The Effect Of Oral Motor Intervention On Brain Function Development In Premature Infants

Background:With the opening of the two-child policy and the increase in maternal age,the incidence of preterm birth has increased significantly in many areas.Although the mortality rate of premature infants has been greatly reduced with the improvement of neonatal medical technology,the incidence of neurological development sequelae is still high.Nervous system sequelae,such as cerebral palsy,mental retardation,cognitive impairment,and autism,not only affect recent exercise,cognition,and sensory function,but also seriously affect the quality of life,reduce the quality population,which bring great spiritual and economic burden to families and society.Focusing on the development of the nervous system and long-term quality of life in premature infants and improving brain development outcomes have become one of the priorities of medical and nursing work in NICU.Oral motor intervention（OMI）is a sensorimotor intervention.Several studies have shown that OMI could promote the coordination of sucking-swallowing-breathing patterns in premature infants,improve feeding performance,and promote feeding process.But whether OMI could promote brain functional development,there are still few studies.The cerebral palsy guideline pressed in 2015 has no clear conclusions about how to perform early sensorimotor interventions to improve neurobehavioral behavior in high-risk children.Objectives:By the use of amplitude integrated electroencephalogram（aEEG）and neonatal behavioral neurological assessment（NBNA）,to investigate the effects of oral motor intervention on brain function development in premature infants.Methods:A total of 110 premature infants,aged 30³3⁺66 weeks,admitted to the Department of Neonatology,Affiliated Hospital of Southwest Medical University within 24 hours after birth from March to December 2018were enrolled in the study.The premature infants were firstly divided into a low gestational age（GA）group and a high GA group.Secondly,they were divided into low GA control group（group A1）,low GA intervention group（group B1）,high GA control group（group A2）and high GA intervention group（group B2）.There were no significant differences in gender,birth weight,mode of delivery,Apgar score,mechanical ventilation between the two groups of preterm infants in the same gestational age（P>0.05）.There were no significant differences on the age,use of hormones and antibiotics before birth of their mothers.There were also no significant differences in premature rupture of membrane and previous history（P>0.05）.The premature infants in each group received routine treatment and care.According to the Fucile oral motor regimen,the premature infants in intervention group underwent oral stimulation for 12minutes and non-nutritive sucking for 3 minutes before feeding,2 times per day,for 14 days.The aEEG monitoring and NBNA scores were performed on the 1^st,7^th,and 14^th day of the enrollment.The aEEG background activity and score of NBNA of the preterm infants were compared between group A and group B.Software SPSS 20.0 was used for data analysis.The measurement data was expressed as mean and standard deviation（x±s）,median and quartile[M(P₂₅,P₇₅)].The count data was expressed as a percentage（%）.The independent sample t test was used to compare the normal distribution between the two groups,and the non-parametric test was used for the non-normal distribution.Theχ² test was used to compare the rates between the two groups.P<0.05 was considered statistically significant.Results:1.With the increasing of age,the background of aEEG gradually matured,showing that the broadband and narrow-band upper border voltage（UB）showed a downward trend,the lower border voltage（LB）showed an increasing trend,and the voltage difference became smaller.2.In low GA group,the narrow-band LB is higher（group B1>group A1）,and the narrow-band voltage difference is lower（group B1<group A1）;On the14^th day,the LB of broadband and narrow-band are higher（group B1>group A1）,the UB of narrow-band and voltage difference are lower（group B1<group A1）.In high GA group,on the 7^th and 14^thh day,there is a statistically significant difference on the LB of broadband and narrow-band（group B2>group A2）.The UB of narrow-band and voltage difference are lower（group B2<group A2）.On the 14^th day,there is a statistically significant in the proportion of mature sleep-wake cycle（SWC）in the low GA group（group B1>group A1）,（P<0.05）.3.On the 7^th and 14^thh day,the aEEG score of group B is higher than that of the group A（group B1>group A1,group B2>group A2）,and the difference is statistically significant（P<0.05）.4.The NBNA score of the low GA intervention group is higher than that of the control group on the 14^thh day（group B1>group A1）.In high GA group,the NBNA score of the intervention group is higher than that of the control group on the7^th and 14^thh day（group B2>group A2）.Conclusions:1.OMI could promote the maturation of aEEG backgrond activities.2.OMI could improve the behavioral neurological manifestations,accelerating the maturation of brain function in premature infants.3.OMI is safe and feasible in premature more than 30 weeks,which can be used as a neuroprotective strategy in clinic.