Costa, S., Schans, C., Zweens, M., Boelema, S., Meij, E., Boerman, M., & Bos, A. (2010).

The
development of sucking patterns in preterm infants with bronchopulmonary dysplasia.
Neonatology, (98), 268-277.
In this journal, Costa et al., attempts to explain the differences in sucking patterns of pre-term
infants born with bronchopulmonary dysplasia (BPD) and pre-term infants without BPD until 10
weeks post-term age. It is believed that infants with BPD have a higher risk of developing brain
abnormalities and breathing difficulties which may affect their sucking patterns. After
determining relevant subjects via the Neontal Oral-Motor Assessment scale, sucking patterns
were labeled as normal, dysfunctional, or disorganized. Results indicated that pre-term infants
born with BPD exhibited more abnormal suck patterns than those born without BPD with the
most common pattern being disorganization. However, there was no significant difference
found between the groups in regard to the age normal sucking patterns are acquired In
conclusion, pre-term babies with BPD demonstrated difficulty coordinating the suck-swallow-
breathe pattern prior to term-equivalent age. After this age, sucking patterns in both groups
were similar. Due to the small population and single-center generalizing should be done
cautiously.

Lee, J., Chang, Y., Yoo, H., Ahn, S., Seo, H., Choi, S., . . . Park, W. (2011). Swallowing
dysfunction in very low birth weight infants with oral feeding desaturation. World Journal
of Pediatrics, 7(4), 337-343.
This study examined infants with very low birth weight (VLBW) and swallowing dysfunctions that
may arise because of this complication. Many VLBW infants experience low blood oxygen levels
which may cause problems feeding. These problems may lead to apnea or aspiration. A
modified barium swallow (MBS) test was administered to detect any swallowing dysfunction.
Subjects included infants who had significant oral feeding desaturation and SpO2 below 80% for
at least 15 seconds with over half their feedings. The oral, pharyngeal, and upper esophageal
stages of the swallow were examined. When given 30 mL of barium at a reclined position of 45
degrees, 41 VLBW infants did not show abnormalities and 28 showed abnormalities including
impaired airway protection, weak sucking power, and reduced pharyngeal peristalsis in the
valleculae. It was determined that bronchopulmonary dysplasia was not a significant risk factor
for impaired airway protection, although these infants tend to have VLBW. A crucial period for
stabilizing the rhythm of suck-swallow-breathe occurs during 32-40 weeks of pregnancy which
the VLBW infants are no longer in utero. VLBW infants born after 28 weeks gestational age
were more likely to have impaired airway protection. It was concluded that BPD is a primary
factor responsible for low levels of oxygen during oral feedings. Because BPD was not found to
be a major risk factor for impaired airway protections, aspiration during swallowing may not be a
major cause of low oxygen during feeding for infants with BPD.
Mizuno, K., Nishida, Y., Taki, M., Hibino, S., Murase, M., Sakurai, M., & Itabashi, K. (2007).
Infants With Bronchopulmonary Dysplasia Suckle With Weak Pressures to Maintain
Breathing During Feeding. Pediatrics, 120(4), E1035-E1042.
This study examined sucking patterns in preterm infants with and without bronchopulmonary
dysplasia (BPD). They utilized three groups; Group A: infants that were not compromised with
BPD, Group B: infants with BPD that did not required home oxygen treatment, and Group C:

infants with BPD that required home oxygen treatments. The researchers examined suck
pressure, frequency, and duration in these infants as well as heart rate and oxygen saturation.
They found that Group C (infants with BPD and home oxygen treatment) showed the lowest
feeding efficiency (volume/total feeding time). Group B (infants with BPD and no home oxygen
treatment) showed smaller and less consistent sucking waveforms than Group A, while Group C
showed the lowest sucking frequency and weakest negative pressure. This indicates that Group
B and C were not as efficient in their coordination of suck-swallow-breathe. Group C also
showed shorter duration of sucks and a greater decrease in oxygen saturation. Groups B and C
showed higher respiratory rates while feeding as well as higher deglutition apnea. This means
they stopped breathing for longer periods of time while swallowing. Overall, the results of the
study indicate that infants with BPD show poorer suck-swallow-breathe coordination and poorer
sucking endurance. This may lead to difficulties completing a meal before the infant becomes
too fatigued to continue.
Mccain, G., Moral, T., Duncan, R., Fontaine, J., & Pino, L. (2012). Transition From Gavage to
Nipple Feeding for Preterm Infants With Bronchopulmonary Dysplasia. Nursing
Research, 61(6), 380-387.
Results of previous studies have indicated that it is more difficult for preterm infants with BPD to
transition from tube feeding to nipple feeding. On average it takes 15-28 days for infants with
BPD to achieve full nipple feeding. It typically takes healthy preterm infants 5-15 days. This task
requires three capabilities: coordination of suck-swallow-breathe, the ability to organize behavior
and express states of wakefulness and sleep, and the ability to regulate cardiorespiratory
control. This study looked at a semi-demand method. With this method, the nurses assessed
infants for their readiness to feed. They looked at their tolerance and intolerance for feeding and
discontinued the feeding when the infant was not tolerating the nipple feeding. This method is
infant led. The infant was offered a pacifier prior to feeding to help bring them into an alert state.
If the infant did not achieve this state they were fed through a tube. The feeding was
discontinued when the infant showed signs of distress, fell asleep, finished the amount given, or
refused to suck any longer. The control group of infants received the standard care, where the
number of nipple feedings per day were increased based on what the infant could ingest without
putting them in distress. The results of this study indicated that the experimental infants took
shorter time to achieve full nipple feeding compared to the control infants. They achieved this
50% sooner (5.9 days for the experimental group). Female infants achieved nipple feeding
sooner than male infants. Infants that were not receiving supplemental oxygen achieved this
faster than infants that were receiving oxygen. However, by achieving full nipple feeding sooner,
it did not decrease the length of the hospital stay.
Gien, J., & Kinsella, J. (2013). Pathogenesis and treatment of bronchopulmonary dysplasia.
Current Opinion in Pediatrics, 305-313.
This article summarizes recent findings of possible factors that could contribute to
bronchopulmonary dysplasia (BPD) as well as treatments that may be effective. Disrupted
alveoli growth is believed to be the strongest association with infants and BPD. However,
inflammation, other infections, and/or genetics can also lead to BPD. It was determined that
vascular endothelial growth factor (VEGF) receptor inhibition reduces lung vascular growth and
alveolarization. VEGF signaling is important for normal lung growth, and any disruptions will
impair growth. One treatment for infants with BPD is mechanical ventilation. Research has been
done and concluded volume ventilation is advantageous in reducing death, BPD, and amount of
days spent on a ventilator. Because numerous factors can contribute to BPD, greater focus has

been targeted towards preventing the development of BPD. Mothers at risk of premature
delivery can be given a steroid, and their babies are given surfactant after birth. The advances
in the health field have allowed more preemies to survive which heightens the incidence of
infants with BPD. Many infants with BPD are placed on ventilators. To avoid this, nasal
continuous positive pressure (NCPAP) has used. A study found that endotracheal intubation
and mechanical ventilation were positively related to the development of BPD. Emerging
preventive treatments are under investigation, but must be studied further to determine
outcomes.