title: Frequency-modulated orocutaneous stimulation promotes non-nutritive suck development in preterm infants with respiratory distress syndrome or chronic lung disease.
abstract: OBJECTIVE
  For the premature infant, extrauterine life is a pathological condition, which greatly amplifies the challenges to the brain in establishing functional oromotor behaviors. The extent to which suck can be entrained using a synthetically patterned orocutaneous input to promote its development in preterm infants who manifest chronic lung disease (CLD) is unknown. The objective of this study was to evaluate the effects of a frequency-modulated (FM) orocutaneous pulse train delivered through a pneumatically charged pacifier capable of enhancing non-nutritive suck (NNS) activity in tube-fed premature infants.
  
  
  METHODS
  A randomized trial to evaluate the efficacy of pneumatic orocutaneous stimulation 3 × per day on NNS development and length of stay (LOS) in the neonatal intensive care unit among 160 newborn infants distributed among three sub-populations, including healthy preterm infants, respiratory distress syndrome (RDS) and CLD. Study infants received a regimen of orocutaneous pulse trains through a PULSED pressurized silicone pacifier or a SHAM control (blind pacifier) during gavage feeds for up to 10 days.
  
  
  RESULTS
  Mixed modeling, adjusted for the infant's gender, gestational age, postmenstrual age and birth weight, was used to handle interdependency among repeated measures within subjects. A significant main effect for stimulation mode (SHAM pacifier vs PULSED orosensory) was found among preterm infants for NNS bursts per min (P=0.003), NNS events per min (P=0.033) and for total oral compressions per min (NNS+nonNNS) (P=0.016). Pairwise comparison of adjusted means using Bonferroni adjustment indicated RDS and CLD infants showed the most significant gains on these NNS performance indices. CLD infants in the treatment group showed significantly shorter LOS by an average of 2.5 days.
  
  
  CONCLUSIONS
  FM PULSED orocutaneous pulse train stimuli delivered through a silicone pacifier are effective in facilitating NNS burst development in tube-fed RDS and CLD preterm infants, with an added benefit of reduced LOS for CLD infants.
authors: 1] Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, Lawrence, KS, USA [2] Program in Neuroscience, University of Kansas, Lawrence, KS, USA [3] Program in Human Biology, University of Kansas, Lawrence, KS, USA [4] Program in Bioengineering, University of Kansas, Lawrence, KS, USA.
authors: S M
authors: SM
authors: Barlow
authors: Center for Research Methods and Data Analysis, University of Kansas, Lawrence, KS, USA.
authors: J
authors: J
authors: Lee
authors: Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, Lawrence, KS, USA.
authors: J
authors: J
authors: Wang
authors: Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, Lawrence, KS, USA.
authors: A
authors: A
authors: Oder
authors: Stormont-Vail HealthCare, Topeka, KS, USA.
authors: S
authors: S
authors: Hall
authors: Stormont-Vail HealthCare, Topeka, KS, USA.
authors: K
authors: K
authors: Knox
authors: Overland Park Regional Medical Center, Overland Park, KS, USA.
authors: K
authors: K
authors: Weatherstone
authors: Overland Park Regional Medical Center, Overland Park, KS, USA.
authors: D
authors: D
authors: Thompson
mesh_terms: D002908:Chronic Disease; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology / Q000523:psychology*; D007902:Length of Stay; D008171:Lung Diseases / Q000503:physiopathology / Q000523:psychology; D008297:Male; D009055:Mouth; D041361:Pacifiers; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology / Q000523:psychology; D013391:Sucking Behavior