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Quantifying the Impact of Common Feeding Interventions on Nutritive Sucking Performance Using a Commercially Available Smart Bottle

Capilouto, Gilson J. PhD; Cunningham, Tommy J. PhD; Desai, Nirmala MD

The Journal of Perinatal & Neonatal Nursing: October/December 2019 - Volume 33 - Issue 4 - p 331–339
doi: 10.1097/JPN.0000000000000435
Feature Articles

An estimated 25% to 40% of infants experience difficulties with learning to breast- or bottle-feed. Yet, guidelines and evidence-based support for common feeding practices are limited. The objective of this case report was to quantify the impact of feeding interventions on nutritive sucking performance after discharge in an outpatient setting. This observational case series involved 2 infants. To determine the impact of cumulative interventions, pre- and postintervention effect sizes were calculated. Sucking performance metrics of interest included nipple movement peak sucking amplitude, duration, frequency, and smoothness. Interventions included positional changes and changes in nipple flow rate, among others. For both infants, cumulative interventions had the greatest impact on suck frequency; postintervention, infants were able to increase their rate of nutritive sucking per burst. Other aspects of sucking performance were differentially impacted for each baby. Researchers agree that neonatal and infant feeding has been understudied and that the evidence for common interventions needs to be strengthened. We have demonstrated the implementation of readily available technology that can be used to quantify the direct impact of any intervention on actual sucking performance. In doing so, we can individualize care to support skill development and improve outcomes for infants at risk for ongoing feeding challenges.

Departments of Rehabilitation Sciences (Dr Capilouto) and Pediatrics (Dr Desai), University of Kentucky, Lexington; and NFANT Labs, LLC, Atlanta, Georgia (Dr Cunningham).

Corresponding Author: Gilson J. Capilouto, PhD, Department of Rehabilitation Sciences, University of Kentucky, 124G Wethington Bldg, Lexington, KY 40536 (

Collection of data was made possible with a grant from the University of Kentucky National Institutes of Health (NIH) Center for Clinical and Translational Science (NIH CTSA UL1TR000117) and the University of Kentucky College of Health Sciences Office of Research (grant no. 1012003440).

Dr Capilouto receives a salary from the University of Kentucky where the work was carried out. She has a financial interest in NFANT Labs, LLC, and serves as a Board member. Dr Cunningham receives a salary from NFANT Labs, LLC, serves as a Board member, and has a financial interest in the company. He is an adjunct assistant professor at the University of Kentucky where the work was performed. Dr Desai receives a salary from the University of Kentucky where the work was performed.

Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Each author has indicated that he or she has met the journal's requirements for Authorship.

Submitted for publication: September 23, 2018; accepted for publication: July 20, 2019.

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