Oral and non-oral sensorimotor stimulation in preterm infants: bibliographic review

Abstracts

Prematurity is very common in children's hospital environment. Performing speech therapy in hospitals attending preterm neonates has becomingan essential proposal to detect deglutition-related disorders, providing resources to neonates which use alternative via of feeding, due to their organic immaturity. Techniques for oral sensorimotor system maturation have been explored, so the preterm neonate develops the transition to a full oral feeding safer and in shorter time. The aim of this study is to carry out a systematic review of national and international literature reporting different techniques and elucidate about their effectiveness, regarding the oral sensorimotor system maturation of preterm neonates that remained in hospitalized. According to literature, the most current technique used in Brazil is the non-nutritive sucking in gloved finger or orthodontic pacifier. Other countries recorded the technique of non-nutritivesucking in pacifiers followed by oral sensorimotor stimulation as the most current approaching. Both techniques have been positively reflecting on neonates' oral function development. Regarding the need of exclusive breastfeeding promotion, recent publications highlighted a concerning percentage of synthetic nipples usage for stimulation in neonatal intensive care units.

Infant, Newborn; Infant, Premature; Feeding; Deglutition Disorders; Intensive Care, Neonatal; Breast Feeding

A prematuridade é um dos fatores mais incidentes no ambiente hospitalar infantil. O trabalho fonoaudiológico realizado em hospitais com foco no recém-nascido prematuro tem conquistado cada vez mais espaço e apresenta como proposta principal a detecção de problemas relacionados à deglutição, proporcionando recurso aos neonatos que fazem uso de via alternativa de alimentação, devido à imaturidade orgânica. O uso de técnicas para maturação do sistema sensório-motor-oral vem sendo explorado a fim de que o recém-nascido pré-termo realize transição, mais segura e em menor tempo, para alimentação plena por via oral. O objetivo deste estudo é realizar revisão sistemática da literatura nacional e internacional a fim de elencar diferentes técnicas e elucidar sobre a eficácia das mesmas, quanto à maturação do sistema sensório-motor-oral em neonatos prematuros que permanecem em ambiente hospitalar. Segundo a literatura, a técnica mais utilizada no Brasil é a sucção não nutritiva com dedo mínimo enluvado ou chupeta ortodôntica. Em outros países, as técnicas mais citadas foram a sucção não nutritiva com chupeta seguida da estimulação do sistema sensório-motor-oral. Tanto as técnicas utilizadas no Brasil quanto no exterior têm refletido positivamente no desenvolvimento das funções orais de neonatos. Levando em conta a necessidade de promoção do aleitamento materno exclusivo, publicações recentes evidenciaram alarmante e preocupante percentual de uso de bicos sintéticos para estimulação em unidades de terapia intensiva neonatal.

Recém-Nascido; Prematuro; Alimentação; Transtornos da Deglutição; Terapia Intensiva Neonatal; Aleitamento Materno

Introduction

Speech therapy performed in hospitals focusing newborns under risk has reaching more space. It aims to detect problems and propose solutions to neonates presenting difficulties with oral feeding (OF), due to their organic immaturity¹.

The speech pathology therapist is part of the minimum team of professionals working with newborns under risk in Neonatal Intensive Care Units (NICU). Their participation is determined by the Ministry of Health under regulation n^o 930,in force since May 10^thof 2012². The professionals evaluates newborns that do not coordinate sucking, swallowing and breathing (SSB), lethargic neonates with weak sucking, apnea, declining saturation levels while feeding, gastroesophageal reflux episodes, coughing while or after swallowing and those who are on gastric tube³.

Prematurity is one of the main factors that provoke neonatal complications, because retains newborn's (NB) natural development. Besides, the preterm infant is inclinedto other future complications, as cognitive function development compromising⁴.

According to World Health Organization (WHO), the preterm newborn (PTNB) or premature is the one that was born before the 37^th gestational week. The classification for those neonates is based on the gestational age (GA),birth weight, on the relation weight and GA and also corrected gestational age (CGA). These data are used on the evaluation of baby's size and development after the 40^th week⁵.

