BACKGROUND:

Children are major consumers in health care. As said by Karl Meninger, “What is done to children, they will do the society.” The pre-term infant’s need special care in nursery until the organ systems has developed enough to sustain life without medical support. Pre-term infants often demonstrate oro motor disco-ordination and are unable to suck and feed orally. So they need external support for his jaw. (Wongs, 2007)

Oral stimulation accelerates the transition from tube to independent oral feeding and its presumed to enhance the maturation of neural systems responsible for oro-rhythmic activity. During entrainment the baby synchronizes her oromotor activity to an externally delivered, patterned orocutaneous stimulus. This process represents a powerful method of achieving neural synchrony among sensorimotor pathways of the orofacial system to drive suck development. (Rohana, 2009)

A study conducted that effect of oral support on sucking efficiency in pre-term infants. Thirteen premature infants between 29 and 31 weeks’ post conceptional age were selected from a group of infants at Children’s Hospital and Medical Centre in Seattle, Washington. They were fed twice within a 26 hour period, once with oral support and once without. This study validates the use of oral support as an effective treatment technique to enhance sucking efficiency in pre-term infants.(Einarsson, 2009)

NEED OF THE STUDY AND LITERATURE REVIEW:

Pre- term infants are a global problem particularly in developing countries. Globally it is estimated that 22 million pre-term infants were born. In India, pre-term infants more prevalent among rural areas compared to 16.4% in urban areas. In Tamilnadu, 24% babies are pre-term. (Beharman, 2008)

Pre-term infants less than 34 weeks of gestation do not have co-ordinate sucking and swallowing movements. Therefore, they are unable to suck at the breast and are liable to get choked. Oral stimulation therapy provide the infant with benefits including improved behavioral control pre and post feed, growth maturation, and gastric motility which decreasing stress and enhancing transition to oral feeds.(Tierra L and Mariely, 2009)

Researcher felt that pre-term infants have poor suck and oro-motor disco-ordination and unable to suck and feed. Oral stimulation can improve their sucking reflex. Therefore, the investigator felt a need to oral stimulation improve the sucking reflex of pre-term infants during hospitalization.

STATEMENT OF PROBLEM:

A study to assess the effectiveness of oral stimulation on improving sucking reflex among pre-term infants in selected hospitals at Kanniyakumari District.

OBJECTIVES:

· To assess pre-test and post-test level of sucking reflex among pre-term infants.

· To find out effectiveness of oral stimulation on improving sucking reflex among pre-term infants.

· To compare pre-test and post-test level of sucking reflex among pre-term infants.

· To associate pre-test level of sucking reflex among pre-term infants with selected demographic variables.

HYPOTHESES:

H1: There is significant improvement in level of sucking reflex among pre-term infants after giving oral stimulation at p <0.05 level.

H2: There is significant association in pre-test level of sucking reflex among pre-term infants after giving oral stimulation with selected demographic variables at p<0.05 level.

RESEARCH METHODOLOGY:

Research Design:

One group pre-test post-test design.

Population :

The population comprised of pre-term infants with gestational age 28-32 weeks who were admitted in selected hospitals.

Sampling technique:

A purposive sampling technique was used to select the samples.

Sample size :

30 pre-term infants at least 7 days in the hospital.

Setting :

NICU of Flemi grace hospital and William hospital was selected.

Tool :

The tool for collection of data for this study includes,

Section A:

Socio demographic variable (5 items)

Section B:

Pre-term infant Breast feeding Behavior scale. It includes readiness to feed, rooting, fixing, sucking pattern.

Validity :

A prepared tool along with the objectives, hypotheses, blue print and criteria checklist was given to expert from the field of child health (Senior pediatric consultant), statistics (1 statistician) & Child health care (5 lectures of child health nursing) for establishing content validity.

Reliability:

The tool was standardized and universally acceptable one. There was no modification done. So the researcher not check reliability.

