Abnormal sucking in preterm babies may indicate neurologic dysfunction

Preterm infants who demonstrate uncoordinated sucking patterns during feeding could have neurologic dysfunction, research suggests.

Tjitske Nieuwenhuis (University Medical Center Groningen, the Netherlands) and team found that preterm infants who were unable to suck, swallow, and breathe had increased rates of fidgety movements - which in previous studies has been linked with motor abnormalities and cognitive impairment.

Indeed, they also observed in the current study that fidgety movements was one of two predictors for an impaired Motor Optimality Score (MOS), a measure of motor repertoire.

Nieuwenhuis and team assessed sucking and swallowing using the Neonatal Oral-Motor Assessment Scale, which distinguishes sucking patterns as normal (mature), disorganized (arrhythmic sucking pattern), and dysfunctional (when abnormal jaw and tongue movements interrupt feeding).

They found that the median age at which the sucking pattern of the 44 preterm infants included in the study became normal was 8 weeks after term, ranging from 34 weeks postmenstrual age up to more than 10 weeks post-term. At 10 weeks post-term, 11 infants (26%) had an abnormal sucking pattern.

At 3 months post-term, 30 of the 42 patients had data available on motor repertoire. Of these, 71% had normal fidgety movements (movements of small amplitude, moderate speed, variable acceleration of the neck, trunk, and limbs in all directions). Ten (24%) infants had abnormal fidgety movements (moderately to greatly exaggerated amplitude, speed, and jerkiness), while two (5%) infants showed no fidgety movements, considered to be abnormal.

The age at which sucking patterns normalized was significantly correlated with the quality of fidgety movements, classified into three categories of increasing abnormality.

Infants with uncoordinated sucking patterns had significantly more abnormal or absent fidgety movements (nine of 19 [47%]) than infants with only arrhythmic sucking patterns (two of 19 [11%]). The presence of either uncoordinated or dysfunctional sucking patterns or both increased the risk for abnormal or absent fidgety movements a significant 7.50-fold.

Finally, multiple regression analysis showed that of multiple factors - including being small for gestational age (SGA), age at normal sucking pattern, and uncoordinated sucking - SGA and uncoordinated sucking were the most significant predictors for having an impaired MOS.

"Assessment of the sucking patterns in preterm infants may be helpful in determining the individual risk of these infants developing clinically relevant neurologic dysfunctions and perhaps feeding problems later in childhood," write the authors in the Journal of Pediatrics. "We believe that infants with uncoordinated sucking patterns require special attention."

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