A study to Evaluate the Effectiveness of Oral Stimulation and Oral Support on Feeding performances among preterm and low birth weight babies (LBW) at R.L Jalappa Hospital &Research Centre, Kolar, Karnataka.

Introduction:

Delivering adequate amounts of nutrients to premature infants¹ at all times is challenging because the infant’s immature gastrointestinal tract is initially unable to accept feedings. Inadequate nutrient intake has resulted in widespread postnatal growth restriction. Now that it is known that postnatal growth restriction is associated with poor neuro-cognitive development, which calls for efforts to increase nutrient intakes² .

Babies need to develop three major skills in order to be able to eat effectively, namely- a mature suck, a mature swallow and coordination of sucking-swallowing and breathing. Feeding premature babies who haven't developed these three skills can be frustrating for parents, nurses, and the babies themselves. A preterm without a mature suck and swallow will quickly become exhausted during a feeding—each feeding session is quite a workout³ .

Once physiological stability has been attained, a major challenge for preterm infants is achievement of oral feeding competence. The American Academy of Paediatrics has included competency at nipple-feeding, either breast or bottle, as a criterion for preterm infant readiness for hospital discharge. Achieving competence at this important task takes time, with the transition from gavage to full bottlefeedings reported to last 10 to 14 days. Longer transition to full bottle-feedings has been associated with increased length of hospital stay⁴ .

A national survey of neonatal intensive care unit feeding practices revealed no consistent criteria for the initiation of oral feeding and no organized protocolfor oral feeding progression. Once oral feedings are initiated, a common but untested practice is to start with one oral feeding attempt per day and gradually, but arbitrarily, increase oral offerings over time. In fact, although research is limited, there is some evidence that preterm infants who have more bottle opportunities attain full oral feeding earlier than infants who receive fewer opportunities⁴ .

Objectives:

1. To evaluate the effectiveness of Oral stimulation and Oral support on Feeding Performances by comparing the findings between Experimental and Control group.

2. To determine the association between Feeding Performances with selected socio demographic variables of Preterm and Low Birth Weight⁵ babies.

Material and Methods:

Quantitative approach with True Experimental Time Series (post test only with control group) design was used for this study. The study was conducted in NICU of R.L Jalappa Hospital and Research centre, Tamaka, Kolar. RLJH&RC is an multi-Specialty Hospital with 1200 bed strength It has well equipped NICU with 16 beds with all life saving equipment and availability of Health care persons round the clock. Total of 40 Preterm and LBW babies, 20 each in experimental and control group were selected by simple random (computer generated random number assignment) sampling technique.

Ethical clearance was obtained from institutional ethics committee of Sri Devaraj Urs college of Nursing. Permission was obtained from concerned authorities before conducting of the study. Patient information sheet and informed consent was taken from the mothers of preterm and LBW babies before conducting the study.

Weight of the babies of both experimental and control group was measured. Oral support and Oral stimulation was given to preterm and LBW babies of experimental group twice a day before the beginning of the scheduled feeding, which include 12 mts of Oral stimulation (non-nutritive sucking and stroking of oral structures) and 3mts of Oral support.

Feeding performances were assessed on 3 ^rd day ,5^th day, & 7 ^th day of initiating the intervention by requesting the mother to put the baby to breast, by using EFS6 scale (early feeding skill assessment check list )

For the babies of control group, routine hospital care was continued; feeding performances were assessed on 3^rd day, 5^th day, & 7^th day as of the experimental group.

Data analysis was done by using descriptive and inferential statistics. Repeated measures of ANOVA and independent‘t’ test were used through SPSS 20 version to analyze effectiveness of Oral Support and Oral Stimulation on Feeding performances .Chi-square analysis was done to determine association between socio demographic variables and feeding performances of Preterm and Low Birth Weight babies.

RESULTS

Section I. Description of demographic variables in Experimental and Control groups.