The intrauterine fetal growing is fast and the organs are constantly through cellular division necessary to complete development, therefore the prematurity or interruption of the proper gestational time exposes the NB to factors that compromise their pulmonary maturation, the oral sensorimotor system (OSS) and the thermoregulatory function, in addition to restrict the nutritive reserve of fat due to anatomic-physiologic issues⁵.

Other authors complement that deficiency of organic maturity causes incoordination in sucking, swallowing and breathing (SSB) and submit the PTNB less than 34 gestational weeks to the use gastric tube as feeding alternative. This invasive procedure is necessary, but retain the infant of receive sensorial stimuli important for OSS development¹.

The speech therapy in NICU is based on the stimulation of the stomatognathic system to fit oral functions, aiming to enable NB, as soon as possible,to be fed orally and to be placed in maternal breast¹. The early stimulation of these functions on PTNB presents satisfactory results globally⁶.

Knowing the techniques used in children's hospital and also of the impact in child's life is essential to promote exclusive breastfeeding, contributing not only to early discharge of the preterm neonate, but also to a proper alimentation, safe and effective.

Regarding the speech pathology therapy, this article aims to develop the systematic review of national and international literature in order to stablish different techniques of OSS maturation and discuss about their effectiveness in preterm neonates that remain in hospital environment.

Methods

It is a systematic review of national and international literature. In September of 2013 were selected articles published in journals indexed on the basis "Latin-American and Caribbean Center on Health Sciences Information" (LILACS), "Scientific Electronic Library" (SciELO) and "Medical Literature Analysis and Retrieval System Online" (MEDLINE).

Afterconsulting Health Science Descriptors (DECs), it was selected the keywords: newborn, oral stimulation and feeding. The descriptors were inserted isolated and combined in all possible manners, respecting the restrictors: humans, newborns and publication language, Portuguese or English.

Two researchers read the texts and it was selected only articles that emphasize techniques applied in neonatal hospital environment with preterm newborns, published among 2006 and 2013.

Data were analyzed qualitatively andquantitatively. The qualitative analysis was made by disposing the results in the following categories: techniques used in Brazil; techniques used in other countries; techniques consider being effective; techniques consider being not effective or not statistically significant. The classification regarding the effectiveness of the techniques was justified in the conclusion of the publications analyzed.

The quantitative analysis was based on obtaining the absolute and relative frequency (percentage) of the results classified on the categories above cited.

It was disqualified articles published out of the period proposed, repeated articles, not availableonline or that did not attend the research objectives.

Literature Review

General View

First, it was found 47 articles, though, only 17 fulfilled the inclusion criteria and they were analyzed (Figure 1).

Figure 1:
Research Strategy and Publications Selection

The majority of the studies, both conducted in national and international scope, had their sample constituted from the subjects with prematurity, absence of head and neckmalformation, genetic syndromes, intracranial hemorrhage level III and IV, perinatal asphyxia,bilirubin encephalopathy, sepsis, severe bronchodysplasia, periventricular Leucomalácia and necrotizing enterocolitis.

Among national articles it was evident the practice of non-nutritive sucking (NNS) with gloved finger as main technique applied in NICUs. Also, the NNS using synthetics nipples and the nutritive sucking (NS) with bottle presented to be an alternative to oral stimulation and feeding. Those interventions were cited as the most applied and the NNS in empty breast and the NS in maternal breast are the techniques less referred by authors (Table1).

Table 1:
National Journals Citation of techniques performed with preterm newborns in neonatal therapy cares (2006-2013)

• Legend: NNS=Non-nutritive suction; NS=Nutritive Suction.

The international articles mentioned the NNS technique with synthetic nipple and the oral sensorimotor stimulation as the most present in the stimulation of preterm neonates. The NNS with synthetic nipple also was performed with new technologic device, a pressured electronic pacifier named NTrainer(r) (Table 2).

Table 2:
International Journals Citation of techniques performed with preterm newborns in neonatal therapy cares(2006-2013)

• Legend: NNS=Non-nutritive suction; NS=Nutritive Suction.

Contrary to Brazil the NSS in gloved finger was less cited by international authors. The natural feeding or techniques similar to this practice was not described in the international articles analyzed.

Although there are differences on the described interventions in national and international articles, all the studies emphasized that techniques closer to natural feeding are rarely used with preterm neonates.

Most of the analyzed studies agreed that the oral stimulation in PTNB provides the acceleration in the maturation of oral functions and, therefore, decreasehospitalization time (Table 3).

