Method Fosters Improved Oral Feeding in Infants with Robin Sequence

In fewer than 11 days, infants with moderate to severe breathing problems significantly improved their oral feeding with the help of feeding-facilitating techniques (FFTs).

Before the introduction of these techniques, infants were at risk of developing gastroesphageal reflux due to prolonged use of a feeding tube. Now a large majority (92%) can feed functionally without the use of a feeding tube, according to a study published in the latest issue of Cleft Palate-Craniofacial Journal.

Robin sequence is a congenital anomaly in which there is obstruction of the upper airways and a generally U-shaped cleft palate. Glossoptosis is one of the etiological mechanisms responsible for breathing difficulties. An infant with Robin sequence has not only breathing problems, but also feeding difficulties. This results because respiratory obstruction leads to difficulty in the coordination of suction, swallowing, and respiratory function. Glossoptosis also impairs the feeding process, especially in obtaining adequate suction with the tongue.

The feeding difficulties prevent oral feeding, leading to the use of a feeding tube. Prolonged use causes even more problems. The goal of these researchers was to determine the effectiveness of FFTs by promoting the discontinuation of a feeding tube.

Feeding-facilitating techniques include a series of steps: suction of a pacifier, massage to anteriorize and relax the tongue, support for sustaining the mandible, use of a certain type of nipple with its original hole (enlargement of the hole depends on certain criteria), postural change, rhythmic movement of the nipple in the oral cavity during nutritional suction, and positioning of the nipple exactly on the tongue.

The researchers conducted the study with 26 nursing infants, age 3 months or less. Half of the infants, Group 1, had airways that could remain open by placing the infants in the prone position. This group was considered to be the low severity group because those patients showed only mild breathing difficulties. Group 2 had highly severe breathing problems and underwent nasopharyngeal intubation.

Initially, the patients were a highly heterogenous group in terms of volume of milk ingested and the duration of feeding. By the end of the study period, the sample became more homogenous and surpassed the researchers' intended targets of testing. The original goal of the volume of ingested milk was 50 mL. Groups 1 and 2 reached levels above this at 63.46 mL and 55.0 mL, respectively. Also in the area of duration of feeding, both groups beat the target of completed feeding within 30 minutes. Group 1 had a mean time of 21.54 minutes and Group 2, 20.38 minutes.