INTRODUCTION:

Preterm infant’s most common problem if feeding difficulties. The two common reasons for the feeding difficulties are immature sucking reflex and inefficient suck, swallow, respiration coordination. The discharge of preterm from hospital needs evidence for full oral feeding and appropriate weight gain. Many studies conducted in order to evaluate the effectiveness of non nutritive sucking on sucking reflex and feeding parameters. This review helps the researchers as a reference to design the future research.

World Health Organization.,(2012),:

published the report "Born Too Soon", to be announced by the British medical journal the Lancet, says nearly 15 million babies were born prematurely in 2010 — more than one in 10 of all births. Sixty percent of these premature babies were born in south Asia and sub-Saharan Africa, but this is not just a problem of the poorest nations: the USA (517,000 preterm births) and Brazil (279,300) ranked among the top 10 countries with the highest number of premature births in 2010. The average rate in 65 countries increased from 7.5% in 1990 (total preterm births 2 million) to 8.6% in 2010 (total preterm births 2.2 million).

Dr. Rajiv Tandon (2012): said: “The problem of premature birth needs both attention and intervention if India is to improve its maternal and child health record. Each year, 15 million babies, making up more than one in 10 births globally, are born too early. More than one million of those babies die shortly after birth; countless more suffer some type of lifelong physical, neurological, or educational disability, often at great cost to families.

Effect of pre feeding stimulation on feeding skills of preterm:

The 15 studies were identified that evaluated the effectiveness of pre feeding oral stimulation on preterm. Details of those 15 studies described in following paragraphs

OBJECTIVES:

The primary objective of this study is critical evaluation of exiting evidence for effectiveness of pre feeding stimulation on feeding skills of preterm infants who are feeders and growers and only prematurity as a primary diagnosis. This helps for the incorporation of evidences in to clinical practices.

METHODOLOGY :

The studies for the review were searched through Pub Med, Medline, CINHAL databases from 2000 – 2016 in order to incorporate the significant recent advancement in the care of preterm in NICU. The studies were searched by using the following search terms

a) Preterm,

b) Pre feeding stimulations

c) NNS (non nutritive sucking)

d) NS (nutritive sucking)

e) Feeding skills

f) Feeding proficiency

g) Rate of transfer

h) Feeding problems

i) Length of hospital stay

Among many 10 studies were identified as strong evidence for feeding skills. The selected studies varied from sample size, type of intervention, various feeding parameters like feeding skill, gestational age of samples, design, and tools for data collection, method of analysis.

Inclusion criteria:

The studies for this review were included based on the following criteria.

Studies conducted to the evaluate the

a) Effectiveness of pre-feeding stimulations

b) Feeding parameters,

c) Length of hospital stay,

d) Preterm infants (more than 28 weeks and less than 37 weeks of gestation).

The selected articles included in this evidence based review can be evaluated the variety of pre feeding stimulations including peri oral, intra oral, NNS, NS and combinations of these. All articles were also required to cite any one of the feeding skills includes feeding proficiency, rate of transfer, length of hospital stay, transition to full oral feeding, Suck- Swallow- Respiration co ordination, pattern of feeding burst – pause rhythm.

Data collection:

The search of the evidences yielded the following variety of evidence based articles which were compatible with the proposed objectives and selection criteria: 1 Meta analysis, 1 systemic review, 1 quasi experimental and 8 RCTs.

The following quality indicators and markers were used in order to estimate the quality of the selected studies.

Table.1. Quality indicators and quality markers

S.No	Indicator	Highest level quality Markers
a)	Study design	Experimental or RCT
b)	Blinding	Assessors blinded
c)	Sample allocation	Random allocation
d)	Controls	Comparable between or within groups
e)	Outcome measures	Clearly defined at least one primary outcomes
f)	Level of significance	Reported or calculable p values

The selected studies were critically evaluated based on the quality markers and met the criteria more than 3out of 6, considered the better evidence for scientific community and clinical practice.

