Disfunção motora oral e dificuldade alimentar durante a alimentação complementar em crianças nascidas pré-termo
Oral motor disorder and feeding difficulty during the introduction of complementary feeding in preterm infants
Carla Steinberg, Larissa Menezes, Ana Caline Nóbrega
Resumo
Objetivo: Investigar a associação entre a disfunção motora oral e a dificuldade alimentar durante o processo de introdução de alimentação complementar em crianças nascidas pré-termo. Método: Trata-se de um estudo transversal, observacional e quantitativo. Nele, foram incluídos prematuros em acompanhamento em um ambulatório de seguimento de recém-nascidos de alto risco, que já tinham iniciado a alimentação complementar e possuíam até 24 meses de idade gestacional corrigida. A dificuldade alimentar foi investigada mediante a percepção da mãe quanto à presença de comportamentos defensivos do filho. A medida do desempenho das habilidades motoras orais foi obtida a partir da aplicação de uma adaptação do Protocolo de Avaliação Clínica da Disfagia Pediátrica (PAD-PED). Resultados: A amostra foi composta por 62 díades de crianças com média de 13,5 meses de idade gestacional corrigida (IGC). A alimentação complementar foi introduzida no sexto mês de IGC por quase metade das mães, e a maioria delas informou algum tipo de dificuldade nessa introdução. A prematuridade extrema revelou associação com o comportamento alimentar defensivo (p=0,005), assim como a introdução inicial de alimentos na consistência liquidificada (p=0,001), o tempo prolongado de uso de sonda enteral (p=0,044), a pressão positiva em vias aéreas (CPAP) (p=0,013) e a nutrição parenteral (p=0,039). Conclusão: Não foi encontrada uma associação significativa entre a disfunção motora oral e a dificuldade alimentar.
Palavras-chave
Abstract
Purpose: To investigate the association between oral motor disorder and feeding difficulty during the process of introducing complementary feeding in preterm infants. Methods: This is a cross-sectional, observational and quantitative study. Preterm infants who had already begun complementary feeding and were up to 24 months corrected gestational age, were followed up at an outpatient clinic for high-risk newborns. The feeding difficulty was assessed using the mother’s perception of the presence of defensive behaviors in their child. The measurement of the oral motor skills performance was obtained through the application of an adaptation of the Clinical evaluation protocol of pediatric dysphagia (PAD-PED). Results: The sample consisted of 62 dyads of children with a mean corrected gestational age (CGA) of 13.5 months. Complementary feeding was introduced at sixth month CGA by almost half of the mothers and the most of them reported some sort of difficulty with this activity. Extreme prematurity revealed an association with defensive feeding behavior (p = 0.005), as well as with the initial introduction of food with liquid consistency (p = 0.001), the extended period of time using enteral tube feeding (p = 0.044), the continuous positive airway pressure (CPAP) (p = 0.013) and parenteral nutrition (p = 0.039). Conclusion: There was no significant association between oral motor disorder and feeding difficult.
Keywords
Referencias
1. Procianoy R, Silveira R. Importância do seguimento ambulatorial do pré-termo. In: Silveira RC, organization. Seguimento ambulatorial do prematuro de risco. [citado em 2018 Jan 4]. Disponível em: http://www. coopedce.com.br/arquivos/files/artigos/2014-seguimento-prematuro.pdf
2. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller A-B, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379(9832):2162-72. http://dx.doi.org/10.1016/S0140-6736(12)60820-4. PMid:22682464.
3. Gupta S, Agarwal R, Aggarwal KC, Chellani H, Duggal A, Arya S, et al. and the Investigators of the CF trial. Complementary feeding at 4 versus 6 months of age for preterm infants born at less than 34 weeks of gestation: a randomised, open-label, multicentre trial. Lancet Glob Health. 2017;5(5):e501- 11. http://dx.doi.org/10.1016/S2214-109X(17)30074-8. PMid:28395845.
4. Morris SE, Klein MD. Pre-feeding skills: a comprehensive resource for mealtime development. Pro-ed; 2000.
5. Delaney AL, Arvedson JC. Development of swallowing and feeding: prenatal through first year of life. Dev Disabil Res Rev. 2008;14(2):105- 17. http://dx.doi.org/10.1002/ddrr.16. PMid:18646020.
6. Dodrill P, McMahon S, Ward E, Weir K, Donovan T, Riddle B. Long-term oral sensitivity and feeding skills of low-risk pre-term infants. Early Hum Dev. 2004;76(1):23-37. http://dx.doi.org/10.1016/j.earlhumdev.2003.10.001. PMid:14729160.
7. Pridham K, Steward D, Thoyre S, Brown R, Brown L. Feeding skill performance in premature infants during the first year. Early Hum Dev. 2007;83(5):293-305. http://dx.doi.org/10.1016/j.earlhumdev.2006.06.004. PMid:16916589.
8. Buswell CA, Leslie P, Embleton ND, Drinnan MJ. Oral-motor dysfunction at 10 months corrected gestational age in infants born less than 37 weeks preterm. Dysphagia. 2009;24(1):20-5. http://dx.doi.org/10.1007/s00455- 008-9161-4. PMid:18688677.
9. Samara M, Johnson S, Lamberts K, Marlow N, Wolke D. Eating problems at age 6 years in a whole population sample of extremely preterm children. Dev Med Child Neurol. 2010;52(2):e16-22. http://dx.doi.org/10.1111/j.1469- 8749.2009.03512.x. PMid:19832883.
