Oral Feeding, Research Paper Example

The paper entitled Oral Feeding is an article to inform families, nursing staff and physicians on how to proceed with oral feeding for high-risk infants. High risk infants are those who are born preterm. The article aims to provide information on positive feeding experiences for these infants as well as the mothers. The prevention of oral aversive disorders is also discussed. The article divides the infant’s feeding stages into two categories, the non-oral stages, and the nutritive sucking stages; these have subcategories which elaborate the processes. The constant observation of the infant is seen, and the assessment of the feeding is followed. This is done before, during and after the non-nutritive sucking (NNS) as well as during the nutritive sucking (NS). Interventions for infant response are seen as essential for each goal to be reached in each of the stages. If necessary, reassessments of oral feeding should be done if signs of its needs occur. The article summarizes the points of emphasis and the needs for these procedures, as well as gives definitions, developments and parameters for the assessment on the feeding.

Since the article is done as a teaching plan, signs of research and comparisons of research studies are not seen. It does not discuss relevant literature on the topic, nor does it define the need for the teaching and assessment plan. Evidence of research use is seen in the context of the assessment where terms for interventions are used; these are medical practices which the researcher used such as skin-to-skin-care, ­and Policy 2-G-1 Gastric Tubes(Amaizu, Shulman, Schanler& Lau, 2007). Literature used can also be seen in the infant characteristics, and the goals were formulated around previous research. This was paired with research done on what the best interventions are.

Other documents do verify the validity of the data and information written in the guidelines about preterm infants and oral care procedures. Research has shown that there is a need to define ways of administering oral feeding to preterm infants which will successfully transition them from tube to independent oral feeding(Amaizu et al., 2008). Other issues, such as the financial burden of the caring and incubation of the preterm infant, were not discussed in the paper. Nurses, physicians and caretakers recognize the fact that immature sucking, delayed swallow and uncoordinated sucking patterns may cause swallowing and respiration issues in oral feeding (Ludington-Hoe, Hosseini &Torowicz, 2005). There are three different components with preterm infant oral feeding, these are: swallow and respiration, immature sucking and delayed swallow and/or uncoordinated suck (Amaizu, Shulman, Schanler& Lau, 2007). These three components have functions which can mature at different times, and this is seen in the development of the suction and expression forms of the sucking.

The cause and effects of feeding difficulties were not clearly shown in the guidelines article. Studies show that delayed and/or impaired suck development results from various cases. This includes things such as insult to the developing brain or other complications with the infant (Lau, 2006). These complications were not discussed in the guideline. Lengthy oxygen supplementation procedures in the NICU can have a negative impact on preterm infants in some cases; this is when respiratory distress syndrome or bronchopulmonary dysplasia is seen, costing them precious sensory and motor experiences during a critical period of brain development when suck and pre-feeding skills are being refined (Amaizu et al., 2008). Interruption of these vital experiences may impair fragile syntheses of how the brain maps these functions. Even the presence of a nasogastric (NG) feeding tube has negative effects on sucking and breathing, this is a significant complication which should be noted when it comes to feeding a preterm infantespecially one found in later stages of development (Ludwig, 2007). The process of doing this was explained in the guidelines, as well as the definitions of the terms. Trussing the lower face with tubes and tape restricts the range and type of oral movements and limits cutaneous experiences with the hands and fingers; this was one of the only measurements which the guidelines showed. This was seen in the interventions for the non-nutritive sucking stage (Amaizu et al., 2008). For some preterm infants, poor suck and oromotor discoordination persist into early childhood and are correlated with significant delays in the emergence of other oromotor behaviors, including feeding, babbling, and speech-language production (Amaizu et al., 2008). Infants who fail to establish oral feeding skills in the NICU may be sent home on gavage or G-tube feedings, which may hinder the development of coordinated oromotor behavior. The difficulties associated with establishing oral feeding competence—coupled with the additional costs for extended hospitalization—underscore the need for assessment and therapeutic tools that facilitate the development of normal oral motor skills (Ludington-Hoe, Hosseini &Torowicz, 2005). The costs of extended hospitalization were mentioned in a number of other studies, yet it was not covered in the guidelines. The financial costs of caring for a preterm infant is well needed, however the guidelines failed to mention anything regarding this.