Table 3:
Efficacy of combined techniques for maturation of the oral sensorimotor system applied in preterm neonates, according bibliographic review (2006-2013)

• Legend: E=Effective; NE= Noteffective or not significant; NNS=Non-nutritive suction; NS=Nutritive Suction.

The effectiveness of the techniques applied was quantified in Table 4. The NNS with gloved finger once more is presented as ahead the other techniques, characterizing the benefits for OSS maturation in PTNB. Few authors relate the improvement on the PTNB oral pattern exclusively to natural development process, which suggest the importance of speech therapy intervention on these babies.

Table 4:
Number of publications evaluating the efficacy of the techniques for maturation of the oral sensorimotor system, according to the conclusion of the authors studied.

• Legend: NNS=Non-nutritive suction; NS=Nutritive Suction.

National View

The literature describe the NNS stimulation as benefic since it fits the oral muscles, contributes to NB's weight gain, stables the awareness states and simplify the digesting process, enabling to anticipate the transition of feeding tube to OF⁷.

The speech therapy intervention on babies under risk is initiated usually by NNS to evaluate and stimulate sucking. The technique also has the objective of observe the rhythm, strength and the number of bursts accomplished by babies⁸.

The NNS is normally performed using the little finger gloved. This technique is described as effective to promote NB oral reflexesmaturation, providing proper coordination on sucking, swallowing and breathing³. The NNS also helps the cerebral oxygenation, soothes and improve the organization of preterm babies⁶.

The literature review highlighted that NNS in little finger gloved associated to intra oral manipulationaccelerates the transition of tube to oral via, without compromise the weight gain in preterm newborns. To verify the effectiveness of this intervention on PTNB is necessary sensible observations of breathing and heart frequency, time between tube and complete oral feeding and weight gain.

The intervention enhanced neonates maturation process and muscles coordination used in sucking^{9 , 10}. The NNS in gloved little finger and oral motor stimulation of OSS enhance the responses of oral reflexes, the NS pattern and the benefits of oral diet, contributing to exclusive breastfeeding¹¹.

Pimenta et al. ¹² used NNS technique in little finger gloved to evaluation and stimulation of 98 PTNB of very low weight and concludedthere was significant benefits to those NB.

Rocha and Delgado¹³ discussed the oral-tactile stimulation in PTNB suffering of gastroschisis (gastric pathology) associated to prematurity. Authors concluded the NNS in finger associated gloved to non-oral stimulation provided adequacy of the stomatognathic system and contributed to promoting breastfeeding.

Delgado¹⁴ reports positive results for the transition of gastric to OF by stimulation the PTNB stomatognathic system presenting genetic syndromes (Popliteal Pterygium Syndrome). The results were not attributed specifically to the technique of NNS with little fingergloved, but to the association to orthodontic pacifier and bottle sucking.

Costa et al. ¹⁵ investigated the impact of oral-tactile stimulation associated to oral and non-oral manipulation on heart and breathing frequencies, transference index (value obtained from dividing the ingested volume by the prescribed volume in milliliters), time on the transition gastric feeding to exclusive oral feeding and PTNB weight gain; the conclusion was among the 13 stimulated infants and the 15 of control group there were no statistically significant differences.

Bonifácio¹⁶ also cited the NNS in gloved finger or the oral-tactile stimulation associated to oral and non-oral manipulationas promoting the coordination of the SSB, not compromising the behavioral state of babies and contributing to a better neurological organization.

It is preconized to perform the oral and non-oral stimulation before the NB feeding time and the sucking stimulation occurs during gastric feeding so the baby associates satiation to the sucking act. Some authors^{6 , 12 , 13} defend the usage of gloved finger and orthodontic pacifier in this interventions.

Delgado et al. ¹⁴ used the NNS technique with little finger gloved only to evaluate the PTNB pattern of sucking. Focusing the development of the OSS they choose to use orthodontic nipples as main stimulation resource. Therefore, the success of intervention was associated to the use of artificial nipple and no to oral-tactile stimulation.

The impact of the pacifier on the PTNB's life during the hospitalization period and also after discharge has been focus of several discussions about the benefit and malefaction of using the artificial nipple in this kind of stimulation.

