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      Validação do conteúdo de um instrumento para avaliação da prontidão do prematuro para início da alimentação oral Translated title: Content validation as a tool for evaluating oral feeding readiness in preterm babies

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          Abstract

          OBJETIVOS: elaborar e validar o conteúdo e a aparência de um instrumento de avaliação da prontidão do prematuro em iniciar a transição da alimentação gástrica para via oral. MÉTODOS: para validação do conteúdo do instrumento e seu respectivo guia instrucional, estabeleceu-se um percentual mínimo de concordância de 85% entre os "juízes ", fonoaudiólogos com experiência na área de neonatologia. RESULTADOS: obteve-se concordância acima de 85% nos itens avaliados. O instrumento e guia instrucional validados ficaram constituídos dos seguintes itens: idade corrigida, estado de organização comportamental (estado de consciência, postura e tônus global), postura oral (lábios e língua), reflexos orais (procura, sucção, mordida e vômito) e sucção não-nutritiva (movimentação e canolamento de língua, movimentação da mandíbula, força de sucção, sucções por pausa, manutenção do ritmo de sucção por pausa e do estado alerta e sinais de estresse). CONCLUSÕES: o instrumento e guia instrucional objetivam e sistematizam a avaliação do bebê prematuro iniciar a transição da alimentação gástrica para via oral. Para o uso em unidades neonatais, há necessidade de sua validação clínica.

          Translated abstract

          OBJECTIVES: to produce and validate the content and appearance of a tool for evaluating the readiness of preterm infants to begin the transition from gastric to oral feeding. METHODS: for the validation of the tool and accompanying instructions, the authors established a minimum percentage agreement of 85% among the 15 peers who participated in the study, all of them speech therapists with broad experience in the area of neonatology. RESULTS: the validated tool and accompanying instructions contained the following items: corrected gestational age, state of behavioral organization (state of consciousness, overall posture and overall muscle tone), oral posture (lips and tongue), oral reflexes (rooting, sucking, biting and gagging) and non-nutritive sucking (tongue movements, cupped tongue configuration, jaw movements, sucking force, sucking pause, maintaining the rhythm sucking and pause, maintaining an alert state and signs of stress). CONCLUSIONS: the tool and accompanying instructions aim to systematize the evaluation of preterm infants, beginning with the transition from gastric to oral feeding. Clinical validation is necessary before they can be used in neonatal wards.

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          Most cited references22

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          Randomized clinical trial of pacifier use and bottle-feeding or cupfeeding and their effect on breastfeeding.

          To enhance breastfeeding practices, the World Health Organization discourages pacifiers and bottle-feeding. However, the effect of artificial nipples on breastfeeding duration is poorly defined. The effects of 2 types of artificial nipple exposure on breastfeeding duration were evaluated: 1) cupfeeding versus bottle-feeding for the provision of in-hospital supplements and 2) early (2-5 days) versus late (>4 weeks) pacifier introduction. A total of 700 breastfed newborns (36-42 weeks, birth weight >or=2200 g) were randomly assigned to 1 of 4 intervention groups: bottle/early pacifier (n = 169), bottle/late pacifier (n = 167), cup/early pacifier (n = 185), or cup/late pacifier (n = 179). The cup/bottle intervention was invoked for infants who received supplemental feedings: cup (n = 251), bottle (n = 230). Data were collected at delivery and at 2, 5, 10, 16, 24, 38, and 52 weeks' postpartum. Intervention effects on breastfeeding duration were evaluated with logistic regression and survival analyses. Supplemental feedings, regardless of method (cup or bottle), had a detrimental effect on breastfeeding duration. There were no differences in cup versus bottle groups for breastfeeding duration. Effects were modified by the number of supplements; exclusive and full breastfeeding duration were prolonged in cup-fed infants given >2 supplements. Among infants delivered by cesarean, cupfeeding significantly prolonged exclusive, full, and overall breastfeeding duration. Exclusive breastfeeding at 4 weeks was less likely among infants exposed to pacifiers (early pacifier group; odds ratio: 1.5; 95% confidence interval: 1.0-2.0). Early, as compared with late, pacifier use shortened overall duration (adjusted hazard ratio: 1.22; 95% confidence interval: 1.03-1.44) but did not affect exclusive or full duration. There was no advantage to cupfeeding for providing supplements to the general population of healthy breastfed infants, but it may have benefitted mother-infant dyads who required multiple supplements or were delivered by cesarean. Pacifier use in the neonatal period was detrimental to exclusive and overall breastfeeding. These findings support recommendations to avoid exposing breastfed infants to artificial nipples in the neonatal period.
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            Characterization of the developmental stages of sucking in preterm infants during bottle feeding.

            It is acknowledged that the difficulty many preterm infants have in feeding orally results from their immature sucking skills. However, little is known regarding the development of sucking in these infants. The aim of this study was to demonstrate that the bottle-feeding performance of preterm infants is positively correlated with the developmental stage of their sucking. Infants' oral-motor skills were followed longitudinally using a special nipple/bottle system which monitored the suction and expression/compression component of sucking. The maturational process was rated into five primary stages based on the presence/absence of suction and the rhythmicity of the two components of sucking, suction and expression/compression. This five-point scale was used to characterize the developmental stage of sucking of each infant. Outcomes of feeding performance consisted of overall transfer (percent total volume transferred/volume to be taken) and rate of transfer (ml/min). Assessments were conducted when infants were taking 1-2, 3-5 and 6-8 oral feedings per day. Significant positive correlations were observed between the five stages of sucking and postmenstrual age, the defined feeding outcomes, and the number of daily oral feedings. Overall transfer and rate of transfer were enhanced when infants reached the more mature stages of sucking. We have demonstrated that oral feeding performance improves as infants' sucking skills mature. In addition, we propose that the present five-point sucking scale may be used to assess the developmental stages of sucking of preterm infants. Such knowledge would facilitate the management of oral feeding in these infants.
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              Coordination of suck-swallow and swallow respiration in preterm infants

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                Author and article information

                Journal
                rbsmi
                Revista Brasileira de Saúde Materno Infantil
                Rev. Bras. Saude Mater. Infant.
                Instituto de Medicina Integral Prof. Fernando Figueira (Recife, PR, Brazil )
                1519-3829
                1806-9304
                December 2008
                : 8
                : 4
                : 391-399
                Affiliations
                [01] Irati PR orgnameUniversidade Estadual do Centro-Oeste orgdiv1UNICENTRO Brasil cifujinaga@ 123456irati.unicentro.br
                [02] Ribeirão Preto SP orgnameUniversidade de São Paulo orgdiv1Escola de Enfermagem de Ribeirão Preto Brasil
                Article
                S1519-38292008000400004 S1519-3829(08)00800404
                87f218d6-b183-4816-8872-662eb9a0246e

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 30 June 2008
                : 22 December 2006
                : 07 April 2009
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 22, Pages: 9
                Product

                SciELO Brazil

                Categories
                Artigos Originais

                Prematuro,Behavior,Premature,Infant,Sucção,Comportamento,Sucking
                Prematuro, Behavior, Premature, Infant, Sucção, Comportamento, Sucking

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