Preterm infants often experience delayed oral feeding skills due to difficulty coordinating an appropriate suck-swallow-breathe pattern; it’s this pattern that leads to the achievement of full oral feedings.¹ The extent of prematurity, severity of illness and the number of medical interventions are positively correlated with a delay in acquisition of eating skills² and increased risk of needing a G-tube placed at discharge.³ Failure to achieve full oral feedings in a timely manner contributes to many short- and long-term complications to the infant, caregivers and healthcare system.⁴

Developmental impacts

Caregiver stress

Increased stress before and after NICU discharge can occur due to their infant’s lack of feeding abilities and difficulties learning their infant’s feeding cues.⁵

Ongoing feeding challenges

Up to
42%
of preterm infants experience feeding problems in the first four years of life.⁶

35%

of preterm infants are more likely to have total feeding problems.⁷

29%

are more likely to have refusal or picky eating.⁷

34%

have oral motor problems compared to full term infants.⁷

Adverse neurological outcomes

Feeding difficulties have the potential to serve as an early marker for brain alterations associated with atypical motor and neurological development.

40%

Preterm infants with feeding difficulties are 40% more likely to be diagnosed with a developmental coordination disorder (DCD) at 4‑5 years of age, compared to infants without feeding issues.⁸

Neurodevelopmental delays

+37%

Preterm infants who do not achieve full oral feedings by 40 weeks post-menstrual age (PMA) are at a 37% increased risk of having adverse neurodevelopmental outcomes, such as lower cognitive, language and motor scores at 18-26 months.⁹

Simply requiring a G-tube at discharge is a predictor of a preterm infant’s future neurodevelopmental delay.¹⁰ Infants discharged on a G-tube had lower cognitive communication and motor composite scores.¹⁰

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Clinical and financial impacts

Prolonged dependency on tube feeding

50%

of infants born at or earlier than 28 weeks were likely to still need a G-tube upon discharge,

25%

compared to 25% of infants born between 28-32 weeks.³

Poor nutritional status

Infants with feeding problems have a higher risk of nutritional deficiencies, regardless of whether they have G-tubes.¹²

Length of stay

Delays in adequate oral feeding increase the time that premature infants remain hospitalized.¹¹

37%

A large, multi-center NIH study found that inadequate oral feeding is the most common barrier to discharge in moderately preterm infants, affecting 37% of infants who remained hospitalized at 36 weeks PMA.¹¹

Growth failure

Poor nutritional status in preterm infants, as a result of delayed feeding, increases the risks of growth failure.¹²

11%

In a study published by the Journal of Pediatrics, 11% of preterm infants with G-tubes had birth weights that were small for their gestational age.¹²

56%

of infants with G-tubes had weight that fell into the <10th percentile.¹²

Preterm birth costs

Preterm birth healthcare costs in the U.S. are estimated to be more than

$26 billion/year

¹³

Variability in approaches to feeding preterm infants likely contributes to this high cost.¹²

Standardizing feeding development

The development of non-nutritive sucking (NNS) skills is an essential precursor for infants to achieve their independent oral feeding milestones and often the last criterion for NICU discharge.

The Cardinal Health™ Kangaroo NTrainer™ System is the only FDA Class ll biofeedback device designed to help newborns and premature infants develop the non-nutritive sucking skills needed to transition to independent oral feeding.

Through real-time assessment technology and therapy delivery, the NTrainer™ System can accurately show, based on objective criteria (i.e., strength and pattern of suck), a baby’s progress toward readiness for oral feeds. This can help clinicians more easily recognize an infants’ readiness to transition to breast or bottle, thus helping to reduce NICU length of stay¹⁴ and reach short-term developmental milestones. It can also reassure parents and other caregivers of their baby’s developmental progress.¹⁵