By the sample of the publications analyzed, it was possible to observe that many professionals use the pacifier as NNS technique in preterm neonates.

Pimenta et al. ¹² report that the PTNB of very low weight can be beneficiated by NNS with gloved finger and synthetic nipple, proved by the improvement in sucking process, development in OSS and hospital discharge with breastfeeding allowed. The authors observed shorter time SSB in newborns submitted to pacifier sucking during gastric feeding.

It is important to say that the NNS stimulation with pacifiers should follow specific criteria. The majority of the articles refer to the specific pacifier for preterm of the brand Nuk^(r), as ideal to stimulation.

Neiva and Leone¹⁷ inferred that thesucking of pacifiers with such specifications may contribute to the lip closure, tongue central groove formation and coordination among SSB, important aspects to early OF diet and hospital discharge.

In a different study Neiva and Leone¹⁸ suggest that the evolution post-birth of the sucking rhythm is mainly attributed to the maturation process, that is, although the benefits highlighted about the sucking stimulation with orthodontic nipple, the improvement occurs due to the corrected gestational age.

In consonance to the studies defending the use of pacifier as an effective oral motor stimulus, Volkmer¹⁹ reinforce the use as stimulus source, in order to maintain the PTNB in alert, what can be associated to a better feeding and greater behavioral organization. Besides, he affirms the NNS stimulation with pacifier do not provoke alteration on breathing patterns, which is essential for these babies, that since very early need to be submitted to oxygen therapy and the use of surfactants.

The pacifier is an instrument much used for NNS stimulation, however, it is preconized the used of gloved finger and cup so the newborn do not make confusion with synthetic and maternal nipples³. Studies show that the synthetic nipples sucking is frequently associated to the early weaning^{20 , 21}. Unfortunately, according to Venson et al. ²², oral-tactile stimulation has been a technique hardly used.

The technique of the empty breast NNS is an alternative so the PTNB do not make confusion with nipples and the breastfeeding isencourage. At the same time it stimulates the NNS, is safe to the baby that does not coordinate the SSB and stablishes an affective bound between mother and son²³.

It is known that inadequate use of pacifier causes damages on speak development, since it reduces the babbling, sound imitation and words evoke. Castilho and Rocha²⁴ add that, regarding the stomatognathic system, this NNS modifies the tongue mobility and its rest position in oral cavity, making it difficult the swallowing and also chewing. The tongue anteriorization modifies the intra oral pressure resulting in teeth protusion collaborating to oral breathing in the future The PTNB who use pacifier during stimulation period is predispose to the addiction of this type of NNS and susceptible to the alteration mentioned above through childhood²⁴.

It is recommended to offer OF to the PTNB when presenting favorable conditions as proper sucking, SSB coordination and proper gastric feeding weaning. The NS in bottle or maternal breast is also an option to feeding and stimulates the PTNB. The natural stimulation in maternal breast is preferred to bottle feeding, since it provides the perioral muscles exercise for proper development of the stomatognathic system, satisfies baby emotionally narrowing the bound between mother and son and anticipates hospital discharge²⁵.

A study conducted with PTNB suffering from popliteal pterygium syndrome which also causes craniofacial anomalies presented improvement on oral patterns after speech therapy intervention. The transition from gastric feeding to OF was developed with NS in bottle. Results presented mouth opening normalization, adequacy of biting and gag reflexes, increasing in the number of strong sucking and proper coordination, breathing stability and completely OF diet. Is important to say that in this study, it was developed the NNS stimulation before offering the OF diet, which contributed essentially on results¹⁴.

Delgado¹⁴ suggests when, besides prematurity, the baby carries any pathology that difficult or make impossible the positioning in maternal breast, the techniques can be adapted, regarding the characteristics of every newborn. It is emphasized that breastfeeding should be priority since it is essential for baby in this phase.

In according, Pedras et al. ²⁶ emphasize that breast milk is essential for neonates, because it feeds fully, the sucking movements provide craniofacial development, enhancing breathing-chewing-swallowing and speaking functions. Also contributing to affective bound between mother and baby, reduces costs and overall, results on decreasing the infant morbi-mortality index²⁶.

