Relationship between prematurity and difficulties in the transition of food consistency in childhood: a systematic review

Guimarães, Hellen Nataly Correia Lagos; Petreça, Renata Henrique; Almeida, Sheila Tamanini de; Magno, Flavio; Santos, Rosane Sampaio; Taveira, Karinna Veríssimo Meira; Araujo, Cristiano Miranda de; Celli, Adriane

doi:10.1590/2317-1782/20242023100en

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Systematic Review • CoDAS 36 (4) • 2024 • https://doi.org/10.1590/2317-1782/20242023100en copy

Relationship between prematurity and difficulties in the transition of food consistency in childhood: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

To systematically review the literature regarding the impact of prematurity on the transition of food consistencies in infants during the introduction of complementary feeding.

Research strategies

Searches were conducted in the EMBASE, Latin American and Caribbean Literature in Health Sciences (LILACS), LIVIVO, PubMed/Medline, Scopus, and Web of Science databases, Google Scholar; for gray literature, searches were conducted on Open Gray, and ProQuest Dissertations & Theses databases, from August 10, 2020, onwards.

Selection criteria

“PECOS” was selected to determine inclusion criteria: Population (P): Infants; Exposure (E): Prematurity; Comparison (C): Full-term newborns; Outcomes (O): Progression of food consistencies in premature newborns with or without comparison; Study design (S): Cohort study, Case-control; Cross-sectional.

Data analysis

The methodological quality of the selected observational studies was assessed using the Meta-Analysis of Statistics Assessment and Review Instrument (MASTARI).

Results

A total of 3,310 articles were found, of which nine were selected for qualitative synthesis. Among the selected studies, a relationship between invasive oral interventions and feeding difficulties was observed for all assessed skills, with feeding difficulties being more frequent in infants with lower gestational age.

Conclusion

Most studies found no significant relationship between prematurity and difficulties in the progression of food consistencies during the introduction of complementary feeding; only three studies demonstrated such a relationship.

Keywords:
Complementary Feeding; Eating Behavior; Premature Infant; Infant; Speech Therapy

