Effect of Non-nutritive Sucking on Transition to Oral Feeding in Infants With Asphyxia
Condition: Swallowing Disorder; Perinatal Asphyxia; Feeding; Difficult, Newborn; Feeding Disorder of Infancy or Early Childhood; Hypoxic-Ischemic Encephalopathy; Speech Therapy
MeSH terms: Deglutition Disorders; Brain Diseases; Brain Ischemia; Hypoxia-Ischemia, Brain; Communication Disorders; Asphyxia Neonatorum; Asphyxia; Feeding and Eating Disorders
Study type: Interventional

Summary: 
      The transition period to full oral feeding in infants with perinatal asphyxia is important in
      predicting long-term outcomes. The transition to independent oral feeding is accepted as a
      discharge criterion by the American Academy of Pediatrics, and the long transition from tube
      feeding to oral feeding prolongs the discharge process. Prolonged transition to oral feeding
      increases maternal stress as it delays gastrointestinal problems, mother-infant interaction
      and attachment, as well as increasing health expenditures. Due to long-term feeding tube use;
      Infection, leakage, delay in wound healing, trauma caused by repeated placement, as well as
      oral reluctance are observed. In asphyxia infants, in whom oral-motor dysfunction is common,
      the transition to oral feeding takes a long time and tube feeding support is required. The
      effect of hypothermia, which is a general therapeutic intervention that reduces the risk of
      mortality and morbidity in infants with asphyxia, on oral feeding has been previously studied
      and shown to have a positive effect. They also found that MR imaging in infants with asphyxia
      and the need for gastrostomy and tube feeding in those with brainstem involvement were
      associated.

      Various interventions that affect the transition to oral nutrition positively and shorten the
      discharge time are included in the literature. Stimulation of non-nutritive sucking (NNS) is
      the most frequently preferred method among these interventions. It has been shown in studies
      that there are no short-term negative effects of NNS stimulation with the help of a pacifier
      or gloved finger, and some clinical benefits such as better bottle feeding performance,
      acceleration of discharge and transition to oral feeding.

      The effect of the NNS stimulation method, which has been shown to be effective in preterm
      infants with large-scale randomized controlled studies, is not known exactly.

      The aim of this study is to examine the effect of NNS stimulation applied to oral feeding,
      feeding skills, weight gain and discharge in asphyxia infants receiving hypothermia
      treatment.
    

Detailed description: 
      Perinatal asphyxia is the interruption of fetal blood flow or gas exchange during the
      perinatal period. Injury to the brain as a result of systemic hypoxia caused by disruption of
      gas exchange and slowing of cerebral blood flow is called hypoxic ischemic encephalopathy
      (HIE). Perinatal asphyxia may be maternally related or may occur as a result of conditions
      related to the placenta and the newborn itself. It may have etiologies such as maternal
      diseases such as diabetes, hypertension or preeclampsia, uterine rupture, cord compression,
      congenital airway anomalies of the newborn, neurological disorder, and severe cardiopulmonary
      disease. According to the World Health Organization (WHO) report, perinatal asphyxia causes 4
      million newborn deaths every year and constitutes 23% of total neonatal deaths. Asphyxia,
      which has effects such as death, seizures and HIE in the short term, has effects such as
      motor disorders such as cerebral palsy, sensory disorders such as vision and hearing loss,
      cognitive, neurodevelopmental, behavioral and emotional disorders in the long term.
      Malnutrition is a problem that can occur both in the short and long term. In the short term,
      it may have consequences such as orogastric or nasogastric tube feeding due to sucking and/or
      swallowing dysfunction, prolonged feeding times in the long term, frequent coughing,
      aspiration pneumonia and gastrostomy. The transition period to full oral feeding in infants
      with perinatal asphyxia is important in predicting long-term outcomes. The transition to
      independent oral feeding is accepted as a discharge criterion by the American Academy of
      Pediatrics, and the long transition from tube feeding to oral feeding prolongs the discharge
      process. Prolonged transition to oral feeding increases maternal stress as it delays
      gastrointestinal problems, mother-infant interaction and attachment, as well as increasing
      health expenditures. Due to long-term feeding tube use; Infection, leakage, delay in wound
      healing, trauma caused by repeated placement, as well as oral reluctance are observed. In
      asphyxia infants, in whom oral-motor dysfunction is common, the transition to oral feeding
      takes a long time and tube feeding support is required. The effect of hypothermia, which is a
      general therapeutic intervention that reduces the risk of mortality and morbidity in infants
      with asphyxia, on oral feeding has been previously studied and shown to have a positive
      effect. They also found that MR imaging in infants with asphyxia and the need for gastrostomy
      and tube feeding in those with brainstem involvement were associated.

      Various interventions that affect the transition to oral nutrition positively and shorten the
      discharge time are included in the literature. Stimulation of non-nutritive sucking (NNS) is
      the most frequently preferred method among these interventions. It has been shown in studies
      that there are no short-term negative effects of NNS stimulation with the help of a pacifier
      or gloved finger, and some clinical benefits such as better bottle feeding performance,
      acceleration of discharge and transition to oral feeding.

      The effect of the NNS stimulation method, which has been shown to be effective in preterm
      infants with large-scale randomized controlled studies, is not known exactly. The NNS
      stimulation method applied in a newborn with severe asphyxia with medical complications was
      investigated in a case study and it was pointed out that it could have positive results, but
      more research should be done in this patient group.

      The aim of this study is to examine the effect of NNS stimulation applied to oral feeding,
      feeding skills, weight gain and discharge in asphyxia infants receiving hypothermia
      treatment.
    

Intervention name(s): Non-Nutritive Sucking
Intervention type(s): Other
Intervention description(s): NNS is stimulated by giving stimulus into the baby's mouth with the help of a finger wearing gloves.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: perinatal asphyxia; non-nutritive sucking; oral feeding; oral stimulation