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1
Koenig, J. S., A. M. Davies, and B. T. Thach. "Coordination of breathing, sucking, and swallowing during bottle feedings in human infants." Journal of Applied Physiology 69, no. 5 (November 1, 1990): 1623–29. http://dx.doi.org/10.1152/jappl.1990.69.5.1623.
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Incoordination of sucking, swallowing, and breathing might lead to the decreased ventilation that accompanies bottle feeding in infants, but the precise temporal relationship between these events has not been established. Therefore, we studied the coordination of sucks, swallows, and breaths in healthy infants (8 full-term and 5 preterm). Respiratory movements and airflow were recorded as were sucks and swallows (intraoral and intrapharyngeal pressure). Sucks did not interrupt breathing or decrease minute ventilation during nonnutritive sucking. Minute ventilation during bottle feedings was inversely related to swallow frequency, with elimination of ventilation as the swallowing frequency approached 1.4/s. Swallows were associated with a 600-ms period of decreased respiratory initiation and with a period of airway closure lasting 530 +/- 9.8 (SE) ms. Occasional periods of prolonged airway closure were observed in all infants during feedings. Respiratory efforts during airway closure (obstructed breaths) were common. The present findings indicate that the decreased ventilation observed during bottle feedings is primarily a consequence of airway closure associated with the act of swallowing, whereas the decreased ventilatory efforts result from respiratory inhibition during swallows.
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Martinelli, Roberta, Irene Marchesan, and Giedre Berretin-Felix. "Poster 2: Posterior lingual frenulum and breastfeeding." International Journal of Orofacial Myology 42, no. 1 (November 1, 2016): 49–54. http://dx.doi.org/10.52010/ijom.2016.42.1.6.
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Introduction: The literature refers to ankyloglossia as anterior, when the lingual frenulum is visible, and posterior, when the frenulum is not visible. Posterior ankyloglossia is sometimes referred to as a submucosal tongue-tie. The anatomical variations of the posterior ankyloglossia and its interference with tongue movements are poorly described in the literature. Aim: The aim of this study is to verify the occurrence of posterior lingual frenulum in infants and its interference with sucking and swallowing during breastfeeding. Methods: This clinical study included 1084 newborns, who were assessed at 30 days of life, using the Lingual Frenulum Protocol for Infants (LFPI). This study included healthy full-term infants, who were being exclusively breastfed. Prematurity, perinatal complications, craniofacial anomalies, neurological disorders, and visible genetics syndromes were the exclusion criteria. The LFPI was administered to the infants, and the assessments were registered and videotaped. Tongue movements, sucking rhythm, sucking/swallowing/ breathing coordination, nipple chewing, and/or tongue clicking were assessed during nutritive and non-nutritive sucking evaluations. Descriptive statistics were performed. Results: Of the 1084 newborns, 479 (44.2%) had normal lingual frenulum; 380 (35%) had posterior lingual frenulum; and 225 (20.8%) had lingual frenulum alterations. Infants with posterior lingual frenulum did not have any restrictive tongue movement during sucking and swallowing. Conclusion: The occurrence of posterior frenulum in this sample was 35%. The posterior frenulum did not interfere with sucking and swallowing during breastfeeding; therefore, surgery was not recommended for any of the subjects in this sample.
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Červenková, Barbora. "Особенности ранней клинико-логопедической помощи при пероральном питании преждевременно рожденных детей с бронхолегочной дисплазией." Logopedia Silesiana, no. 9 (December 29, 2020): 1–16. http://dx.doi.org/10.31261/logopediasilesiana.2020.09.22.
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Oral food intake in premature infants has its own specificity, and this is especially true for children diagnosed with bronchopulmonary dysplasia (BPD). Respiratory diseases are one of the primary risks factors for the development of aversive eating behavior in early childhood. Eating difficulties in this group of children correlate with the severity of this diagnosis. This article provides an overview of the literature on the subject devoted to abnormalities of the motor component of sucking as well as coordination of sucking, swallowing and breathing (SPD) and specific clinical-speech therapy interventions suitable for children with BPD.
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Rosi, Andrea, Emiliano Schena, Carlo Massaroni, Eleonora Tamilia, Domenico Formica, and Fabrizio Taffoni. "A Device for Respiratory Monitoring during Nutritive Sucking: Response to Neonatal Breathing Patterns." Journal of Sensors 2016 (2016): 1–9. http://dx.doi.org/10.1155/2016/7450859.
