Pickler, R. H., Chiaranai, C., & Reyna, B. A. (2006). Journal of Perinatal & Neonatal Nursing, 20, 157-163.
New mothers and pediatric nurses continue to worry about feeding outcomes in preterm infants. Although several published studies have shown that gestational age, muscle tone, heart and respiratory rates, behavioral states, energy levels, and sucking behaviors are predictive of an infant's readiness and ability to successfully nipple-feed, no research to date has explored the relationships between nonnutritive or nutritive sucking behaviors and feeding outcomes. In this nonexperimental NIH-funded study, a prospective research design was used to study the relationship between the number of sucks in the first nutritive suck burst and feeding outcomes of proficiency, efficiency, consumption, and feeding success in 95 hospitalized preterm infants. The study was conducted over a 3-year period and used well-designed and controlled procedures and measures. All study infants were started on bottle feedings at 32 weeks' postmenstrual age (PMA). Most infants had moderate severity of illness as measured by the Neonatal Medical Index (NMI). Most infants were in the states of light sleep, active sleep, drowsy, or quiet awake at prefeeding as measured by the Anderson Behavior State Scale (ABSS). Feeding experience, defined as the cumulative number of bottle-feeding attempts and measured daily by a feeding record review sheet, ranged from 0 to 131 bottle-feeding events over the 2 to 3 week study period (M = 57.7, SD = 30.8). Sucking was elaborately and safely measured by a highly reliable stretch-sensitive chin strain gauge placed under the infant's chin, secured by hypoallergenic tape, and connected to a plethysmograph that detected changes in resistance during sucking. Although there were statistically significant and positive relationships between the number of sucks in the first burst and all outcomes, feeding experience was the best predictor of feeding success. This research suggests that feeding protocols that include the assessment of the first nutritive suck burst should be developed and tested with further research. In the meantime, inclusion of informal and nonmechanical nursing assessment of this characteristic is not only safe but also warranted as part of any assessment of feeding behaviors.
Judy Beal