Hypothesis Preterm babies who receive sensory motor stimulation from their mothers as compared to trained nurses will 1. Start taking oral feed at the same time as compared to control group 2. Take the same amount of milk at the commencement of oral feeding 3. Take milk with equal efficiency 4. Not face more adverse effects
Aim To determine the maternal role in sensory-motor stimulation for oral feed establishment in preterm neonates Objective 1. Determine the effect of sensory-motor stimulation offered by the mother on the onset of oral feeding 2. Efficiency of mother-mediated stimulation techniques on oral feeding as compared to trained nurses 3. Study maternal role in the establishment of oral feed Hypothesis Preterm babies who receive sensory motor stimulation from their mothers as compared to trained nurses will 1\. Start taking oral feed at the same time frame as compared to the control group 2. Take the very same amount of milk at the commencement of oral feeding 3. Take milk with equal efficiency 4. There is no extra burden of adverse effects Data Collection All on going and related trials for this intervention shall be registered in the ClinicalTrials.gov. Study shall be conducted after ethical approval from IRB. All participants shall be enrolled after written informed consent from mothers after approval from attending neonatologist (annexure 2). All relevant maternal and neonatal data shall be collected on a specially designed proforma (annexure 3) with following details 1. Part 1: Maternal demographic and clinical data (age, parity, educational qualification, residence, previous preterm baby, job status, diabetes, hypertensive disorders, chronic ailment, multifetal gestation 2. Part 2: Neonatal demographic data (gender, gestation age, birth weight, growth centiles, diagnosis, APGAR score, noninvasive (NIV) and invasive ventilation with duration, caffeine, days taken for establishment of gavage feeding, age, and weight at commencement of intervention, any other complication during study) 3. Part 3: Neonatal feeding physiological measurements (SpO2, respiratory rate, heart rate before and after feeding, daily weight gain, type of milk offered) 4. Part 4: Oral feeding skill (OFS) assessment adapted from the model presented by Lau and Smith (p). All parameters shall be recorded twice a day for D1, D2, and D3 separately. It includes * Total volume prescribed (ml) * Total volume has taken during feeding (ml) * Volume has taken during the first 5 min of feeding (ml) * Duration of oral feeding (min) * Overall transfer (OT %) volume taken/total volume prescribed * Proficiency(PRO%) volume taken during the first 5 min/total volume prescribed * Rate of transfer (RT) ml/min * SSB (Suck Swallow Breaths) coordination * Adverse events (cough, fatigue) * According to this oral feeding ability can be classified into four levels depending upon the level of maturity in ascending order as follows: * Level 1: PRO \< 30% and RT \< 1.5 ml/min * Level 2: PRO \< 30% and RT ≥ 1.5 ml/min * Level 3: PRO ≥ 30% and RT \< 1.5 ml/min * Level 4: PRO ≥ 30% and RT ≥ 1.5 ml/min
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
130
Step 1 - 6 over 5 minutes 1 With the help of the index finger, on the external surface of the cheek, make a circle starting from the angle of the mouth towards the ear then back 7x each cheek 2 While holding both sides of the cheek with help of the thumb and index finger repeat step 1 7x each cheek 3 Move index finger from one corner to opposite one over both lips separately 7x each lip 4 Gentle massage and compress the gums from center to back of mouth 7x each half of the gum 5 Move the finger from front to back on the hard palate while applying gentle pressure 7x 6 Displace the center of the tongue with gentle pressure 7x 7 Offer pacifier at the end 2 minutes Note: 7x means 7 times
Rafia Gul
Lahore, Shadman, Pakistan
Transition Time to Full Oral Feeding
Time interval between commencement of perioral sensory stimulation on D1 to establishment of full oral feed in both groups. It was done daily till 14th day of perioral sensory motor stimulation. Transition time to full oral feeding was the day at which baby was able to take oral feed of volume of 120-140ml/kg/day.
Time frame: Expected time of oral feed establishment
Improvement (Change) in Efficiency in Oral Feed Establishment
According to this efficiency in oral feed establishment in terms of amount and time is determined for the intervention group vs the control group. It can be classified into four levels depending upon the level of maturity in ascending order as follows: * Level 1: PRO \< 30% and RT \< 1.5 ml/min * Level 2: PRO \< 30% and RT ≥ 1.5 ml/min * Level 3: PRO ≥ 30% and RT \< 1.5 ml/min * Level 4: PRO ≥ 30% and RT ≥ 1.5 ml/min For all neonates, efficacy was measured at 11.00 am and 5.00 pm following sensory motor stimulation for both groups till achievement of full oral feed.
Time frame: For record purpose in this study results, efficacy level was noted as L4 on the following days D1, D2, D3, D5, D7 and D14
•Adverse Outcome Monitoring
monitor for any adverse events like cough, breath holding, chocking, aspiration, tachycardia, and or bradycardia with 1. stimulation 2. feed Adverse outcome monitoring as non-life threatening adverse events including cough, tachycardia HR 180-200/min, bradycardia HR120 - 100/min, , tachypnea RR 60 - 70/min while maintaining SpO2 of \>90% at room air
Time frame: Adverse events were noted on D1, D2,D3,D5,D7 and D14
•Adverse Events Monitoring
monitor for any adverse events like cough, breath holding, chocking, aspiration, tachycardia, and or bradycardia with 1. stimulation 2. feed Adverse outcome monitoring as non-life threatening adverse events including cough, tachycardia HR 180-200/min, bradycardia HR120 - 100/min, , tachypnea RR 60 - 70/min while maintaining SpO2 of \>90% at room air
Time frame: Adverse events were noted on D1, D2,D3,D5,D7 and D14
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• Total Volume Taken During Each Feeding
It is the measure of how much feed has been taken orally out of total feed prescribed for each feeding
Time frame: It was noted on D1, D2, D3, D5, D7 and D14
• Volume Taken During the First 5 Min of Feeding (ml) VT5
during each feed taken orally by neonate VT5 is the amount of feed was taken by neonate during first 5 minutes
Time frame: Volume taken during the first 5 min of feeding (ml) VT5 was measured on D1, D2, D3, D5, D7 and D14
•Rate of Transfer (RT) ml/Min
RT is the time taken by neonate to finish oral feed
Time frame: RT was measured on D1, D2, D3, D5, D7 and D14
• Overall Transfer (OT Percent) Volume Taken/Total Volume Prescribed
trend towards oral feed establishment and is measured as overall transfer of milk yo oral out of total amount prescribed
Time frame: OT was measured on D1, D2, D3, D5, D7 and D14
• Proficiency(PRO Percent) Volume Taken During the First 5 Min/Total Volume Prescribed
how much amount of milk is taken during first 5 minutes while administering oral feeding
Time frame: PRO % was measured on D1, D2, D3, D5, D7 and D14
• Neonates Feeding With SSB Coordination
number of neonates who are feeding well and showing coordinated pattern of suck swallow and breath (SSB)
Time frame: It was measured on D1, D2, D3, D5, D7 and D14