Concerning the effective breastfeeding, the NS in bottle used in NICU can be applied as favorable technique, when developed properly²³. According to Medeiros and Bernardi²¹, the bottle can be used to verify the presence or absence of sucking, but does not contribute to the OSS maturation in PTNB. Some authors^{17 , 27} believe that the OSS maturation and the early hospital discharge also are results of the GAC advance. Therefore, it is questionable for these authors if the bottle use brings any benefits during the hospitalization period of these babies.

Neiva²⁸ enounce that using the bottle can put the NB life in risk, since the nipples have bigger flow of milk and can cause chocking. Besides, synthetic nipples contribute to an early weaning and therefore, is directed connected to noxious habits that influence negatively chewing, swallowing, breathing and phoneme articulation²⁸.

World Health Organization, aiming to promote exclusive breastfeeding and following "ten steps to succeed in breastfeeding" includes the use of cup in this issue.

It is an alternative method for OF inmother's absence, so the NB does not confuse the bottle and the maternalnipple²⁶

In addition, the cup is described as a technique that helps babies there are in transitory phase from gastric feeding to OF in maternal breast and also as a evaluative tool of SSB on PTNBs^{11 , 23}.

In an anatomy-physiologic view, the use of cups is not the proper method for NB feeding. Although, according to Almeida and Modes³, it is an alternative to avoid using bottles and providingmothers confidenceto follow the exclusive breastfeeding.

Another option to avoid synthetic nipples, inside children's hospital, is NS using finger tube. Calado and Souza¹¹quote that this technique can be applied to evaluation of the sucking, swallowing and coordination reflexes among SSB. The study was based on the amount of diet ingested by NB and it was proved enhancing on oral reflexes and NNS patterns, presenting better use of the OF diet.

According to Almeida and Modes³,the finger tube technique can be indicated to newborns that did not receive the diet in cup, that need longer hospitalization time or presented neurologic complications. For this technique is necessary to use gastric tube (number six) attached to little finger gloved and placed inside a cup of milk. It aims to provide the exercise of orofacial muscles, promoting the sucking pattern maturation³.

Fujinaga et al. ²⁹ reported that the finger tube technique can be applied with the gastric tube connected to a syringe with plunger and attached to little finger gloved. According to authors, this technique should help to fitting the sucking patternof PTNB or on term NB who presented oral disorders. Human milk should always be priority during offering, so the technique becomes closer to natural feeding²⁹.

International View

The techniques more evident in international scope followed, in general, a combination of procedures of oral motor stimulation associated to tactile-kinesthetic stimulation.

Fucile et al. ³⁰ developed an experimental study with 75 PTNB, based on speech intervention with stimulation techniques of OSS and body tactile-kinesthetic stimulation. The OSS stimulation consisted in caress cheeks, lips, gums and tongue, while the tactile stimulation was developed by touching head, neck, arms and legs. The results showedthat groups which received both isolated and combined stimulation presented enhancing in SSB coordination and anticipated the transition of tube feeding diet to OF.

Another study was conducted by these authors using the same techniques and the same sample, specifying the NNS using pacifier. This research indicated a positive result of tactile-kinesthetic stimulation on the OSS pattern of the PTNB. Results showed that the isolated practice of the techniques provide positive effects, however, only the combination between them is indeed satisfactory³¹.

Boirion et al. ³²leda trial with 43 PTNB. The newborns were divided in three groups, one group using oral sensorimotor stimulation, the other stimulation and oral support, and the third group only oral support - considered by authors as control group. For oral support, the therapist with the left hand supported one side of the NB's cheek toward lip. With the other hand pushed the other side of the cheek with third finger. While the little finger gave support to mandible under chin, the other fingers supported the bottle. The stimulation was described as cheeks, lips and tongue manipulations, NNS in gloved finger to motivate sucking and swallowing reflexes and NS in bottle. The therapist should make regular pauses, placing the bottle nipple in the corner of the neonate's mouth, this way was observed better SSB control.

It was used the pressured pacifier to collect information about neonate's sucking rhythm. This pacifier was connected to pressure amplifier device, sending information about sucking pattern to a computer,for further analysis. The research concluded that oral stimulation increased salivation and made the swallowing process easier. The study focused on NS techniques in bottle associated to oral support and the results verified that oral support had apositive influence on feeding routine and sucking patterns of the studied population³².