The assessment for feeding is discussed in the article and how to be able to distinguish the feeding stages and readiness. Feeding readiness is often evaluated by an infant’s display of non-nutritive sucking and oromotor patterning (Arvedson, Clark, Lazarus, Schooling &Frymark, 2010). Suck appears in utero during the second trimester and is remarkably stable and well-patterned by 34 weeks post-menstrual age (gestational age plus chronological age) in a healthy preterm infant. The non-nutritive suck (NNS)—any repetitive mouthing activity on a blind nipple or pacifier that does not deliver a liquid stimulus—typically consists of a series of compression bursts and pause intervals (Ludwig, 2007). Each burst typically consists of several suck cycles that decelerate in rate over the first five cycles until a steady state of approximately 2 Hz is achieved. The maturation and coordination of the NNS precedes the suck-swallow-breathe pattern associated with the slower 1-Hz pattern characteristic of the nutritive suck. This was not all too well discussed in the paper, as the paper did not state anything in regards to the infant’s difficulty in breathing or any complications with the respiratory system.

Establishing a patterned NNS for the developing infant has many benefits, including growth, maturation, and gastric motility, and also decreases stress. NNS also improves behavioral state control pre-feed and post-feed, decreases the frequency of apnea and cyanosis, and improves breastfeeding scores (Amaizu et al., 2008). The article covers this, however from a different angle. Instead of assessing these three categories, it explained goals in each one. In addition to these patterns discussed, it is found that it accelerates swallow frequency and development with differential effects among infants with bronchopulmonary disease promotes development of specific sucking skills, and enhances oral feeds (Ludwig, 2007). The oral feeding guidelines only stated the last two which were discussed in other articles as the feeding guidelines were not concerned with the respiratory system as much. Morever, the NNS is said to accelerates the transition from tube to independent oral feeding and is presumed to enhance the maturation of neural systems responsible for ororhythmic activity. Accurate assessment of oromotor discoordination in the preterm infant may also serve as a potent clinical marker for brain development and neurodevelopmental outcomes.

Another topic not clearly covered with the guidelines was future outcomes for the study. This may be because the guidelines were only concerned with the present; however implications with other studies and researches could be helpful for the nursing staff as well as physicians determine what the preterm infant may need, and how oral feeding procedures may be improved (Barlow et al., 2010).A new randomized controlled trial (RCT) is underway to assess the effects of a new synthetic patterned orocutaneous stimulation technique designed to entrain the sCPG in human infants. This technique of oral entrainment stimulation mimics the temporal features of the NNS burst, including age-appropriate NNS burst length and the frequency-modulated component of suck typically observed during burst initiation. Using this technique, the infant’s pacifier is transformed into a mimicked version of a pulsating nipple that closely resembles the temporal pattern of well-formed NNS bursts (Lau, 2006). Application of the oromotor entrainment therapy is correlated to the rapid organization of suck in preterm infants who exhibit poor feeding skills, including improved NNS burst structure, lower NNS spatiotemporal index measures (sCPG activity pattern invariance), and a shorter transition to oral feeds.

Primary outcome variables include daily measures of non-nutritive suck dynamics, spatiotemporal index of the non-nutritive suck, ororhythmic motor behavior, NNS cycle period analysis, early feeding skills assessment, transition time from tube-to-oral feed, feeding efficiency, and length of hospital stay (Barlow et al., 2010). This is discussed in the assessments for the guidelines in the article.

The article on oral feeding of preterm infants missed quite a number of facts. This may be because it only pertains to goals which are to be achieved in terms of feeding, and other clinical studies behind it were not needed to be discussed. The article is a guideline and an assessment plan for the oral feeding of preterm infants, and not a study. However, studies on this topic could have been utilized in explaining the needs for the steps taken in the overall procedure.

References

Amaizu, N., Shulman, R.J., Schanler, R.J., & Lau, C.L. (2008). Maturation of oral feeding skills in preterm infants. Acta Pediatrics. 97(1); 61-67.

Arvedson, J., Clark, H., Lazarus, C., Schooling, T. &Frymark, T. (2010). Evidence-Based Systematic Review: Effects of Oral Motor Interventions on Feeding and Swallowing in Preterm Infants. American Journal of Speech-Language Pathology. 19(1); 321-340.

Barlow, S.M., Poore, M.A., Zimmerman, E.A., &Finan, D.S. (2010). Feeding skills in the preterm infant. The ASHA Leader,Retrieved from http://www.asha.org/Publications/leader/2010/100608/Feeding-Skills-Infant/

Lau, C. (2006). Oral feeding in the preterm infant. American Academy of Pediatrics, (7), 19-27.

Ludington-Hoe, S.M., Hosseini, R., &Torowicz, D.L. (2005). Skin-to-skin contact (kangaroo    care) analgesia for preterm infant heel stick. Advanced Practice in Acute and Critical Care. 16(3); 373-387.

Ludwig, S.M. (2007). Oral feeding and the late preterm infant. Newborn & Infant Nursing Reviews, 7(2), 72-75.