| With the improvement in perinatology , the survival of preterm infants has increased . The feeding is improved to be concerned. Controversy exists concerning the advantages of the different methods of enteral feeding , as well as the oral stimulation and sucking during ga-vage feeding in preterm infants. Preterm infants are often bolus fed via a tube, This way of feeding is unphysiological since the natural sucking behavior is omitted. Nonnutritive sucking ( NNS) has been considered to be a benign intervention. The study of its effect on neonatal physiology has been more recent development , but the consistent benefit of NNS has not been revealed. The purpose of this study was to assess the effect of NNS on preterm infants'plasma gastrin , motilin and gastrointestinal motility.Material and MethodThirty - eight healthy preterm infants ( Gestational ages 28 ~ 35weeks) were studied . The infants were appropriate for gestational age. The infants were randomized to study or control group. Infants in study group (n = 18) were given a pacifier 15 minutes beginning on the first day of life (before, during and after all feeds 5 min, respectively). Infants in control group were not given the opportunity of sucking.Daily feeding volumes, caloric intake and weight, number ofstools passed, gastric residuals and weekly length, head circumference were measured in all infants. In addition the switch over time from all tube feeds to all bottle feeds and from parenteral nutrition to all tube feeds were noted.Blood specimen for measurement of gastrin, motilin were obtained by venipuncture before the starting feeding , after 7 and 14 day , the specimen were obtained within 10min after feed ( 08 : 30 - 09 : 00 ) . Serum gastrin and plasma motilin were measured using radioim-munoassay.At the 14th day , a well validated intra - oesophageal pH monitoring system utilizing an crystalline antimony pH electrode was used o-ver a 24 hour period. Record the number of reflux episode , reflux index , the number of reflux episodes greater than five minutes , the longest reflux time and the total time of pH <4.Gastric emptying was estimated using the ultrasonic method. The infants were placed in supine position. The stomach was emptied by aspirating the feeding tube for retained milk, gastric secretion, and the air, and then a prefeed ACSA ( antral cross section area) measurement was taken before a milk was given. Immediately after complete administration of the feeding, the first postfeeding measurement was taken followed by measurements at 10,20, 30,45, 60, 75, 90, 105 and 120 minutes. Calculate the percentage change in ACSA from the prefeeding value. The 50% change in ACSA or the half antral clearance time is the time taken for the maximal ACSA to decrease by half(Tl/2).ResultsThe NNS and control groups did not differ in birth weight (1561.39 ±220. 39 versus 1551. 00 ±209. 89kg, respectively) or gestational age (31. 89 ± 1. 88 versus 32. 10 ± 1. 86 weeks, respectively). The feeding volume, caloric intake, Apgar 1' value and the time of beginning feeding was similar between groups.The effect of NNS on Growth:7 day received in birth weight for infants in the study group infants was 38.9% ,the control group was 10% , difference was signifi-cant(P<0.05).The effect of NNS on plasma gastrin and motilin:The basal gastrin was similar between groups, by 7 days the NNS group was significant higher than the control group ( 157. 56 ±46. 05 versus 127. 70 ±42. 18 pg/ml, respectively,P <0. 05) , and by 14 days concentrations of study group were still significantly above control groups levels. The basal, by 7 days and 14 days, motilin level were similar between groups.The effect of NNS on GER:84. 2% of the recordings showed a reflux index of > 1%. In NNSgroup, the number of reflux episodes was significant reduced (10. 33±6.68 次, 15. 30 ±7. 37 次, respectively ,P <0.05). The totaltime of pH < 4 and reflux index were lower than control group, but thedifference was not significant. |
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