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The quantitative monitoring of breathing, sucking, and swallowing is required to predict newborns’ neurodevelopmental outcomes. In particular, the coordination of breathing timing with respect to sucking cycle is crucial. In this work, we present the characterization of a low-cost flowmeter designed for noninvasive recording of breathing pattern during bottle feeding. The transducer is designed to be integrated on a commercial feeding bottle also instrumented with a system for sucking monitoring. The flowmeter consists of two transistors (hot bodies) supplied at constant current, which are placed in a duct used to convey the inspiratory and expiratory flow coming from the newborn’s nostrils. The transducer design, its static calibration, and its response time are discussed. Moreover, a custom-made active lung simulator was used to perform a feasibility assessment of the proposed flowmeter for respiratory monitoring of neonatal respiratory patterns. The flowmeter has a discrimination threshold <0.5 L·min−1and a response time of347±12 ms. The breathing period estimated by the proposed transducer was compared with the one measured by a high performance flowmeter, used as reference: the mean absolute error was <11%. Results highlighted the ability of the device to track respiratory patterns at frequencies typical of neonatal breathing.
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Mayerl, Christopher J., Francois D. H. Gould, Laura E. Bond, Bethany M. Stricklen, Randal K. Buddington, and Rebecca Z. German. "Preterm birth disrupts the development of feeding and breathing coordination." Journal of Applied Physiology 126, no. 6 (June 1, 2019): 1681–86. http://dx.doi.org/10.1152/japplphysiol.00101.2019.
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All mammals must breathe and breathe continuously from birth. Similarly, all mammals, including infants, have high functional demands for feeding. However, the pathway that food takes through the pharynx interrupts respiration. The coordination between swallowing and breathing is therefore critical for all infant mammals. Clinically, this coordination differs between term and preterm infants. However, the neurological mechanisms underlying this coordination and how it matures as infants grow are poorly understood. Here, we integrate high-resolution data from multiple physiologic processes across a longitudinal time frame to study suck-swallow-breathe dynamics in a preterm animal model, the infant pig. In doing so, we test the hypothesis that preterm birth will have an impact on some, but not all, behaviors associated with suck-swallow-breath performance. We hypothesize that coordination will be disrupted, reflecting incomplete connections in the brainstem. We found that preterm pigs became rhythmic and mature in sucking and swallowing behaviors, suggesting substantial postnatal maturation in the coordination of these behaviors. However, their ability to coordinate swallowing and breathing never developed. These results have implications for the nature of clinical care of human infants, as well as for how feeding processes develop in mammals. Clinically, they provide a foundation for developing interventions for preterm infants. Additionally, these results suggest that the lack of coordination between swallowing and breathing may be a significant factor in determining the minimum gestation time across mammals. NEW & NOTEWORTHY Preterm infants face a variety of challenges associated with safe feeding, but obtaining high-resolution longitudinal data to understand these challenges in humans is challenging. We used a pig model to acquire high-speed videofluoroscopic and respiratory inductance plethysmograph data throughout the nursing period to show that preterm birth does not have substantial impacts on the ability of infants to perform isolated behaviors. However, it does decrease the ability of preterm infants to coordinate among behaviors during feeding.
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Selley, W. G., R. E. Ellis, F. C. Flack, and W. A. Brooks. "Coordination of sucking, swallowing and breathing in the newborn: Its relationship to infant feeding and normal development." International Journal of Language & Communication Disorders 25, no. 3 (January 1990): 311–27. http://dx.doi.org/10.3109/13682829009011980.
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Goldfield, Eugene C., Michael J. Richardson, Kimberly G. Lee, and Stacey Margetts. "Coordination of Sucking, Swallowing, and Breathing and Oxygen Saturation During Early Infant Breast-feeding and Bottle-feeding." Pediatric Research 60, no. 4 (October 2006): 450–55. http://dx.doi.org/10.1203/01.pdr.0000238378.24238.9d.
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López, Claudia Peyres, Brasília Maria Chiari, Ana Lúcia Goulart, Ana Maria Furkim, and Zelita Caldeira Ferreira Guedes. "Assessment of swallowing in preterm newborns fed by bottle and cup." CoDAS 26, no. 1 (February 2014): 81–86. http://dx.doi.org/10.1590/s2317-17822014000100012.