10. DeMauro SB, Patel PR, Medoff-Cooper B, Posencheg M, Abbasi S. Postdischarge feeding patterns in early-and late-preterm infants. Clin Pediatr (Phila). 2011;50(10):957-62. http://dx.doi.org/10.1177/0009922811409028. PMid:21856965.
11. Ruedell AM, Haeffner LSB, Silveira LM, Keske-Soares M, Weinmann ARM. Avaliação de habilidades orais de crianças nascidas pré-termo. Rev CEFAC. 2011;10(1):126-33.
12. Törölä H, Lehtihalmes M, Yliherva A, Olsén P. Feeding skill milestones of preterm infants born with extremely low birth weight (ELBW). Infant Behav Dev. 2012;35(2):187-94. http://dx.doi.org/10.1016/j.infbeh.2012.01.005. PMid:22364897.
13. Den Boer SL, Schipper JA. Feeding and drinking skills in preterm and low birth weight infants compared to full term infants at a corrected age of nine months. Early Hum Dev. 2013;89(6):445-7. http://dx.doi.org/10.1016/j. earlhumdev.2012.12.004. PMid:23273865.
14. Sanchez K, Spittle AJ, Slattery JM, Morgan AT. Oromotor Feeding in children born before 30 weeks’ gestation and term-born peers at 12 months’ corrected age. J Pediatr. 2016;178:113-8. http://dx.doi.org/10.1016/j. jpeds.2016.07.044. PMid:27609073.
15. Johnson S, Matthews R, Draper ES, Field DJ, Manktelow BN, Marlow N, et al. Eating difficulties in children born late and moderately preterm at 2 y of age: a prospective population-based cohort study–3. Am J Clin Nutr. 2016;103(2):406- 14. http://dx.doi.org/10.3945/ajcn.115.121061. PMid:26718420.
16. Silveira R. Nutrição do pré-termo de muito baixo peso: aspectos gerais e no primeiro ano. 2012. In: Silveira RC, organizadores. Seguimento ambulatorial do prematuro de risco. São Paulo: SBP; 2012.
17. Jaafar NH, Othman A, Majid NA, Harith S, Zabidi-Hussin Z. Parent-report instruments for assessing feeding difficulties in children with neurological impairments: A systematic review. Dev Med Child Neurol. 2019;61(2):135- 44. http://dx.doi.org/10.1111/dmcn.13986. PMid:30079517.
18. Almeida FCF. Protocolo de avaliação clínica da disfagia pediátrica (PADPED). Barueri: Pró-Fono; 2014. p. 34.
19. Ramos CC, Maximino P, Machado RH, Bozzini AB, Ribeiro LW, Fisberg M. Delayed Development of Feeding skills in children with feeding difficulties: cross-sectional study in a Brazilian reference center. Front Pediatr. 2017;5:5. http://dx.doi.org/10.3389/fped.2017.00229. PMid:29164081.
20. Kerzner B, Milano K, MacLean WC Jr, Berall G, Stuart S, Chatoor I. A practical approach to classifying and managing feeding difficulties. Pediatrics. 2015;135(2):344-53. http://dx.doi.org/10.1542/peds.2014-1630. PMid:25560449.
21. Menezes LVP, Steinberg C, Nóbrega AC. Complementary feeding in infants born prematurely. CoDAS. 2018;30(6):e20170157. http://dx.doi. org/10.1590/2317-1782/20182017157. PMid:30328902.
22. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Dez passos para uma alimentação saudável: guia alimentar para menores de dois anos: um guia para o profissional da saúde na atenção básica. 2. ed. Brasília: Ministério da Saúde; 2010.
23. Alder EM, Williams FL, Anderson AS, Forsyth S, Florey CV, Van der Velde P. What influences the timing of the introduction of solid food to infants? Br J Nutr. 2004;92(3):527-31. http://dx.doi.org/10.1079/BJN20041212. PMid:15469658.
24. Ministério da Saúde (BR). II pesquisa de prevalência de aleitamento materno nas capitais brasileiras e Distrito Federal. Brasília: Ministério da Saúde; 2009.
25. Pagliaro CL. Desenvolvimento das habilidades motoras orais de alimentação em lactentes prematuros durante o primeiro ano de vida [dissertação]. São Paulo: Universidade de São Paulo; 2015. 132 p.
26. Harris G, Mason S. Are There sensitive periods for food acceptance in infancy? Curr Nutr Rep. 2017;6(2):190-6. http://dx.doi.org/10.1007/ s13668-017-0203-0. PMid:28596932.
27. Hoogewerf M, Ter Horst HJ, Groen H, Nieuwenhuis T, Bos AF, Van Dijk MWG. The prevalence of feeding problems in children formerly treated in a neonatal intensive care unit. J Perinatol. 2017;37(5):578-84. http:// dx.doi.org/10.1038/jp.2016.256. PMid:28102855.
28. Crapnell TL, Rogers CE, Neil JJ, Inder TE, Woodward LJ, Pineda RG. Factors associated with feeding difficulties in the very preterm infant. Acta Paediatr. 2013;102(12):e539-45. http://dx.doi.org/10.1111/apa.12393. PMid:23952198.
29. Nieuwenhuis T, Verhagen EA, Bos AF, van Dijk MW. Children born preterm and full term have similar rates of feeding problems at three years of age. Acta Paediatr. 2016;105(10):e452-7. http://dx.doi.org/10.1111/apa.13467. PMid:27170494.
30. Parker LA, Neu J, Torrazza RM, Li Y. Scientifically based strategies for enteral feeding in premature infants. Neoreviews. 2013;14(7):e350-9. http://dx.doi.org/10.1542/neo.14-7-e350.
Submitted date:
07/07/2019
Accepted date:
17/02/2020
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