characteristics of nutritive sucking (number of sucks, sucks/burst, and sucks/minute) change over time and to examine the effect of select factors (morbidity, maturity, prefeeding behavior state, and feeding experience) on those changes.Study design:A longitudinal, non-experimental study was conducted in a Level 3 neonatal intensive care unit using a convenience sample of 88 preterm infants. Statistical analyses were performed using a repeated-measures mixed-model in SAS.Results:Sucking activity (number of sucks, sucks/burst, and sucks/minute) was predicted by morbidity, maturity, feeding experience and prefeeding behavior state. Experience at oral feeding had the greatest effect on changes in the number of sucks, suck/burst and sucks/minute.Conclusion:Experience at feeding may result in more rapid maturation of sucking characteristics.

Effects of stress and social support on postpartum health of Chinese mothers in the United States.

Postpartum maternal well being across cultures has received limited research attention. We examined relationships among stress, social support, and health in 152 Chinese mothers <1 year postpartum in the United States. These mothers did not perceive high levels of stress, although they did not receive as much support as they indicated they needed; 23.7% of mothers scored high for depressive symptoms. About half of the mothers experienced interrupted sleep, decrease in memory, and lack of sexual desire. All health measures were inter-correlated. Social support moderated the effects of stress on depressive symptoms. Culturally relevant care that is perceived as supportive may promote postpartum maternal health.

A model of neurodevelopmental risk and protection for preterm infants.

The purpose of this article is to introduce a model of neurodevelopmental risk and protection that may explain some of the relationships among biobehavioral risks, environmental risks, and caregiving behaviors that potentially contribute to neurobehavioral and cognitive outcomes. Infants born before 30 weeks of gestation have the poorest developmental prognosis of all infants. These infants have lengthy hospitalization periods in the neonatal intensive care unit (NICU,) an environment that is not always supportive of brain development and long-term developmental needs. The model supports the premise that interventions focused on neuroprotection during the neonatal period have the potential to positively affect long-term developmental outcomes for vulnerable very preterm infants. Finding ways to better understand the complex relationships among NICU-based interventions and long-term outcomes are important to guiding caregiving practices in the NICU.

The effect of feeding experience on clinical outcomes in preterm infants

Objective:The purpose of this analysis was to investigate the effect of oral feeding experience on clinical outcomes (time to full oral feedings and length of stay) in preterm infants.Study Design:This analysis was completed on 92 infants who participated in a longitudinal, non-experimental study. Data were collected daily for maturity, weight and experience at oral feeding. Additional data were collected to assess overall morbidity.Result:Time to full oral feedings was predicted by experience at oral feeding and morbidity. Length of stay from the start of oral feedings until discharge was predicted by feeding experience and by maturity at the first oral feeding. Weight gain was not affected by feeding experience.Conclusion:Experience at feeding may result in more rapid transition to full oral feedings regardless of severity of illness and may contribute to shorter length of stay. These positive clinical outcomes related to feeding experience warrant further research attention.

A descriptive study of bottle-feeding opportunities in preterm infants.

ABSTRACT PURPOSE: The purposes of this study were to describe patterns of bottle feeding opportunities in preterm infants and to analyze the relationships between feeding opportunities and outcomes. SUBJECTS: The sample was composed of 25 preterm infants who were bottle fed. DESIGN: Retrospective, correlational. METHODS: Data were collected from medical records and analyzed descriptively. Correlation coefficients among variables were computed. MAIN OUTCOME MEASURES: Postconceptional age (PCA) at the time of full bottle feedings and transition time from the first to full bottle feedings. PRINCIPAL RESULTS: The number of bottle feedings received per day during the transition from first to full bottle feedings was inversely related to length of transition to full bottle feedings. There was no relationship between the number of bottle‐feeding opportunities and PCA at full bottle feedings. CONCLUSIONS: The achievement of full bottle feedings may be facilitated by increased bottle‐feeding opportunities. More research about the relationships among feeding readiness, outcomes, and opportunities is needed.