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Purpose: To compare the swallowing performance of premature infants using a cup and a bottle during the first offer of food by mouth. Methods: This study was carried out with preterm newborns who presented low weight at birth and no neurological illnesses, genetic syndromes or congenital malformations. The newborns were assessed by videofluoroscopy while using a cup and a bottle, when they reached a post-conceptual age of ≥34 weeks, weight ≥ 1,500 g and showed signs of readiness for oral feeding. All children were fed exclusively by gavage during the period prior to the study. Results: This study included 20 preterm newborns, with average birth weight of 1,356 g and gestational age of 31.3 weeks. The majority of the bottle-fed newborns (68%) presented strong and rhythmic suction and 63% showed good sucking/swallowing/breathing coordination. The same percentage of newborns fed by cup (68%) could not perform the sipping movement and only 32% could suck a minimal amount of liquid contrast. There were no signs of laryngeal penetration and tracheal aspiration in both procedures. Conclusion: At the first oral feeding, preterm newborns showed better swallowing performance with a bottle in comparison to using a cup.
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Červenková, Barbora. "THE EFFECT OF NEUROLOGICAL MUSIC THERAPY ON ORAL INTAKE IN PRETERM CHILDREN." SOCIETY. INTEGRATION. EDUCATION. Proceedings of the International Scientific Conference 3 (May 28, 2021): 15–27. http://dx.doi.org/10.17770/sie2021vol3.6144.
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Preterm birth is associated with increased risk of neurological, cognitive, motor or sensory impairment and behavioral problems. Music therapy appears to promote neurobehavioral outcomes and can improve brain structure functions.The aim of the study presented in the article is to analyse a potential of a special music therapy technique to shorten time to achieve full oral intake in children born extremely preterm, to (28 weeks) with bronchopulmonary dysplasia (BPD). We used the mother's singing during breastfeeding, with the slow tempo (60 beats per minute) and a recurring pattern of stressed (strong) and unstressed (weak) syllables (each second was highlighted) to help preterm babies to organize coordination of sucking swallowing and breathing. This therapeutic approach is based on the theory and methods of neurological music therapy called Patterned Sensory Enhancement (PSE). A total of 40 children were included in this Oxford pretest - posttest study design. The experimental group used the PSE intervention technique (n = 20) was compared with the control group of children (n = 20) without the specific therapy.
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Botelho, Ana Carla Gomes, Luana Valeriano Neri, Marina Queiroz Ferreira da Silva, Thaisa Teixeira de Lima, Karla Gonçalves dos Santos, Raysa Mayara Araújo da Cunha, Alessandra Carolina de Santana Chagas, Nauane de Oliveira Lima, Ariádne Dias Maux Gonçalves, and Marcela Raquel de Oliveira Lima. "Presumed congenital infection by Zika virus: findings on psychomotor development - a case report." Revista Brasileira de Saúde Materno Infantil 16, suppl 1 (November 2016): 39–44. http://dx.doi.org/10.1590/1806-9304201600s100004.
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Abstract Introduction: the identification of Zika virus (ZikV) in the amniotic fluid, in the placenta and in newborns' brains suggests a neurotropism of this agent in the brain development, resulting in neuro-psycho-motor alterations. Thus, this present study reports the assessment of children diagnosed by a congenital infection, presumably by ZikV, followed-up at the Rehabilitation Center Prof. Ruy Neves Baptist at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP). Description: as proposed by the Ministry of Health, the following instruments were used to evaluate the neuro-motor functions of four children with microcephaly aged between three and four months: The Test of Infant Motor Performance (TIMP); the functional vision assessment; the manual function scale development; and the clinical evaluation protocol on pediatric dysphagia (PAD-PED). Discussion: the children evaluated presented atypical motor performance, muscle tone and spontaneous motricity which encompass the symmetry and the motion range of the upper and lower limbs proven to be altered. The functional vision showed alterations which can cause limitations in the performance of functional activities and the learning process. Regarding to the speech articulator's functions observed that the maturation and coordination of sucking, swallowing and breathing did not yet encounter the appropriate age maturity level.
