Improving Gastrointestinal Function In High-Risk Newborns By Stimulation Of The Enteric Nervous System

Infants born preterm or with congenital diaphragmatic hernia (CDH) are at risk for several long-term unfavourable outcomes that can be related to feeding difficulties from birth onwards. Adverse nutritional outcomes in both patient groups mainly originate from mechanical dysfunction, based on dysmotility. Mechanical function includes suck-swallow coordination, gastrointestinal sphincter tone, gastric emptying and intestinal motility and is regulated by the complex interplay of the autonomic (ANS) and enteric (ENS) nervous system with modulation by the central nervous system (CNS). The intra-uterine environment provides the fetus with developmentally timed sensory exposures through 'touch' that are necessary for development of sensory control and autonomous coordination of bodily functions. Preterm infants miss out this normal maturation, while newborns with CDH may exhibit a delayed maturation probably as a result of the deviant anatomical situation and the severe illness during the direct postnatal period. In the postnatal situation both patient groups may be confronted with either 'negative' sensory stimulation through exposures such as procedural touch/handling, pain or otherwise a reduction in sensory exposures through avoidance of positive touch in relation to supposed clinical instability. All together this may affect normal development and may lead to sensory deprivation and delayed maturation of the nervous regulation and cerebral maturation. Tactile-kinaesthetic and oral sensorimotor stimulation using positive gentle touch have been shown to positively affect cardiorespiratory stability, weight gain, gastro-intestinal performance, and length of stay in hospital for preterm infants. However, these strategies have not been evaluated in high-risk infants. The current study aims at evaluating an intervention programme that provides positive stimuli through touch adapted to the stage of development of the infant with regard to timing, duration and intensity that supports the maturational development of gastrointestinal functionality. (Handling Adapted to Postnatal age with Tactile-kinaesthetic and Oral sensorimotor Stimulation; HAPTOS intervention). We hypothesize that the HAPTOS intervention will improve the postnatal maturation of the autonomous and enteral nervous system and cause improvements in gastrointestinal motility, enteral and oral feeding and cardiorespiratory stability.

• First meconium passage [Срок оценки: 14 days]
• Duration of meconium passage [Срок оценки: 14 days]
• Use of laxatives [Срок оценки: 60 days]
• Gastrointestinal Motility [Срок оценки: 100 days]
• Vomiting [Срок оценки: duration of hospitalization up to 15 months]
• Periodic breathing [Срок оценки: duration of hospitalization up to 15 months]
• Feeding difficulties [Срок оценки: 24 months]
• Maturation of heart rate variability [Срок оценки: duration of intensive care stay up to 60 days]
• Growth at postmenstrual age [Срок оценки: at 40 weeks, 3, 6, 12, 18 and 24 weeks]
• Morbidity [Срок оценки: 100 days]
• Duration hospital stay [Срок оценки: 100 days]
• Neurocognitive development [Срок оценки: at 24 months]