Table 2. Results

Citation	N	Diagnosis	Intervention	Treatment schedule and duration	Outcome measures	Significance P value	Quality marker
Tian-chan Lyu, et.al (2014)	72	Pre maturity	Experimental group – oral stimulation Control group – routine	12 mts of oral stimulation, 3 mts of NNS	Volume transfer at introduction of oral feeding (%) Efficiency at independent oral feeding (mL/min)	0.118 0.053	5/6
Poonam Bala, et.al, (2016)	51	Pre maturity	Experimental group – oral motor stimulation with routine care (NNS, KMC) Control group – routine care (NNS, KMC) only	OMS practiced 5 times a day before feed by mother	Transition time from gavage feeding to full oral feeding a) Partial spoon feed b) Full spoon feed c) Partial breast feed	0.006 0.03 0.32	5/6
Zhang, Y. et.al (2014)	120	Pre maturity	Group I: Oral stimulation (OMS) Group II: NNS Group III: OS + NNS Control group: Routine care	Group I: 12 mts OMS, once a day Group II: 5 mts Pacifier for 7 – 8 times a day Group III: 12 mts OS + 3 mts NNS, once a day Control group: Routine care	Transition time One way ANOVA	0.001	4/6
Poore et al. (2008)	31	Pre maturity	Experimental - patterned oro cutaneous stimulation during daily gavage feeds using the NTrainer device Control – Soothie pacifiers during their gavage feeds	Experimental – 3 mts stimulation, 4 times a day	Suck burst – pause	0.001	4/6
Harding, C. (2009)	14	Pre maturity	NNS stimulation	10 mts during first 10 mts of tube feeding by parents	Transition time for full oral feeding	0.05	3/6
Fucile et.al, (2002)	32	Pre maturity	Intervention group – pre feeding oral stimulation and NNS Control – Routine care	Once in a day for 10 days	Time to achieve 8 oral feedings per day	0.05	6/6
Fucile et.al, (2005)	32	Pre maturity	Intervention group – pre feeding oral stimula tion and NNS Control – Routine care	Once in a day for 10 days	Rate of milk transfer per day	0.02	5/6
Hill (2005)	156	Pre maturity	Group I: OS Cheek and Jaw stability Group II: NNS Control: Routine care	Group I: OS for entire feeding Group II: 5 mts before NNS	Length of feeding time OS Vs control OS vs NNS NNS Vs Control	0.01 0.05 0.01	3/6
Rocha et.al (2007)	98	Pre maturity	Intervention group – sensory motor oral stimulation Control – Routine care	15 mts oral stimulation before feeding for 10 days	Transition period for full oral feeding Weight gain	0.05 0.01	6/6
Khalessi N et al (2010)	2014	Pre maturity	Group I: OS and NNS once in a day Group II: OS and NNS twice a day Control: Routine care	Group I: Once in a day for 10 days Group II: Twice a day for 5 days Control: Routine care	Days for full oral feeding	0.977	5/6

Limitations of current review:

Several limitations were found in the current integrated literature reviews while interpreting the findings of the reviewed literatures. Those includes, the participants included had only the prematurity as a primary diagnosis, not included the preterm with other medical conditions. Included studies were varies with type, duration and intensity of treatments, varied degree of prematurity. The articles which were published in English and peer reviewed journals only considered and included for the review. Recent publications after 2002 were included for this review.

CONCLUSION:

The integrated review of literature helps the research scholars, clinical practitioners, and clinical researchers for incorporating the current evidences into practices. Evidence based practices act as a foundation for decision making in clinical situations and management in critical population like preterm. This integrated review will act as a tool for successful judgments by clinical practitioners and health care professionals.

REFERENCES:

1. Amaizu, N., Shulman, R., Schanler, R., and Lau, C. (2008). Maturation of oral feeding skills in preterm infants. Acta Paediatrica, 97, 61–67.

2. American Academy of Pediatrics. (1998). Hospital discharge of the high-risk neonate—proposed guidelines. Pediatrics, 102, 411–417.

3. Centers for Disease Control and Prevention. (2008). CDC features: Premature birth. Retrieved from www.cdc.gov/features/ PrematureBirth/.

4. Gaebler, C. P., and Hanzlik, J. R. (1996). The effects of a prefeeding stimulation program on preterm infants. American Journal of Occupational Therapy, 50, 184–193.

5. Lau, C. (2007). Development of oral feeding skills in the preterm infant (French). Archives of Pediatrics, 14(Suppl. 1), S35–S41.

6. Fucile, S., Gisel, E., and Lau, C. (2002). Oral stimulation accelerates the transition from tube to oral feeding in preterm infants. Journal of Pediatrics, 141, 230–236.

7. Fucile, S., Gisel, E. G., and Lau, C. (2005). Effect of an oral stimulation program on sucking skill maturation of preterm infants. Developmental Medicine and Child Neurology, 47, 158–162.

8. Rocha, A. D., Moreira, M. E., Pimenta, H. P., Ramos, J. R., and Lucena, S. L. (2007). A randomized study of the efficacy of sensory-motor-oral stimulation and non-nutritive sucking in very low birth weight infant. Early Human Development, 83, 385–388.

Received on 03.06.2017 Modified on 11.09.2017

Int. J. Nur. Edu. and Research. 2018; 6(2): 214-216.

DOI: 10.5958/2454-2660.2018.00049.2