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França, Ellia Christinne Lima, Lucas Carvalho Aragão Albuquerque, Roberta Lopes de Castro Martinelli, Ilda Machado Fiuza Gonçalves, Cejana Baiocchi Souza, and Maria Alves Barbosa. "Surface Electromyographic Analysis of the Suprahyoid Muscles in Infants Based on Lingual Frenulum Attachment during Breastfeeding." International Journal of Environmental Research and Public Health 17, no. 3 (January 30, 2020): 859. http://dx.doi.org/10.3390/ijerph17030859.
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Muscle electrical activity analysis can aid in the identification of oral motor dysfunctions, such as those resulting from an altered lingual frenulum, which consequently impairs feeding. Here, we aim to analyze the suprahyoid muscle electrical activity of infants via surface electromyography, based on lingual frenulum attachment to the sublingual aspect of the tongue and floor of the mouth during breastfeeding. In the present study, we have studied full-term infants of both genders, aged between 1 and 4 months old. The mean muscle activities were recorded in microvolts and converted into percent values of the reference value. Associations between the root mean square and independent variables were tested by one-way analysis of variance and Student’s t-test, with a significance level of 5% and test power of 95%, respectively. We evaluated 235 infants. Lower mean muscle electrical activity was observed with the lingual frenulum attached to apex/lower alveolar ridge, followed by attachment to the middle third/lower alveolar ridge, and between the middle third and apex/lower alveolar ridge. Greater suprahyoid muscle activity was observed with lingual frenulum attachment to the middle third of the tongue/sublingual caruncles, showing a coordination between swallowing, sucking, and breathing. Surface electromyography is effective in diagnosing lingual frenulum alterations, the attachment points of which raises doubt concerning the restriction of tongue mobility. Thus, it is possible to identify oral motor dysfunctions.
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Ross, Erin, and Lauren Fuhrman. "Supporting Oral Feeding Skills Through Bottle Selection." Perspectives on Swallowing and Swallowing Disorders (Dysphagia) 24, no. 2 (April 2015): 50–57. http://dx.doi.org/10.1044/sasd24.2.50.
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Infants who have feeding difficulties often struggle with coordinating sucking, swallowing, and breathing, and have difficulty eating sufficient quantities for adequate growth. Speech-language pathologists (SLPs) need advanced expertise across a number of areas (e.g., development, medical, swallowing) to work effectively with these young infants, and they use a variety of strategies when treating this population. Therapists working with infants who have feeding difficulties use bottles as a primary therapy tool; how the infant tolerates the flow rate from the bottle/nipple is a major consideration. Caregivers must understand the influence of bottle/nipple flow rates on eating skills, so they can support the emerging oral skill development for these fragile infants, and help parents decide what bottle system to use in their home. Both infant and equipment factors influence bottle/nipple flow rates. This article discusses the influencing factors that need to be considered when determining the optimal flow rate for an individual infant.
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Raminick, Jennifer, and Hema Desai. "High Flow Oxygen Therapy and the Pressure to Feed Infants With Acute Respiratory Illness." Perspectives of the ASHA Special Interest Groups 5, no. 4 (August 17, 2020): 1006–10. http://dx.doi.org/10.1044/2020_persp-19-00158.
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Purpose Infants hospitalized for an acute respiratory illness often require the use of noninvasive respiratory support during the initial stage to improve their breathing. High flow oxygen therapy (HFOT) is becoming a more popular means of noninvasive respiratory support, often used to treat respiratory syncytial virus/bronchiolitis. These infants present with tachypnea and coughing, resulting in difficulties in coordinating sucking and swallowing. However, they are often allowed to feed orally despite having high respiratory rate, increased work of breathing and on HFOT, placing them at risk for aspiration. Feeding therapists who work with these infants have raised concerns that HFOT creates an additional risk factor for swallowing dysfunction, especially with infants who have compromised airways or other comorbidities. There is emerging literature concluding changes in pharyngeal pressures with HFOT, as well as aspiration in preterm neonates who are on nasal continuous positive airway pressure. However, there is no existing research exploring the effect of HFOT on swallowing in infants with acute respiratory illness. This discussion will present findings from literature on HFOT, oral feeding in the acutely ill infant population, and present clinical practice guidelines for safe feeding during critical care admission for acute respiratory illness. Conclusion Guidelines for safety of oral feeds for infants with acute respiratory illness on HFOT do not exist. However, providers and parents continue to want to provide oral feeds despite clinical signs of respiratory distress and coughing. To address this challenge, we initiated a process change to use clinical bedside evaluation and a “cross-systems approach” to provide recommendations for safer oral feeds while on HFOT as the infant is recovering from illness. Use of standardized feeding evaluation and protocol have improved consistency of practice within our department. However, further research is still necessary to develop clinical practice guidelines for safe oral feeding for infants on HFOT.
