Oral and non-oral sensorimotor interventions enhance oral feeding performance in preterm infants.

Advances in newborn intensive care have dramatically improved the survival of infants born preterm; however, many present with oral feeding difficulties.1 These difficulties are of concern to health professionals because they often impede the transition to independent oral feeding and thus delay hospital discharge,2 negatively affect mother-infant interactions,3 and potentially lead to childhood feeding disorders.4 Such consequences point to the need for efficacious early interventions to enhance preterm infants' oral feeding performance.5 Sensorimotor intervention is used to improve oral feeding. It is described as the provision of developmentally appropriate sensory inputs including oral, tactile, kinaesthetic, vestibular, and auditory to facilitate the development of existing rudimentary skills and to prevent/minimize the deleterious environmental effects.6–8 Oral sensorimotor interventions have been the major focus of studies because they provide direct, targeted input to the oral structures involved in feeding.9 Studies have shown that oral sensorimotor intervention for at least 15 minutes per day for 10 days improves oral feeding performance in preterm infants.9–12 However, oral feeding is a complex multisystem process that involves both the oral and other systems, including cardiorespiratory, gastrointestinal, and neurological.1 It is conceivable, therefore, that sensorimotor input targeting non-oral systems, such as trunk and limbs, may have distributed effects that go beyond the target system and improve oral feeding performance.6 Empirical evidence for the effectiveness of trunk and limb stimulation is limited. Two studies found that tactile/kinaesthetic (T/K) intervention, consisting of input to the trunk and limbs, for 15 minutes a day for 10 days, increased the volume of milk ingested by preterm infants.13,14 However, it was not specified whether the volume intake was via tube or oral feeding13 and there was no randomization.14 Further studies are needed to clearly establish the effect of T/K intervention on oral feeding performance. In addition, combined sensorimotor interventions may have an additive/synergistic effect. This notion is partially supported by White-Traut et al.,15 who demonstrated that a combined auditory, tactile, and vestibular stimulation accelerates the transition to complete oral feeding in preterm infants. However, individual contributions to additive/synergistic effects could not be determined because only combined stimulation was provided. A prospective study in which single and combined sensorimotor interventions are compared would be more conclusive. Therefore, the following hypotheses are proposed: (1) preterm infants who receive oral, T/K, or combined (oral + T/K) interventions before the introduction of nipple feeding will demonstrate improved oral feeding performance over control infants. Specifically, compared with control infants, they will attain independent oral feeding sooner and demonstrate greater proficiency, volume transfer, rate of transfer, and less volume loss; and (2) preterm infants who receive a combined intervention will demonstrate better oral feeding performance than those who receive oral or a T/K intervention alone.