Feeding Therapy: A boon for preterm infants

Bunions- Physiotherapy rehabilitation | Zandu Fast Relief

Infant feeding, by its nature is an interactive and developmental task. Current research and evidence in feeding preterm infants shows that infant’s ability to feed well is related to the caregiver’s ability to understand and sensitively respond to his/her physiology and behavioural communications. Even though, breastfeeding is the most superior form of feeding, great majority of preterm infants in the neonatal intensive care unit are fed by a bottle or a paladai. Feeding therapy focuses more on the quality of feeding rather than its quantity.

What is Feeding Therapy?

Feeding therapy in an infant is an holistic evidence based approach that examines multiple factors that influences the success of feeding, including sensory processing concerns, positioning difficulties, and oral-motor skills deficits such as difficulty in sucking, swallowing, and co-ordinating suck-swallow-breathe rhythm. Evidence based approaches include Premature infant oral motor intervention (PIOMI) and Supporting oral feeding in fragile infants (SOFFI).

What is the need of feeding therapy?

The feeding experiences of premature infant in their first year are different from a full-term infant. They experience problems in eating food with new texture, sensitivity to new textures, refusal to eat food, poor suck-swallow-breathe coordination causing delay in development of oral-motor skills. Moreover, feeding dysfunction requires the infant to use a lot energy, which may also lead to developmental delay. In addition, long term use of endo-tracheal tube or nasogastric tube can cause oral sensory problems later in life. Feeding therapy using evidence based approaches such as PIOMI and SOFFI for preterm, ill, and fragile infants helps promote oral feeds to support nutrition, hydration, adequate growth and to ensure development of feeding skills in the NICU, while simultaneously taking care of apnea, desaturation, choking hazards and aspirational pneumonia. This in turn, facilitates weight gain and this increases the infant’s ability to thrive and thus increases the chances of early discharge. It also decreases the chances of oral sensitivity and food aversions in the future. For infants on supplemental feedings by tube (Nasogastric, Orogastric or G-tube), it helps preserve oral motor skills, which is critical in the long term for weaning the tube and transitioning to oral feeds.

Feeding interventions in preterm, ill, and fragile infants:

A Preterm infant born as early as 29 weeks with low gestational weight requires oral-motor interventions before the start of oral feeds. Evidence based interventions such as PIOMI aims to mimic the in-utero oral experience that strengthens and develops feeding mechanism. Studies have shown that the PIOMI resulted in increased oral intake, reduced transition days to full oral feedings in preterm infants and decreased length of hospital stay. It also significantly increased direct breastfeeding rates at one month and three months after the NICU discharge. Supporting oral feeding in fragile infants (SOFFI) is used to help preterm infants transition to oral feeds. SOFFI focuses on supporting the physiologic stability of the infant, the ability of the infant to self-regulate to increase the infant’s readiness to feed, to engage the infant and actively participate so that the infant can learn a coordinated well-regulated feeding behaviour.

Why are feeding interventions important?

Most of the times, premature infants experience a period of hospitalization in the NICU. Oral feeding, physiological stability, and weight gain are among the necessary criteria for hospital discharge. The most important cause of delayed hospital discharge for premature infants is the lack of independent feeding. Therefore, oral feeding problems lead to longer hospitalization of premature infants in the NICUs, consequently imposing additional costs on the families and the health care systems of the country. Thus, facilitating oral feeding of premature infants using feeding rehabilitation protocols seems to lead to better development of the infants. This is very important in reducing parental worry, preventing long-term hospitalization of infants in the NICUs, and reducing the costs.

Dr. Snehal Gadhecha

Consultant at Surya Hospital

(Paediatric Physiotherapist, Certified Neonatal & Paediatric Early Intervention Specialist (UK), Paediatric Neuro-rehab Specialist, Neonatal Therapist, Feeding Specialist)

References-

  1. Ross ES, Philbin MK. Soffi: an evidence-based method for quality bottle-feedings of preterm, ill, and fragile infants. The Journal of perinatal & neonatal nursing. 2011 Oct;25(4):349.
  2. Ghomi H, Yadegari F, Soleimani F, Knoll BL, Noroozi M, Mazouri A. The effects of premature infant oral motor intervention (PIOMI) on oral feeding of preterm infants: A randomized clinical trial. International journal of pediatric otorhinolaryngology. 2019 May 1;120:202-9.