Non-nutritive sucking for gastro-oesophageal reflux disease in preterm and low birth weight infants

Background

Gastro-oesophageal reflux is the passage of the contents of the stomach into the oesophagus (feeding tube) with or without vomiting. It is relatively common in preterm infants and can sometimes lead to troublesome complications. Non-nutritive sucking is sucking on a dummy (pacifier) before, during, or after feeding by tube; before or after a bottle/breast feed; or outside of feeding times. It has been proposed as a way to reduce gastro-oesophageal disease in preterm infants.

Study characteristics

We searched scientific databases for clinical trials in preterm infants (born at less than 37 weeks' gestation) and low birth weight (less than 2500 g) at three months of age or less with signs or symptoms of gastro-oesophageal reflux.

Key results

We found no studies meeting our criteria. There is insufficient evidence from large clinical trials on the use of non-nutritive sucking for gastro-oesophageal disease in preterm and low birth weight infants.

Quality of the evidence

We found no studies meeting our criteria.

Authors' conclusions: 

There was insufficient evidence to determine the effectiveness of NNS for GORD. Adequately powered RCTs on the effect of NNS in preterm and low birth weight infants diagnosed with GORD are required.

Read the full abstract...
Background: 

Gastro-oesophageal reflux (GOR) is commonly diagnosed in the neonatal population (DiPietro 1994), and generally causes few or no symptoms (Vandenplas 2009). Conversely, gastro-oesophageal reflux disease (GORD) refers to GOR that causes troublesome symptoms with or without complications such as damage to the oesophagus (Vandenplas 2009). Currently there is no evidence to support the range of measures recommended to help alleviate acid reflux experienced by infants. Non-nutritive sucking (NNS) has been used as an intervention to modulate neonatal state behaviours through its pacifying effects such as decrease infant fussiness and crying during feeds (Boiron 2007; Pickler 2004).

Objectives: 

To determine if NNS reduces GORD in preterm infants (less than 37 weeks' gestation) and low birth weight (less than 2500 g) infants, three months of age and less, with signs or symptoms suggestive of GORD, or infants with a diagnosis of GORD.

Search strategy: 

We performed computerised searches of the electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 9, 2013), MEDLINE (1966 to September 2013), CINAHL (1982 to September 2013), and EMBASE (1988 to September 2013). We applied no language restrictions.

Selection criteria: 

Controlled trials using random or quasi-random allocation of preterm infants (less than 37 weeks' gestation) and low birth weight (less than 2500 g) infants three months of age and less with signs or symptoms suggestive of GORD, or infants with a diagnosis of GORD. We included studies reported only by abstracts, and cluster and cross-over randomised trials.

Data collection and analysis: 

Two review authors independently reviewed and selected trials from searches, assessed and rated study quality and extracted relevant data. We identified two studies from the initial search. After further review, we excluded both studies.

Main results: 

We identified no studies examining the effects of NNS for GORD in preterm and low birth weight infants

Share/Save