Author (Country)	Sample size	Age, sex	Study design	Objective	Results and Conclusion
Brusco and Delgado(¹⁰10 Brusco TR, Delgado SE. Caracterização do desenvolvimento da alimentação de crianças nascidas pré-termo entre três e 12 meses. Rev CEFAC. 2014;16(3):917-28. http://doi.org/10.1590/1982-021620145313. http://doi.org/10.1590/1982-021620145313... ) (Brazil)	32 preterm infants	Mean: 4 months 27 days and CA: 1 month 27 days	Cross-sectional	To characterize the feeding development of preterm infants from three to 12 months, checking the breastfeeding type, the timing of introduction of complementary feeding, the deleterious oral habits, the guidance received, the feeding difficulties, and the sociodemographic profile.	Fluid supply observed early.
		Min: 90 days and Max: 10 months 29 days			Pasty food started at an appropriate age, but solids at an early age, 17 reported feeding difficulties. There was an association between refusal and GA and underweight, as well as hypotonia of the lip, tongue, and cheek with GA.
		21 males
		11 females
Buswell et al.(¹⁸18 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://doi.org/10.1007/s00455-008-9161-4. PMid:18688677. http://doi.org/10.1007/s00455-008-9161-4... ) (England)	15 preterm infants	10 months CA	Cross-sectional	To determine the presence of OMD during feeding in early childhood and whether neonatal factors associated with feeding difficulties are predictors of OMD	3 children had borderline or indicative OMD scores, 1 child had BMD for all consistencies, 2 had OMD for all except solids, and 3 did not eat solids.
		9 males			12 infants accepted all consistencies and there was no relationship between neonatal variables and the SOMA score.
		6 females
Cleary et al.(¹⁵15 Cleary J, Dalton SM, Harman A, Wright IM. Current practice in the introduction of solid foods for preterm infants. Public Health Nutr. 2020;23(1):94-101. http://doi.org/10.1017/S1368980019002337. PMid:31547891. http://doi.org/10.1017/S1368980019002337... ) (Australia)	85 preterm infants	21 weeks preterm infant	Prospective cohort	To determine the age of introduction of solid foods in preterm infants, compared to preterm infants and associated factors.	They found early introduction of solids in preterm infants.
	65 full-term infants	19 weeks full-term infants			Type of breastfeeding and birth weight were not associated with the age at which solids were introduced.
		56 males			In full-term infants, lower maternal education and lower maternal age were associated with early introduction of solids.
		29 females			OMD was not evaluated in this study.
Dodrill et al.(⁸8 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://doi.org/10.1016/j.earlhumdev.2003.10.001. PMid:14729160. http://doi.org/10.1016/j.earlhumdev.2003... ) (Australia)	20 preterm infants	Mean 11-17 months CA	Case-control	To verify differences in oral sensitivity and feeding development between preterm and full-term infants and to examine differences in oral sensitivity and feeding development between infants who received shorter and longer periods of nasogastric feeding.	Differences were observed between preterm infants and full-term infants in behaviors suggestive of altered oral sensitivity (p = 0.000), and preterm infants had more tongue protrusion (p = 0.010) and escape when swallowing solids (p = 0.006).
	10 full-term infants	Females: 6 full-term infants and 11 preterm infants
		Males: 4 full-term infants and 9 preterm infants
Ferreira(²⁰20 Ferreira PF. Estado nutricional e desenvolvimento das habilidades motoras orais para a alimentação em crianças nascidas pré-termo [tese]. Santa Maria: Universidade Federal de Santa Maria; 2016.) (Brazil)	45 preterm infants	M1 32.9 weeks	Prospective cohort	To verify the nutritional status and development of oral motor skills in preterm infants during the first year of life and the possible associations between them.	At 4 months, oral motor dysfunction was observed in 78% for the puree consistency, and at 6 months it decreased to 41%.
		M2 37.2 weeks			In the semi-solid consistency at six months, OMD was observed in 9% and none for liquids.
		M3 4.1 months			At 9 months, the OMD for liquids in cups was 14%. At 12 months, the OMD for liquids and solids was 13% and 9%, respectively.
		M4 6 months
		M5 8.9 months
		M6 11.9 months
		24 females / 21 males
Hübl et al.(²²22 Hübl N, Costa SPD, Kaufmann N, Oh J, Willmes K. Sucking patterns are not predictive of further feeding development in healthy preterm infants. Infant Behav Dev. 2020;58:101412. http://doi.org/10.1016/j.infbeh.2019.101412. PMid:31877391. http://doi.org/10.1016/j.infbeh.2019.101... ) (Germany)	40 preterm infants	6/9/12/24 months	Prospective cohort	Examine early OMD and relate to difficulties in feeding semi-solids and solids	Food introduction was started with puree by all and at a lower age than recommended.
		21 females			Half of the infants received semi-solid and solid foods before the recommended age.
		19 males			At 12 months (postmenstrual age), 6 infants were not receiving solids due to choking and parental fear. In the evaluation of spoon feeding at 6 months, 10% achieved a total score; 9 months, 65.8%; and 12 months, 71.8%. Improvement in chewing was observed from 9 to 12 months and from 9 to 24 months.
Pridham et al.(¹⁹19 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://doi.org/10.1016/j.earlhumdev.2006.06.004. PMid:16916589. http://doi.org/10.1016/j.earlhumdev.2006... ) (United States)	41 preterm infants	Mean Min 40.2 Max 375.1 days	Prospective cohort	To examine the independent and interactive contribution of biological and maternal infant feeding conditions to feeding skill performance	Only 51% showed a sign of readiness for food introduction.
		1 av. 22 males and 22 females			At 8 months, 60% showed cup skills and coordination for grainy foods.
		2 av. 19 males and 16 females			At 12 months, 70% had the ability to eat all consistencies.
		3 av. 21 males and 17 females
		4 av. 21 males and 20 females
Steinberg et al.(¹¹11 Steinberg C, Menezes L, Nóbrega AC. Disfunção motora oral e dificuldade alimentar durante a alimentação complementar em crianças nascidas pré-termo. CoDAS. 2021;33(1):e20190070. http://doi.org/10.1590/2317-1782/20202019169. PMid:33978058. http://doi.org/10.1590/2317-1782/2020201... ) (Brazil)	62 preterm infants	Mean 13.5 months CA	Cross-sectional	To investigate whether there is an association between oral motor dysfunction and feeding difficulties during the process of introducing complementary feeding to preterm infants.	27 mothers reported difficulty in feeding their children. After applying the checklist, this number increased, and 43 of them reported that their child had some difficulty.
		36 females			Children who were exclusively breastfed up to 6 months had less tendency to refuse feeding.
		26 males			The most frequent defensive behavior was refusal to open the mouth. No association was observed between oral motor difficulty and feeding difficulty.
					However, there was an association between liquefied food, GI, nasogastric feeding tube time, and feeding difficulties.
Yamamoto(²¹21 Yamamoto RCC. Caracterização do desenvolvimento das habilidades motoras orais de crianças de 0 a 12 meses de idade nascidas pré-termo [tese]. Santa Maria: Universidade Federal de Santa Maria; 2017.) (Brazil)	52 preterm infants	4/6/9/12 months	Prospective cohort	To investigate whether there is an association between oral motor dysfunction and feeding difficulties during the process of introducing complementary feeding to preterm infants.	At 4 months, most of them had oral motor dysfunction, and no association was observed between the result of the SOMA for puree and gestational age. At 6 months, 65.6% had normal oral motor function for puree, and 97% for semisolids. At 9 and 12 months, more than 85% had normal oral motor function for all consistencies.
		28 females
		24 males

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[1] Conflict of interests: nothing to declare.