Original Article . . . . . . . . . . . . . . Pacing as a Treatment Technique for Transitional Sucking Patterns Leslie Law-Morstatt, MHS Debra M. Judd, PhD Patricia Snyder, PhD R. John Baier, MD Ramasubbareddy Dhanireddy, MD OBJECTIVE: To ascertain whether the implementation of a paced feeding protocol in a sample of preterm infants with respiratory diagnoses will result in the development of more efficient sucking patterns, increased weight gain, decreased incidence of bradycardia during feeding, and shorter length of hospital stay. METHOD: A total of 36 premature infants were enrolled into a nonrandomized clinical trial conducted in a neonatal intensive care unit (NICU). The first 18 infants were traditionally bottle-fed. Following this cohort’s discharge from NICU, nursing staff completed continuing education on implementing a paced feeding protocol and the next 18 infants were delivered paced feedings. RESULTS: The two cohorts were equivalent at the initiation of oral feedings on gestational age, birth weight, 1 and 5 minute Apgar scores, weight, and postconceptual age. The paced infants demonstrated statistically and clinically significant decreases in bradycardic incidences during feeding and gains in development of more efficient sucking patterns at discharge. Discharge and average weekly weight gain did not differ between the two groups. CONCLUSIONS: The incorporation of pacing into NICU care practices appears to be beneficial for preterm infants with respiratory disease. Journal of Perinatology (2003) 23, 483–488. doi:10.1038/sj.jp.7210976 INTRODUCTION Feeding, a seemingly simple, instinctual act of human newborns, is in fact a complex task requiring intricate coordination of sucking, swallowing, and breathing. The complexity of the task is increased in neonates born prematurely, most of whom do not display adequate oral motor coordination to breast- or bottle-feed until approximately 34 weeks postconceptual age (PCA). 1,2 Respiratory illness experienced by many preterm infants can result in increased risk for feeding difficulties once oral feedings begin. Contributory factors include difficulty in exchanging oxygen efficiently and suppressing breathing while sucking. 3–8 ‘‘Transitional’’ sucking is a pattern likely to be utilized by the preterm infant with respiratory difficulties. Palmer 7 describes this pattern as an incoordination of sucking and swallowing with respiration, characterized by six to 10 sucks and swallows per burst with arrhythmic breathing occurring primarily during pauses. Infants using a transitional pattern may experience coughing, choking, bradycardia, apnea, and fatigue during feeding. 3,7 This pattern is disorganized and atypical as compared to the consistent pattern seen in immature and mature feeding patterns. The mature pattern is characterized by sucking, swallowing, and respiration in a one-to-one-to-one ratio up to 30 times per burst with brief pauses and is primarily seen in infants over 37 weeks PCA. 9–11 An immature pattern is characterized by fewer sucks per bursts with swallowing and respiration occurring during pauses and is primarily seen in infants less than 37 weeks PCA. 9,12,13 In contrast to transitional suck, mature and immature patterns are considered typical and not in need of intervention to improve efficiency. Palmer 7 suggested that early identification and treatment of problematic sucking patterns should assist infants to develop more efficient feeding patterns and prevent secondary feeding and growth disorders. However, only a few studies have specifically addressed effects of treatment on disorganized feeding patterns in infants with respiratory difficulties. Als et al. 14 demonstrated that individualized care in the neonatal intensive care unit (NICU) in which caregivers recognized and reacted to infant stress cues resulted in a statistically significant decrease in number of days to begin bottle- feeding. The experimental sample consisted of eight very-low-birth- weight (VLBW) infants with bronchopulmonary dysplasia (BPD); a matched-pair control group of eight infants received routine nursery care. Decreased levels of infant stress, perhaps enhancing each infant’s ability to self-regulate or organize behavior during Address correspondence and reprint requests to Leslie Law-Morstatt, MHS, Department of Child and Family Services, Louisiana State University Health Sciences Center, 3730 Blair Street, Shreveport, LA 71103, USA. Department of Child and Family Services (L.L.-M., D.M.J., R.J.B., R.D.), Louisiana State University Health Sciences Center, Shreveport, LA, USA; and Louisiana State University Health Sciences Center (P.S.), New Orleans, LA, USA. Journal of Perinatology 2003; 23:483–488 r 2003 Nature Publishing Group All rights reserved. 0743-8346/03 $25 www.nature.com/jp 483