Hwang et al. ³³ proposed the effectiveness of transition from tube to OFdiet, under intervention with perioral and intra oral motor stimulation in 90 preterm babies. It was offered the pacifier as NNS stimuli. Both stimulated PTNB and control group did not presented performance statistically significant, but regarding the NNS work, the stimulated group presented greater number of sucking than control group.

The technology also is a great allied of PTNB interventions. Pooreet al. ³⁴ and Barlow et al. ³⁵ developed trials in order to evaluate the effectiveness of NNS with electronic pacifier (pressured) named NTrainer(r) in PTNB.

According to authors, the NTrainer(r) is a biomedical device which develop the function of a NNS synthetic, in which pulsing stimulus are sent to pacifier (as a pulsing nipple) attached to an electronic device. This device promotes sucking stimuli and captures information about rhythm, number of pauses and blurts and sends information for computer analysis.

Poore et al. ³⁴and Barlow et al. ³⁵ developed a trial and cohort research, respectively, both with 31 PTNB sample, using NTrainer(r)as oral motor intervention. The results were satisfactory, since the stimulation was associated to the acceleration of the sucking process, the increasing in the number of blurts, to the enhancing of the oral dynamic system and early hospital discharge.

The authors suggest that this type of resource contributed to oral sensorimotor development of the PTNB that presented weak sucking. They described that the resource reflects in the increase of cerebral skills, organization of the oral dynamic system and non-nutritive pattern (skills that is initial to the complexity that involves oral feeding and the success of other skills as chewing and speaking). The fast advent of NNS in children submitted to NTrainer(r)therapyaccelerated the transition to OF diet^{34 , 35}. Similar NTrainer(r)technology was not reported in any national article analyzed.

Four articles^{30 , 33 - 35} out pf the six international studies analyzed, used the pacifier as resource for the non-nutritive sucking stimulation. Two articles^{31 , 32} used the non-nutritive sucking in gloved finger. None of the studies used non-nutritive sucking in empty breast or nutritive sucking in finger tube.

Boiron et al. ³² used bottle in nutritive sucking, but did not use synthetic nipple to non-nutritive sucking.

It was applied the NNS stimulation in little finger gloved in less than half of the international articles analyzed, thatisdisagreeing compare to Brazilian findings, in which there is priority to practice this technique.

Final Considerations

The analyzed sample of national articles attested the non-nutritive sucking technique with the little finger gloved as the most current practice in neonatal intensive care units, followed by the non-nutritive sucking with pacifier. Both techniques presented to be effective in the OSMS maturation process, providing an early the hospital discharge of the preterm newborns.

The sample of international articles showed that the practice of the non-nutritive sucking technique associated to body and oral and non-oral manipulation reflect positively on neonates' development of the oral function. Further, it brings further knowledge about technologies aiming to improve the sucking patterns in preterm newborns.

Breastfeed should be promoted on children hospital environment and the techniques of NNS and NS performed in PTNB may contribute to the success of breastfeed or provoke an early weaning process, when occurs the use of synthetic nipples.

New studies should be developed focusing the impacts of NNS with orthodontic pacifier and NS in bottle during the lactation process. There is a necessity of systematic and scientific data about the benefits or malefaction of these instruments during the period of PTNB hospitalization and after hospital discharge.