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Pados, Britt F., and Victoria Feaster. "Effect of Formula Type and Preparation on International Dysphagia Diet Standardisation Initiative Thickness Level and Milk Flow Rates From Bottle Teats." American Journal of Speech-Language Pathology 30, no. 1 (January 27, 2021): 260–65. http://dx.doi.org/10.1044/2020_ajslp-20-00272.
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Purpose The purpose of this study was to evaluate the effect of infant formula type and preparation (i.e., ready-to-feed vs. powder) on International Dysphagia Diet Standardisation Initiative (IDDSI) thickness level and milk flow rates from bottle teats/nipples. Method The ready-to-feed and powder formulations of the following products were tested for IDDSI thickness level, using IDDSI guidelines, and for milk flow rate, using established flow testing methods: Similac Advance, Similac For Spit-Up, Enfamil Infant, and Enfamil A.R. Analysis of variance was used to compare flow rates among formula types/preparations. Results Enfamil A.R. ready-to-feed was classified as IDDSI “slightly thick.” All other formula types/preparations were found to be IDDSI “thin” liquids. The standard infant formulas (Similac Advance and Enfamil Infant) had comparable flow rates to each other, regardless of preparation (ready-to-feed and powder). The gastroesophageal reflux–specific formulas (Similac For Spit-Up and Enfamil A.R.) had slower flow rates than the standard formulas; within this category, there were significant differences in flow rates between ready-to-feed and powder. Enfamil A.R. powder had the slowest flow rate, but was the most variable. Conclusion For infants with difficulty coordinating sucking, swallowing, and breathing, clinicians and parents should consider the impact that changes to infant formula type and preparation may have on the infant's ability to safely feed.
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"Coordination of breathing, sucking, and swallowing during bottle feedings in human infants." International Journal of Pediatric Otorhinolaryngology 21, no. 3 (May 1991): 286–87. http://dx.doi.org/10.1016/0165-5876(91)90022-4.
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Shandley, Sabrina, Gilson Capilouto, Eleonora Tamilia, David M. Riley, Yvette R. Johnson, and Christos Papadelis. "Abnormal Nutritive Sucking as an Indicator of Neonatal Brain Injury." Frontiers in Pediatrics 8 (January 12, 2021). http://dx.doi.org/10.3389/fped.2020.599633.
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A term neonate is born with the ability to suck; this neuronal network is already formed and functional by 28 weeks gestational age and continues to evolve into adulthood. Because of the necessity of acquiring nutrition, the complexity of the neuronal network needed to suck, and neuroplasticity in infancy, the skill of sucking has the unique ability to give insight into areas of the brain that may be damaged either during or before birth. Interpretation of the behaviors during sucking shows promise in guiding therapies and how to potentially repair the damage early in life, when neuroplasticity is high. Sucking requires coordinated suck-swallow-breathe actions and is classified into two basic types, nutritive and non-nutritive. Each type of suck has particular characteristics that can be measured and used to learn about the infant's neuronal circuitry. Basic sucking and swallowing are present in embryos and further develop to incorporate breathing ex utero. Due to the rhythmic nature of the suck-swallow-breathe process, these motor functions are controlled by central pattern generators. The coordination of swallowing, breathing, and sucking is an enormously complex sensorimotor process. Because of this complexity, brain injury before birth can have an effect on these sucking patterns. Clinical assessments allow evaluators to score the oral-motor pattern, however, they remain ultimately subjective. Thus, clinicians are in need of objective measures to identify the specific area of deficit in the sucking pattern of each infant to tailor therapies to their specific needs. Therapeutic approaches involve pacifiers, cheek/chin support, tactile, oral kinesthetic, auditory, vestibular, and/or visual sensorimotor inputs. These therapies are performed to train the infant to suck appropriately using these subjective assessments along with the experience of the therapist (usually a speech therapist), but newer, more objective measures are coming along. Recent studies have correlated pathological sucking patterns with neuroimaging data to get a map of the affected brain regions to better inform therapies. The purpose of this review is to provide a broad scope synopsis of the research field of infant nutritive and non-nutritive feeding, their underlying neurophysiology, and relationship of abnormal activity with brain injury in preterm and term infants.
