Non-nutritive sucking for promoting physiologic stability and nutrition in preterm infants

An infant born prematurely may be fed through a tube into the stomach, so is often given a pacifier to suck on to improve nutrition. An infant needs coordinated sucking, swallowing and breathing to feed. The ability to suck and to swallow is present by 28 weeks gestation, but infants are not fully coordinated until 32 to 34 weeks. This means that preterm infants less than 32 weeks gestation are usually not able to feed effectively from the breast or a bottle. They are fed by a small tube that is placed up the nose into the stomach (gavage feeding). Sucking on a pacifier (non-nutritive sucking) during gavage feeding may encourage the development of sucking behaviour and improve digestion of the feeding. Non-nutritive sucking may also have a calming effect on infants, although it does have the potential to interfere with breastfeeding. The authors searched the medical literature and found 21 studies, 15 were randomized controlled trials and six were non-randomized. The total number of infants in each study ranged from 10 to 59. Weight gain was similar with and without use of a pacifier. Preterm infants with pacifiers did not stay in hospital as long as those without and hospital costs were less (two studies). These infants showed less defensive behaviors during tube feedings, spent less time in fussy and active states during and after tube feedings, and settled more quickly into sleep. Their transition to full enteral (by tube or mouth) or bottle feeds (three studies) and bottle feeding performance, in general, (one study) were easier. No negative outcomes were reported.