Date Presented 04/23/21
Infants discharged with gastrostomy tubes are more likely to have lower scores in all neurodevelopment outcomes than full-feed infants. A noninvasive application of vagal nerve stimulation (VNS), transcutaneous auricular VNS (taVNS), stimulates the auricular branch of the vagal nerve. Yet, the long-term impact of the application of taVNS remains unknown. Early findings from this study reveal that taVNS could have a positive impact on children's neurodevelopmental and sensory performance observed at 18 months follow-up evaluation.
Primary Author and Speaker: Turki Khaild Aljuhani
PURPOSE: Feeding difficulty in infancy is an important occupational deficit that requires skilled therapy intervention. When compared to healthy infants, infants diagnosed with feeding difficulties score significantly lower in all neurodevelopmental performance (1). Also, infants discharged with a g-tube have lower scores in all neurodevelopment outcomes than infants discharging from the hospital on full oral feeds (2). A non-invasive application of VNS, transcutaneous auricular VNS (taVNS), stimulates the auricular branch of the vagal nerve. In a first-in-neonates application, infants who failed to achieve full oral feeds received 2 weeks of daily taVNS-paired with bottle feeding (3). 58% successfully attained full oral feeds (responders) vs. 42% who received a g-tube (non-responders) (4). For a secondary outcome, we hypothesize that at 18 months follow up evaluation, infants who responded to taVNS treatment may show additional treatment effects.1) Responders to taVNS treatment will have better performance in Bayley-III scaled scores than non-responders. 2) Responders will show more typical responses on the toddler Sensory Profile-2 (SP2) caregiver questionnaire
DESIGN: Prospective cohort study with a convenience sample of infants enrolled at the Medical University of South Carolina (MUSC). All infants were at a high risk of developmental delays and all were scheduled for the g-tube procedure before the start of treatment. 30 infants have completed the taVNS feeding and 11 children have completed the 18-month follow up assessments to date. All assessments completed by an OT with pediatric expertise
METHOD: The Bayley-III was used to evaluate motor, language, and cognitive skills; the toddler SP2 caregiver questionnaire was used to assess children's sensory system and processing patterns. Data were analyzed using descriptive data analysis of means, standard deviation, and independent t-test
RESULTS: Eleven children have complete follow-up data to date (6 responders, 5 non-responders). Infants who responded to early taVNS feeding treatment showed greater avg. Bayley III scaled scores than non-responders in the Cognition (+1.6), Receptive Language (+0.3), Fine Motor (+0.7), and Gross Motor (+1.6) domains, although differences were not statistically significant. SP2 forms were completed for 7 children (4 responders, 3 non-responders) and showed that all children in the non-responders group had an atypical sensory performance, while only one child in the responder group showed atypical sensory performance. In the 4 quadrants sensory patterns, a total of 7 atypical sensory patterns were noted in the non-responders group, while there were only 4 atypical quadrant scores in infants who responded to taVNS treatment
CONCLUSION: While a high percentage of infants enrolled in this taVNS study were able to achieve full oral feeds before hospital discharge, the long-term impact of taVNS treatment remains unknown. Early findings from this study reveal that responders to taVNS treatment (attainment of full oral feeds), on average, had higher scaled Bayley-III scores when compared to non-responders and demonstrated more typical sensory processing patterns. We will have the results of the 18-month follow-up assessment for all 30 infants enrolled in this study by the time of the conference next year. This will allow for a more rigorous analysis of between-group differences
IMPACT STATEMENT: OTs play a large role in working with infants and children with feeding difficulties and their families. The finding from this study elucidate the use of neuromodulation techniques, such as taVNS, to support the early feeding success of high-risk newborns and how successful early feeding behaviors impact overall development and sensory processing later in life
References
1. Badran, B. W., Jenkins, D. D., Cook, D., Thompson, S., Dancy, M., DeVries, W. H., . . . George, M. S. (2020). Transcutaneous Auricular Vagus Nerve Stimulation-Paired Rehabilitation for Oromotor Feeding Problems in Newborns: An Open-Label Pilot Study. Front Hum Neurosci, 14(77). https://doi.org/10.3389/fnhum.2020.00077
2. Yi, S. H., Joung, Y. S., Choe, Y. H., Kim, E. H., & Kwon, J. Y. (2015). Sensory Processing Difficulties in Toddlers With Nonorganic Failure-to-Thrive and Feeding Problems. J Pediatr Gastroenterol Nutr, 60(6), 819-824. https://doi.org/10.1097/mpg.0000000000000707
3. Badran, B. W., Jenkins, D. D., DeVries, W. H., Dancy, M., Summers, P. M., Mappin, G. M., . . . George, M. S. (2018). Transcutaneous auricular vagus nerve stimulation (taVNS) for improving oromotor function in newborns. Brain Stimul, 11(5), 1198-1200. https://doi.org/10.1016/j.brs.2018.06.009
4. Jadcherla, S. R., Khot, T., Moore, R., Malkar, M., Gulati, I. K., & Slaughter, J. L. (2017). Feeding Methods at Discharge Predict Long-Term Feeding and Neurodevelopmental Outcomes in Preterm Infants Referred for Gastrostomy Evaluation. J Pediatr, 181, 125-130.e121. https://doi.org/10.1016/j.jpeds.2016.10.065