• ¹
  Prade SR. Recém-nascidos pré-termo: critérios para a introdução da alimentação por via oral [Dissertação]. Santa Maria (RS): Universidade Federal de Santa Maria; 2006.
• ²
  Brasil. Ministério da Saúde. Define as diretrizes e objetivos para a organização da atenção integral e humanizada ao recém-nascido grave ou potencialmente grave e os critérios de classificação e habilitação de leitos de Unidade Neonatal no âmbito do Sistema Único de Saúde (SUS). Portaria n.930, 10 maio 2012. Diário Oficial da União; 2012.
• ³
  Almeida EC, Modes LC. Leitura do prontuário: avaliação e conduta fonoaudiólogica com recém-nato de risco. Rio de Janeiro: Revinter; 2005.
• ⁴
  Zuanetti PA, Fukuda MTH. Aspectos perinatais, cognitivos e sociais e suas relações com as dificuldades de Aprendizagem. Rev CEFAC. 2012;14(6):1047-56.
• ⁵
  Macedo FH. Recém-nascido pré-termo: limites da intervenção fonoaudiológica. [Monografia na Internet]. São Paulo (São Paulo):Centro de Especialização em Fonoaudiologia Clínica; 1998 [acesso em 2013 jul 17]. Disponível em: http://www.cefac.br/library/teses/5f20e3736d19de32fb8473629bf5c5b8.pdf.
  » http://www.cefac.br/library/teses/5f20e3736d19de32fb8473629bf5c5b8.pdf
• ⁶
  Piazza FB. O trabalho da fonoaudiologia hospitalar em UTI neonatal [Monografia na Internet]. Curitiba (PR): Centro de Especialização em Fonoaudiologia Clínica; 1999 [acesso em 2013 out 19]. Disponível em: http://www.cefac.br/library/teses/d555217e5bc712c7723b0fa257d9e975.pdf.
  » http://www.cefac.br/library/teses/d555217e5bc712c7723b0fa257d9e975.pdf
• ⁷
  Caetano LC, Fujinaga CI, Scochi CGS. Sucção não nutritiva em bebês prematuros: estudo bibliográfico. Rev Latino-Am Enfermagem. 2003;11(2):232-6.
• ⁸
  Moura LTL, Tolentino GM, Costa TLS, Aline A. Atuação fonoaudiológica na estimulação precoce da sucção não-nutritiva em recém-nascidos pré-termo. Rev CEFAC. 2009;11(Suppl 3):448-56.
• ⁹
  Bauer MA, Yamamoto RCC, Weinmann ARM, Keske-Soares M. Avaliação da estimulação sensório-motora-oral na transição da alimentação enteral para a via oral plena em recém-nascidos pré-termo. Rev Bras Saude Mater Infant. 2009;9(4):429-34.
• ¹⁰
  Yamamoto RCC, Bauer MA, Häeffner LSB, Weinmann ARM, Keske-Soares M . Os efeitos da estimulação sensório-motora-oral na sucção nutritiva na mamadeira de recém-nascidos pré-termo. Rev CEFAC. 2010;12(2):272-9.
• ¹¹
  Calado DFB, Souza R. Intervenção fonoaudiológica em recém-nascido pré-termo: estimulação oromotora e sucção não-nutritiva. Rev CEFAC. 2012;14(1):176-81.
• ¹²
  Pimenta HP, Moreira MEL, Rocha AD, Gomes Junior SC, Pinto LW, Lucena SL. Efeitos da sucção não-nutritiva e da estimulação oral nas taxas de amamentação em recém-nascidos pré-termo de muito baixo peso ao nascer: um ensaio clínico randomizado. J Pediatr. 2008;84(5):423-7.
• ¹³
  Rocha MS, Delgado SE. Intervenção fonoaudiológica em recém-nascido pré-termo com gastrosquise. Rev Soc Bras Fonoaudiol. 2007;12(1):55-62.
• ¹⁴
  Delgado SE . Atuação fonoaudiológica na unidade de terapia intensiva em bebê com síndrome de pterígeo poplíteo. Rev Soc Bras Fonoaudiol 2009;14(1):123-8.
• ¹⁵
  Costa PP, Ruedell AM, Weinmann ARM, Keske-Soares M . Influência da estimulação sensório-motora-oral em recém-nascidos pré-termo. Rev CEFAC. 2011;13(4):599-606.
• ¹⁶
  Bonifácio T. Atuação Fonoaudiológica com bebê prematuro: estimulação sensório-motora-oral [Monografia na Internet]. São Paulo (SP): Centro de Especialização em Fonoaudiologia Clínica; 1999 [acesso em 2013 set 11]. Disponível em: http://www.cefac.br/library/teses/a9e11e10ba75e134d3e55d717c1e1fe5.pdf.
