Oropharyngeal Administration of Mother's Milk in Preterm Infants and Gastrointestinal Motility
Condition: Preterm Infant; Feeding Disorder Neonatal; Gastrointestinal Motility Disorder
MeSH terms: Premature Birth; Feeding and Eating Disorders
Study type: Interventional

Summary: 
      Mother's milk does not come in contact with the oropharyngeal pouch of preterm infants during
      gavage feeding. We hypothesized that stimulation of the oropharyngeal pouch using small
      amount of the mother's milk 5 minutes before initiation of regular gavage feeding will
      increase the level of GIT hormones.
    

Detailed description: 
      Feeding preterm infants continues to challenge health care providers because of difficulty to
      provide adequate volume of milk that maintains optimum nutrition without increasing the risk
      of feeding intolerance. Preterm, VLBW, infants are at increased risk of feeding intolerance
      as they have shorter GIT with lower digestive, absorptive, and motility capabilities than
      those of full-term infants. Intolerance to enteral feeding has been associated with abdominal
      distention, initiation of inflammatory cascade, edema of the bowel, and subsequent
      development of necrotizing enterocolitis.

      Oral feeding is the best physiologic method for enteral nutrition of preterm infants.
      However, because of immaturity of suckling reflex and poor coordination between suckling and
      swallowing, gavage feeding (oro-gastric or naso-gastric tube feeding) has been used an
      alternative method of enteral nutrition in preterm infants.

      During breastfeeding, mother's milk comes in contact with mouth and oro-pharyngeal pouch
      which, theoretically, stimulates both oro-pharyngeal receptors that improves the motility,
      secretory, and absorptive ability of the GIT. Furthermore, anti-inflammatory and
      pro-inflammatory cytokines, which are present abundantly in mother's colostrum and milk, may
      exert an immuno-protective effect when they come in contact with oro-pharyngeal as well as
      GIT mucosa.

      Preterm, VLBW, infant in the NICU receives enteral feedings by a naso-gastric or oro-gastric
      gavage tube. Thus, mother's milk does not typically come into contact with oro-pharyngeal
      pouch which delays the maturation of oral suckling and swallowing skills in preterm infants.

      Oral stimulation has been shown to improve oral feeding performance, attain early oral
      feeding, improve weight gain and shorten the length of hospital stay. Investigators aimed to
      study the effect of Oro-pharyngeal administration of mother's milk before regular gavage
      feeding on gastrointestinal movement in preterm infants.
    

Intervention name(s): Oro-pharyngeal Administration of Mother's Milk
Intervention type(s): Procedure
Intervention description(s): Infants will receive mother's milk (to the maximum of 0.2 ml ) by dropper to the oro-pharyngeal pouch, tongue and cheeks every 3 hours (5 minutes before time of feeding)
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: Oropharyngeal Administration of mother's milk (OPAMM)
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care