Sucking Organization Following an Infant Directed Developmental Intervention

Objective:  Inefficient oral feeding that results from immature behavioral organization requires substantial energy expenditure and delays hospital progression, thus increasing costs.  Failure to coordinate breathing, sucking, and swallowing predisposes the premature infant to apneic events, bradycardia and oxygen desaturation and fatigue during feeding.  Slight arousal prior to feeding helps infants achieve an active awake state, which is conducive to nipple feeding.  The purpose of this study was to evaluate sucking organization in premature infants following a multisensory intervention when compared with infants assigned to a control group. 

Design: Experimental design 

Setting: Two community based neonatal intensive care units (NICUs)

Sample: A convenience sample of 185 healthy premature infants born between 29 - 34 weeks gestation were recruited.

Methods: This randomized trial tested the Impacts of Hospital-Home Transition: Optimizing Prematures' Environment (H-HOPE).  The intervention included: (1) infant remediation using a multisensory approach (the auditory, tactile, visual and vestibular intervention ATVV intervention); and (2) maternal redefinition and re-education, using maternal participatory guidance.  Sucking organization was measured at baseline (prior to random assignment to the experimental or control groups) followed by weekly assessments during the infant’s hospital stay.  Sucking organization was measured by the number of sucks, number of sucks per burst, and sucking pressure.  A sucking maturity index was constructed from these three variables.

Results:  At baseline, there were no significant differences between the H-HOPE and Control groups for number of sucks, number of sucks per burst, and sucking pressure.  A sucking maturity index.  Over the course of the infants’ hospitalization, significant increases in the number of sucks (p < .05) , number of sucks per burst(p < .03)  , sucking pressure (p < .10) and the sucking maturity index (p < .01) were identified between the two groups.  Several infant characteristics were related to measures of sucking organization.

Conclusion/Implications for nursing practice: H-HOPE infants exhibited improved sucking organization over the course of hospitalization, suggestive that the H-OPE intervention improves oral feeding. 

Keywords:  premature infants, sucking organization, oral feeding