Majority i.e. 70% (14) mothers were in the age group of 24-27 years in Experimental group where as in control group 55 % ( 11) mothers were in 24-27 years. Majority i.e. 35% (07) of babies were born between 35-36 in Experimental group where as in control group. 40% (08) of babies were born between 32- 33weeks.Majority i.e. 40% (08) of babies were born between 1.5-1.8kgs in Experimental group where as in control group 40% (08) of babies were born between 1.2-1.5kgs. Majority i.e. 60 %( 12) babies were first born in Experimental group where as in Control group 45 %( 09) babies were first born.

Section II:

The Mean scores with SD of Experimental group on Day-3, 5 & 7 was 19.85±5.00 & 26.80±3.41 & 28.35±1.72 where as in control group 13.70±6.08 &19.30±6.68 &23.85±6.02 at 38 df and calculated independent‘t’-value was 3.48 & 4.46 & 3.21 which is more than table value (p<0.01) at 0.05 level of significance indicating Statistically Significant difference in establishment of feeding performances between Experimental and Control group. 

The Mean scores with SD of Experimental group on Day-3, 5 & 7 was 19.85±5.00 & 26.80±3.41 & 28.35±1.72 and F-value of 36.22 with p-value of .001 shows statistically significant difference in Feeding performances from Day- 3 to Day-7 among Preterm and LBW babies.

The Mean scores with SD of Control group on Day-3, 5 & 7 was 13.70±6.08 & 19.30±6.68 & 23.85±6.02 and F-value of 46.24 with p-value of .001, also shows statistically significant difference in Feeding performances from Day- 3 to Day-7 among Preterm and LBW babies. However mean scores are higher in the experimental group compared to control group, indicating the impact of the intervention. Hence the stated H₀₁ is accepted.

Section III:

The above table indicates chi- square calculated value is less than table value at 0.05 level of significance for Gestational age, Birth weight of child and Order of birth and Feeding performances of Preterm and LBW babies in Experimental group. Hence the stated H₀₂ is accepted. 

The above table indicates, chi- square calculated value is less than table value at 0.05 level of significance for Gestational age, Birth weight of child and Order of birth and Feeding performances of Preterm and LBW babies in Control group. Hence the stated H₀₂ is accepted.

Discussion:

Preterm infants frequently experience oral feeding difficulties because of underdeveloped central nervous system and oral musculature, with lack of coordination for the suck-swallow-breath mechanism, which make them rely on artificial feedings and parenteral nutrition to meet their nutritional requirements. This may lead to difficulties in establishing direct breast feeding after the stabilization of preterm and LBW babies. 

The present study aims to evaluate the Effectiveness of Oral Stimulation and Oral Support on Feeding performances among preterm and low birth weight babies (LBW). The findings of the study reveals that calculated independent‘t’-value was 3.48 & 4.46 & 3.21 which is more than table value (p<0.01) at 0.05 level of significance indicating Statistically Significant difference in establishment of feeding performances between Experimental and Control group. the study findings are supported by a study conducted by, Amer H.W etal, shows significantly increase in the mean total oral intake of required rate, decreased net leakage and shortened oral feeding duration for the intervention group7 .Similar study was conducted by Gaebler CP etal and the result shows that an effective in enhancing the infants' feeding skills along with weight gain and decreased hospital stays⁸ .

Repeated Measures ANOVA revealed statistically significant difference in feeding performances from Day-3 to Day-7 both in experimental and control group. However the mean scores of feeding performance s of babies of experimental group are higher compared to the control group (Experimental group: F-value of 36.22 with p-value of .001, and Control Group: F-value of 46.24with pvalue of .001). With regard to association of feeding performances and Gestational age, Birth weight of child and Order of birth, the chi square value did not reveal any significant association at 0.05 level.

Hence the present study suggest that pre feeding oral stimulation and oral support may be an effective intervention to modulate oral motor functioning to improve the feeding performances among the preterm and LBW babies.

Conclusion:

Oral stimulation and Oral support helps in improving the feeding performances of Preterm and LBW babies, as early establishment of breast feeding is the most common problem among the babies born premature and LBW.

Conflict of Interest: None