Procedure for Data Collection:

Written permission was obtained from the administrative authority of the hospital prior to the data collection. A total 30 pre-term infants born with gestational age of 28 to 32 weeks with at least 7 days in hospital were selected for the study. Oral stimulation was explored by fine circular massage on the upper lip and the anterior gum side for ten minutes and the massage was continued towards the lateral gum side and inside the cheeks for five minutes. After the procedure, the researcher assessed the pre-term infants sucking reflex about with pre-term infant breast feeding behavior scale. The data were collected approximately two to three study subjects per day.

FINDINGS:

Section 1 : Socio Demographic Variables:

Findings revealed that majority 16 (53%) pre-term infants in the age group of 5-7 days. With regard to gender, majority 18 (60%) were females and 12(40%) were males. Regarding gestational age, majority 16 (53%) were 28-30 weeks and 14 (46%) were 31-32 weeks. Regarding birth weight of pre-term babies, majority 17 (56%) were 2.1- 2.5kg. Regarding type of delivery, majority 16 (53%) pre-term babies were normal vaginal delivery. Remaining 14(46%) were born by LSCS delivery.

Section II: Frequency and percentage distribution of pre-test and post-test level of sucking reflex among pre-term infants.

Sucking reflex	Pre-test		Post-test
Sucking reflex	F	%	F	%
Effective vigorous sucking	-	-	16	53
Moderately effective feeders	6	20	14	46
Sucking rhythm not established	24	80	-	-

Table 1 shows that before involvement in oral stimulation none of them (0%) were in the category of effective vigorous sucking, 6 (20%) in the category of moderately effective feeders, 24(80%) pre-term infants in the category of sucking rhythm not established. Whereas after involvement in oral stimulation, 16(53%) pre-term infants in the category of effective vigorous sucking, 14 (46%) were in the category of moderately effective feeders and none of them were in the category of sucking rhythm not established.

SECTION III : Computation of Mean percentage, SD and ‘t’ value between pre-test and post- test scores of sucking reflex among pre-term infants.

Level of sucking reflex		Mean	S.D	Mean Diff.	‘t’ value
Pre- test		5.23	0.22	5.33	3.72 S
	Post- test	10.56	0.4	5.33

Data in table 2 depicits mean pre test score was 5.23 and post test score was 10.53, the computed t value was 3.72 which was found to be significant at level p<0.05.

SECTION IV: Association of post-test level of sucking reflex among pre-term infants and their demographic variables:

Chi Square test was carried out to find out association between age, gender, gestational age, birth weight, type of delivery and sucking reflex of pre-term infants.

The calculated chi-square value was 1.132, 1.831, 0.163, 0.072, 0.163 respectively which showed that there was association between demographic variables of pre-term infants and sucking reflex at p<0.05 level.

DISCUSSION:

Effectiveness of Oral stimulation on improving sucking reflex among pre-term infants:

The findings of the present study revealed that mean post-test level of sucking reflex score 10.56 was higher than mean pre-test level of sucking reflex score 5.23 of pre-term infants. Calculated mean difference was 5.33 and SD was 0.22, computed value (t=3.72) was highly significant at p<0.05 level. Thus there is a significant improvement in sucking reflex among pre-term infants after applying oral stimulation.

Similar findings were obtained in a study conducted by Bragelian and Markestad (2009) on effects of oral stimulation improve the suck pattern of pre-term infants. Pre-term infants were randomized to receive one daily session of stimulation according to no intervention other than standard nursing care. In 36 infants, 18 received stimulation and 18 were observed without intervention. Mean gestational age at birth was 31.2 weeks (SD 2.4) versus 31.4 (2.3) weeks, p=0.27. Results showed that the stimulation program enhance the feeding performance of pre-term infants.

Thus the hypotheses H1 made by the researcher that there was a significant improvement in sucking reflex after applying oral stimulation was accepted.

CONCLUSION:

Orocutaneous stimulation techniques designed to entrain the suck central pattern in pre-term infants. Application of oromotor entrainment therapy is correlated to the rapid organization of suck in pre-term infants. This process represents a powerful method of achieving neural synchrony among sensori motor pathways of the orofacial system to drive suck development.

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Received on 05.10.2020 Modified on 11.11.2020

Asian J. Nursing Education and Research. 2021; 11(1):25-27.

DOI: 10.5958/2349-2996.2021.00007.0