| 제목 |
Uncoordinated sucking pattern in premature infants is associated with development at 2 years of age |
| 소속 |
Seoul National University Hospital, Department of Rehabilitation Medicine1, National Traffic Injury Rehabilitation Hospital, Department of Rehabilitation Medicine2 |
| 저자 |
You Gyoung Yi1,2*, Hyung-Ik Shin1†, Byung-Mo Oh1, Hee Soo Kim1 |
Background
It has been reported that uncoordinated sucking patterns in preterm infants are associated with abnormal fidgety movements at 14 weeks postterm. However, the association of uncoordinated sucking pattern with long term motor developmental outcomes has not yet been investigated. We focused on investigating whether uncoordinated sucking pattern during bottle-feeding in premature infants is associated with the motor developmental outcomes at 18-24 months of corrected age.
Methods
We reviewed the video recordings for the Neonatal Oral-Motor Assessment Scale (NOMAS) and medical records of pre-term infants born before 32 weeks gestational age. We included infants with disorganized sucking pattern according to the NOMAS at the time of oral feeding initiation and divided them into two groups based on the presence or absence of uncoordinated sucking patterns. The Bayley-III motor composite scores of the incoordination-positive and incoordination-negative group were compared at 18-24 months of corrected age. We then used a multiple linear regression analysis to analyze which predictors contributed independently to the motor development at 18-24 months of corrected age.
Results
A total of ninety-six premature infants exhibited a disorganized sucking pattern according to the NOMAS. Among them, 35 infants showed uncoordinated sucking pattern. The post-menstrual age at the NOMAS evaluation was 34.9 ± 3.0 weeks and 34.6 ± 1.3 weeks for the incoordination-positive (n=35) and incoordination-negative groups (n=61), respectively (p=0.571). The average Bayley-III motor composite scores at 18-24 months of corrected age were lower in incoordination-positive group (90.1 ± 15.3) than that of incoordination-negative group (99.2 ± 8.6) (p=0.002, Figure 1). Among continuous variables, birth weight, gestational age, and Apgar score at 5 minute correlated with Bayley-III motor composite score at 18-24 months of age. Among categorical variables, history of respiratory distress syndrome, moderate to severe bronchopulmonary dysplasia, sepsis, uncoordinated sucking pattern, and grade 3 or 4 germinal matrix hemorrhage–intraventricular hemorrhage were associated with low Bayley-III motor composite score at 18-24 months of age (Table 1). A multiple linear regression analysis indicated that the presence of uncoordinated sucking pattern, grade 3 or 4 germinal matrix hemorrhage–intraventricular hemorrhage, and moderate to severe bronchopulmonary dysplasia were independently associated with motor development at 18-24 months of corrected age (Table 2).
Conclusions
Uncoordinated sucking pattern in premature infants is associated with developmental delay in the motor development at 18-24 months of corrected age. There may be a need for periodic follow-up and early intervention for developmental delay when incoordination of sucking, swallowing, and respiration that results in stress signals on the NOMAS is observed at the time of oral feeding initiation.
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Figure 1. Bayley-III motor composite score at 18-24 months of age (corrected for prematurity) according to the presence of uncoordinated sucking pattern on the Neonatal Oral-Motor Assessment Scale.
Table 1. Bayley-III motor composite score at 18-24 months of corrected age according to baseline characteristics of the premature infants (n=96).
Table 2. Multiple linear regression analysis: Bayley-III motor composite score at 18-24 months of corrected age (R square=0.522, R=0.273)
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