One of the major challenges in taking care of preterm infants is their feeding problems. Often preterm infants stay longer in the hospital as they are not ready to eat well and complete their feeds. This presentation focuses on implementation of a technology called NTrainer system for early assessment and therapy to help preterm infants to eat well and go home faster. Evidence-based practice demonstrates NTrainer system enhance care quality, the patient experience and nursing practice.
Relevance/Significance
Extra uterine life is a pathological condition for preterm infants. Preterm infants have longer length of stay as they are not ready to eat well and complete their feeds. Non-nutritive sucking is promoted as this accelerates and helps the premature infants to develop their nutritive sucking. Non-nutritive sucking is generally facilitated by providing pacifiers. The Evidence-based practice team identified practices of using standardized patterned somatosensory oral stimulation to foster full oral feeds. A system available, that was developed to provide pneumatic pulse to a hand held device attached to a pacifier is used to provide this kind of somatosensory oral stimulation to preterm infants. To translate evidence-based strategies into solutions, NTrainer system was used by the Evidence-based practice team to assess and provide standardized patterned somatosensory oral stimulation therapy, which helps preterm infants to arrive at full oral feeds sooner and decreases length of stay.
Strategy and Implementation
The Evidence-based practice team conducted a comprehensive search of online research databases for articles using standardized patterned somatosensory oral stimulation to foster full oral feeds. The team identified the following:
1) Repeated stimulus mimicking non-nutritive suck accelerates development of nutritive suck.
2) NTrainer system help preterm babies to arrive at full oral feeds sooner and decreases length of stay.
Using the IOWA Model strategy, this project evaluated NTrainer system. The NTrainer has been shown to enhance non-nutritive sucking and nutritive feeding ability by standardized patterned somatosensory oral stimulation. A specially trained interdisciplinary team including neonatal nurses and neonatal occupational therapists introduced the NTrainer therapy to preterm infants of gestational age 32 weeks and above.
NTrainer system has two components:
- A hand held device connected to a computerized system that deliver standardized pneumatic pulse that is transmitted to the pacifier attached to this hand held system.
- The second component is the electronic system that monitors and records the sucking pattern of the infant when the somatosensory oral stimulation initiates sucking.
Using NTrainer system, pulsed pneumatic stimulation of NNS was delivered in three, 3-minute epochs. Hand held device with pacifier was offered to the preterm infant to suck. The preterm infant’s response was recorded electronically. 10 infants were studied for the assessment and therapy using NTrainer system. Aggregated data collection compared 10 preterm infants without any stimulus with the 10 infants who received assessment and therapy with NTrainer system.
Evaluation/Outcomes
NTrainer therapy is effective for preterm infants to transition into full feed, ultimately decreasing length of stay. And this was evident in this Evidence-based study. This study initiated trials of similar therapies that is available to promote non-nutritive sucking and assess nutritive sucking when feeding a preterm infant. It brought forward the attention for feeding policy changes to change cue-based feeding earlier than the practice of starting feeding at 34 weeks of gestation. It has also demonstrated promising improvement in enhancing care and patient experience. However, due to the small sample size, statistically significant results were not seen, therefore this EBP project is ongoing.
Implications for Practice
This EBP study highly recommend to implement standardized patterned somatosensory oral stimulation therapy to foster full feeds in preterm infants in neonatal intensive care units globally. Consider changing feeding policy and practices to introduce cue-based feeding earlier than starting at 34 weeks of gestation. Further exploration into benefits of non-nutritive sucking is suggested. Non-nutritive sucking enhances and promotes nutritive sucking abilities. Practices of this kind will help preterm infants to eat well and go home faster to be with their families.