An infant’s ability to orally feed is dependent upon complex physiologic and neurodevelopmental processes. While an infant born at term will have these complex systems in place to eat at birth, infants born preterm or with medical morbidities often have not yet developed these processes and need to have their oral feedings delayed until ready. When considering initiation of oral feeds, healthcare providers must use a whole-child approach to appropriately balance the preterm infant’s needs with these complex processes.1-5
One important skill, which is highly dependent upon physiologic and neurodevelopmental maturation, is non-nutritive sucking (NNS). This skill requires the presence of strong, timely and coordinated oral movements, which are the foundation for nutritive suck-swallow-breathe coordination seen at a breast or bottle feeding. Mature NNS, and the consistency of these skills, are correlated with more successful oral feedings as measured by the percentage of oral feeding ingested.6
This suggests that when an infant presents with poor NNS, they may not yet be a good candidate to begin oral feedings.
To evaluate an infant’s NNS skills, healthcare providers often use informal subjective assessments and scoring tools;6,7 however, the ability to consistently assess skills, measure progress and translate findings to the team is difficult. To date there is only one tool available to objectively assess NNS in infants: the Cardinal Health™ Kangaroo NTrainer™ System.
One suck measure, called the spatiotemporal index (STI), represents how consistently an infant can organize their NNS skills.
The NTrainer™ System measures an infant’s full oral motor activity, providing the medical team with four numerical metrics to define the infant’s NNS:
Strength of sucking compressions
Number of sucking bursts per minute
Number of sucks per burst
STI to represent how consistent and reproducible the sucking activity is
Ranges for each of these metrics are available to help gauge where the infant’s skills are in comparison to a full-term healthy infant, based upon years of evidence. As the infant sucks on the pacifier attached to the NTrainer™ Handpiece, the display shows a visual waveform in real time to represent the NNS movements.
For example, Waveform 1 shows a mature NNS pattern, where the infant organizes several sucking bursts of similar strength with pauses for respirations.
This pattern is similar to what a near-term fetus would do in the womb, as well as that of a healthy full-term infant. Waveform 2, by contrast, shows an immature NNS pattern, with weak, disorganized sucking activity and poor strength.
After the assessment is complete the display provides the ability to scroll the length of the waveform and zoom in and out to further analyze the movements. This is helpful when educating the infant’s family and medical team about their skills and how they are progressing.
Waveform 1: developed NNS
Waveform 2: under-developed NNS
While there are many factors to assess when considering an infant’s readiness to orally feed, a strong, timely and coordinated NNS is proven to be an important aspect that should be evaluated. The NTrainer™ System 2.0 provides the medical team with an objective measurement of the infant’s NNS skills that can be used in conjunction with other assessments to help ensure the infant has both the physiologic and neurodevelopmental processes needed to feed by mouth safely and efficiently.