  » http://www.cefac.br/library/teses/a9e11e10ba75e134d3e55d717c1e1fe5.pdf
• ¹⁷
  Neiva FCB, Leone CR. Sucção em recém-nascidos pré-termo e estimulação da sucção. Pró-Fono R Atual Cient. 2006;18(2):141-50.
• ¹⁸
  Neiva FCB, Leone CR . Evolução do ritmo de sucção e influência da estimulação em prematuros. Pró-Fono R Atual Cient. 2007;19(3):241-8.
• ¹⁹
  Volkmer ASF. O efeito do uso da sucção não nutritiva com chupeta na apneia da prematuridade [Tese]. Porto Alegre (RS): Faculdade de Medicina da Pontifícia Universidade Católica de Porto Alegre; 2011.
• ²⁰
  Lamounier JA. O efeito de bicos e chupetas no aleitamento materno. J Pedriatr. 2003 ;79(4):284-6.
• ²¹
  Pedras CTPA, Pinto EALC, Mezzacappa MA. Uso do copo e da mamadeira e o aleitamento materno em recém-nascidos prematuros e a termo: uma revisão sistemática. Rev Bras Saude Mater Infant. 2008;8(2):163-9.
• ²²
  Venson C, Fujinaga CI, Czluniak GR. Estimulação da sucção não nutritiva na "mama vazia" em bebês prematuros: relato de casos. Rev Soc Bras Fonoaudiol. 2010;15(3):452-7.
• ²³
  Medeiros AMC, Bernardi AT. Alimentação do recém-nascido pré-termo: aleitamento materno, copo e mamadeira. Rev Soc Bras Fonoaudiol. 2011;16(1):73-9.
• ²⁴
  Castilho SD, Rocha MAM. Uso de chupeta: história e visão multidisciplinar. J Pediatr. 2009;85(6):480-9.
• ²⁵
  Costa CN, Lima GRS, Jorge RM, Malta RACG, Nemr K. Efetividade da intervenção fonoaudiológica no tempo de alta hospitalar do recém-nascido pré-termo. Rev CEFAC. 2007;9(1):72-8.
• ²⁶
  Pedras CTPA, Pinto EALC, Mezzacappa MA . Uso do copo e da mamadeira e o aleitamento materno em recém-nascidos prematuros e a termo: uma revisão sistemática. Rev Bras Saude Mater Infant. 2008;8(2):163-9.
• ²⁷
  Yamamoto RCC, Keske-Soares M, Weinmann ARM . Características da sucção nutritiva na liberação da via oral em recém-nascidos pré-termo de diferentes idades gestacionais. Rev Soc Bras Fonoaudiol. 2009;14(1):98-105.
• ²⁸
  Neiva FCB . Crescimento e desenvolvimento estomatognático. In. Issler H. O aleitamento materno no contexto atual: políticas, prática e bases científicas. São Paulo: Sarvier; 2008. P.238-40.
• ²⁹
  Fujinaga CI, Duca AP, Petroni RACL, Rosa CH. Indicações e uso da técnica "sonda-dedo". Rev CEFAC. 2012;14(4):721-4.
• ³⁰
  Fucile S, Gisel EG, Mcfarland DH, Lau C. Oral and non-oral sensoriomotor interventions enhance oral feeding performance in preterm infants. Dev Med Child Neurol. 2011;53(9):829-35.
• ³¹
  Fucile S, Gisel EG, Mcfarland DH, Lau C . Oral and nonoral sensorimotor interventions facilitate suck-swallow-respiration functions and their coordination in preterm infants. Early Hum Dev. 2012;88:345-50.
• ³²
  Boiron M, Nobrega LD Nobrega, Roux S, Henrot A, Saliba E. Effects of oral stimulation and oral support on non-nutritive sucking and feeding performance in preterm infants. Dev Med Child Neurol. 2007;49:439-44.
• ³³
  Hwang Y, Vergara E, Lin C, Coster WJ, Bigsby R, Tsai W. Effects of prefeeding oral stimulation on feeding performance of preterm infants. Indian J Pediatr. 2010; 77(8):869-73.
• ³⁴
  Poore M, Zimmerman E, Barlow SM, Wang J, Gu F. Patterned ococutaneous therapy improves sucking an oral feeding in preterm infants. Acta Pediatr. 2008;97(7):920-7.
• ³⁵
  Barlow SN, Finan DS, Lee J, Chu S. Synthetic orocutaneous stimulation entrains preterm infants with feeding difficulties to suck. J Perinatol. 2008;28:541-8.

Publication Dates

• Publication in this collection
  June 2015

History

• Received
  23 Apr 2014
• Accepted
  25 Oct 2014