Breaking News

Oral feeding premature infants: Research update

by Chantal Lau, PhD
Assistant Professor of Pediatrics—Neonatology

Many premature infants have difficulty feeding by mouth. Knowledge gained in this area over the last 10 years through our research has helped increase understanding of the physiologic mechanisms underlying a premature infant’s inability to feed orally. By using an apparatus that simultaneously monitors sucking, swallowing, and respiration during bottle-feeding, we are able to study the development of sucking.

A mature sucking pattern consists of the rhythmic alternation of suction (negative intra-oral pressure) and expression (compression/stripping of the nipple). However, a mature sucking pattern alone is not necessary for a premature infant to feed by mouth successfully or safely. Also essential for safe oral feeding is proper coordination of suck-swallow-breathe. Although studies suggest that this is attained when a 1:1:1 or 2:2:1 suck:swallow:breathe ratio is observed, it is unclear what such a ratio implies. In a recent study, we observed that the 1:1 suck:swallow ratio is already attained by the time healthy premature infants begin to bottle feed. However, the swallow:respiration ratio seems less important than exactly when swallowing occurs during the respiratory cycle. A five-point sucking scale has been developed to assist us in identifying the maturation level of infants’ sucking. Further examination of the role of suck-swallow-breathe coordination and the timing of swallowing during the respiratory cycle is ongoing.

Two additional practical points should be noted.

• The natural vacuum build-up inside a bottle during a feeding can hinder milk flow for the preterm infant whose suction component is weak.
• Incoordination of swallow-breathe mechanism means that attention must be given to the pace of oral feeding in a preterm neonate.

The Baylor College of Medicine neonatal feeding team coaches mothers to help their babies through this crucial developmental phase to become successful feeders. For more information, see our booklet for parents about oral feeding (Oral Feeding The Premature Infant), which is available from our web site.