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Lagarde, M. L. J., N. van Alfen, S. A. F. de Groot, A. C. H. Geurts, and L. van den Engel-Hoek. "Adaptive capacity of 2- to 5-month-old infants to the flow, shape, and flexibility of different teats during bottle feeding: a cross-sectional study." BMC Pediatrics 19, no. 1 (December 2019). http://dx.doi.org/10.1186/s12887-019-1859-y.
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Abstract Background Nutritive sucking is a complex activity, the biomechanical components of which may vary in relation to respiratory phase, swallow-rate per minute, suck-swallow ratio, and swallow non-inspiratory flow (SNIF). Quantitative measurement of these components during nutritive sucking in healthy infants could help us to understand the complex development of sucking, swallowing, and breathing. This is important because the coordination between these components is often disturbed in infants with feeding difficulties. The aims of this study were to describe the biomechanical components of sucking and swallowing in healthy 2- to 5-month-old infants during bottle feeding, to assess whether infants adapt to the characteristics of two different teats, and to determine which independent variables influence the occurrence of SNIF. Methods Submental muscle activity, nasal airflow, and cervical auscultation were evaluated during bottle-feeding with two different teats. Results Sixteen term-born infants (6 boys) aged 2–5 months were included. All infants showed variable inhalation and exhalation after swallowing. The swallow rate per minute was significantly higher when infants fed with a higher flow teat (Philips Avent Natural 2.0™). Infants had suck:swallow ratios ranging from 1:1 to 4:1. A suck:swallow ratio of 1:1 occurred significantly more often when infants fed with a higher flow teat, whereas a suck:swallow ratio of 2:1 occurred significantly more often when infants fed with a low-flow teat (Philips Avent Classic+™). A suck:swallow ratio of 1:1 was negatively correlated with SNIF, whereas a suck:swallow ratio of 2:1 was positively correlated with SNIF. Conclusion Healthy infants aged 2–5 months can adapt to the flow, shape, and flexibility of different teats, showing a wide range of biomechanical and motor adaptations.
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Lima, Anna Letícia Xavier de, and Monique Ramos Paschoal Dutra. "Influence of frenotomy on breastfeeding in newborns with ankyloglossia." CoDAS 33, no. 1 (2021). http://dx.doi.org/10.1590/2317-1782/20202019026.
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ABSTRACT Purpose: evaluate the influence of frenotomy on the breastfeeding of newborns diagnosed with ankyloglossia. Methods: this is an intervention study performed with 50 newborns diagnosed with ankyloglossia. It was conducted in three stages: diagnosis, intervention and reassessment. In the diagnostic phase, the Protocol for the Assessment of Speech Language with Scores for Babies was applied to diagnose ankyloglossia and a questionnaire assessing the symptoms and coordination of sucking, swallowing and breathing during breastfeeding. In the intervention, frenotomy was performed, and at reassessment, the diagnostic protocol and questionnaire in order to compare the post-surgical effects. Results: of the 50 babies participating in the study, 35 (70%) were boys and 15 (30%) girls. A total of 68% of ankyloglossia cases were reported in the family, a majority (38%) involving cousins. There was a statistically significant reduction in the average protocol score in the reassessment stage, from 8.38 (7-12 points) to 0.86 (0-5 points), as well as a statistically significant improvement in all variables related to the symptoms of breastfeeding. Conclusion: surgical intervention, known as frenotomy, made it possible to improve the negative symptoms of breastfeeding in newborns diagnosed with ankyloglossia.
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Saberi Louyeh, Zahra, Mahin Naderifar, Hamed Faghihi, Brenda S. Lessen Knoll, and Nasrin Mahmoodi. "Comparing the Effect of Breast Milk Odor and Incubator Cover on Nutritional Adequacy of Premature Infants: A Quasi-Experimental Study." Medical - Surgical Nursing Journal 9, no. 2 (July 25, 2020). http://dx.doi.org/10.5812/msnj.99993.
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Background: Premature babies face nutritional problems caused by underdevelopment and lack of coordination between sucking, swallowing, and breathing. Appropriate early interventions are needed to promote the nutritional adequacy of these infants. Objectives: This study was designed to compare the effect of breast milk odor and incubator cover on the nutritional adequacy of premature infants. Methods: A quasi-experimental study was conducted on 105 preterm infants aged 28 - 33 weeks who were admitted to the Neonatal Intensive Care Unit (NICU) of Ali Ibn Abi Taleb Hospital in Zahedan in 2018. The subjects were selected via convenience sampling and randomized into three groups: breast milk odor (BMO), incubator cover (IC), and control. Infants in the IC group were placed in an incubator for two hours before feeding. In the BMO group, a gauze soaked with breast milk was placed 1.5 cm away from the infant’s nose in the incubator, and a prescribed amount of milk was given by a syringe to the infant through the mouth. The amount of milk that the baby orally received in the first 10 min (nutritional adequacy) was recorded by a camera, and the results were compared in the three groups. Results: One-way analysis of variance showed a statistically significant difference between the control group and the two groups of incubator cover and breast milk odor (P < 0.001) such that nutritional adequacy was lower in the control group than in the two other groups. Conclusions: Both the smell of breast milk and incubator cover improved the nutritional adequacy of premature infants and enabled them to orally receive more breast milk.
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Piro, Ettore, Gregorio Serra, Vincenzo Antona, Mario Giuffrè, Elisa Giorgio, Fabio Sirchia, Ingrid Anne Mandy Schierz, Alfredo Brusco, and Giovanni Corsello. "Novel LRPPRC compound heterozygous mutation in a child with early-onset Leigh syndrome French-Canadian type: case report of an Italian patient." Italian Journal of Pediatrics 46, no. 1 (September 24, 2020). http://dx.doi.org/10.1186/s13052-020-00903-7.
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Abstract Background Mitochondrial diseases, also known as oxidative phosphorylation (OXPHOS) disorders, with a prevalence rate of 1:5000, are the most frequent inherited metabolic diseases. Leigh Syndrome French Canadian type (LSFC), is caused by mutations in the nuclear gene (2p16) leucine-rich pentatricopeptide repeat-containing (LRPPRC). It is an autosomal recessive neurogenetic OXPHOS disorder, phenotypically distinct from other types of Leigh syndrome, with a carrier frequency up to 1:23 and an incidence of 1:2063 in the Saguenay-Lac-St Jean region of Quebec. Recently, LSFC has also been reported outside the French-Canadian population. Patient presentation We report a male Italian (Sicilian) child, born preterm at 28 + 6/7 weeks gestation, carrying a novel LRPPRC compound heterozygous mutation, with facial dysmorphisms, neonatal hypotonia, non-epileptic paroxysmal motor phenomena, and absent sucking-swallowing-breathing coordination requiring, at 4.5 months, a percutaneous endoscopic gastrostomy tube placement. At 5 months brain Magnetic Resonance Imaging showed diffuse cortical atrophy, hypoplasia of corpus callosum, cerebellar vermis hypoplasia, and unfolded hippocampi. Both auditory and visual evoked potentials were pathological. In the following months Video EEG confirmed the persistence of sporadic non epileptic motor phenomena. No episode of metabolic decompensation, acidosis or ketosis, frequently observed in LSFC has been reported. Actually, aged 14 months corrected age for prematurity, the child shows a severe global developmental delay. Metabolic investigations and array Comparative Genomic Hybridization (aCGH) results were normal. Whole-genome sequencing (WGS) found a compound heterozygous mutation in the LRPPRC gene, c.1921–7A > G and c.2056A > G (p.Ile686Val), splicing-site and missense variants, inherited from the mother and the father, respectively. Conclusions We first characterized the clinical and molecular features of a novel LRPPRC variant in a male Sicilian child with early onset encephalopathy and psychomotor impairment. Our patient showed a phenotype characterized by a severe neurodevelopmental delay and absence of metabolic decompensation attributable to a probable residual enzymatic activity. LRPPRC is a rare cause of metabolic encephalopathy outside of Québec. Our patient adds to and broaden the spectrum of LSFC phenotypes. WGS analysis is a pivotal genetic test and should be performed in infants and children with hypotonia and developmental delay in whom metabolic investigations and aCGH are normal.