Transcutaneous Auricular Vagus Nerve Stimulation-Paired Rehabilitation for Oromotor Feeding Problems in Newborns: An Open-Label Pilot Study
Neonates born premature or who suffer brain injury at birth often have oral feeding dysfunction and do not meet oral intake requirements needed for discharge. Low oral intake volumes result in extended stays in the hospital (>2 months) and can lead to surgical implant and explant of a gastros...
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doaj-6b93976dc7b6428988a01da4bad8ab5c2020-11-25T03:20:41ZengFrontiers Media S.A.Frontiers in Human Neuroscience1662-51612020-03-011410.3389/fnhum.2020.00077512481Transcutaneous Auricular Vagus Nerve Stimulation-Paired Rehabilitation for Oromotor Feeding Problems in Newborns: An Open-Label Pilot StudyBashar W. Badran0Dorothea D. Jenkins1Daniel Cook2Sean Thompson3Morgan Dancy4William H. DeVries5Georgia Mappin6Philipp Summers7Marom Bikson8Mark S. George9Mark S. George10Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United StatesDepartment of Pediatrics, Medical University of South Carolina, Charleston, SC, United StatesDepartment of Psychiatry, Medical University of South Carolina, Charleston, SC, United StatesDepartment of Psychiatry, Medical University of South Carolina, Charleston, SC, United StatesDepartment of Psychiatry, Medical University of South Carolina, Charleston, SC, United StatesDepartment of Psychiatry, Medical University of South Carolina, Charleston, SC, United StatesDepartment of Psychiatry, Medical University of South Carolina, Charleston, SC, United StatesDepartment of Psychiatry, Medical University of South Carolina, Charleston, SC, United StatesDepartment of Biomedical Engineering, City College of New York, New York, NY, United StatesDepartment of Psychiatry, Medical University of South Carolina, Charleston, SC, United StatesRalph H. Johnson VA Medical Center, Charleston, SC, United StatesNeonates born premature or who suffer brain injury at birth often have oral feeding dysfunction and do not meet oral intake requirements needed for discharge. Low oral intake volumes result in extended stays in the hospital (>2 months) and can lead to surgical implant and explant of a gastrostomy tube (G-tube). Prior work suggests pairing vagus nerve stimulation (VNS) with motor activity accelerates functional improvements after stroke, and transcutaneous auricular VNS (taVNS) has emerged as promising noninvasive form of VNS. Pairing taVNS with bottle-feeding rehabilitation may improve oromotor coordination and lead to improved oral intake volumes, ultimately avoiding the need for G-tube placement. We investigated whether taVNS paired with oromotor rehabilitation is tolerable and safe and facilitates motor learning in infants who have failed oral feeding. We enrolled 14 infants [11 premature and 3 hypoxic–ischemic encephalopathy (HIE)] who were slated for G-tube placement in a prospective, open-label study of taVNS-paired rehabilitation to increase feeding volumes. Once-daily taVNS was delivered to the left tragus during bottle feeding for 2 weeks, with optional extension. The primary outcome was attainment of oral feeding volumes and weight gain adequate for discharge without G-tube while also monitoring discomfort and heart rate (HR) as safety outcomes. We observed no adverse events related to stimulation, and stimulation-induced HR reductions were transient and safe and likely confirmed vagal engagement. Eight of 14 participants (57%) achieved adequate feeding volumes for discharge without G-tube (mean treatment length: 16 ± 6 days). We observed significant increases in feeding volume trajectories in responders compared with pre-stimulation (p < 0.05). taVNS-paired feeding rehabilitation appears safe and may improve oral feeding in infants with oromotor dyscoordination, increasing the rate of discharge without G-tube, warranting larger controlled trials.https://www.frontiersin.org/article/10.3389/fnhum.2020.00077/fulltranscutaneous auricular vagus nerve stimulationtranscutaneous vagus nerve stimulationvagus nerve stimulationvagus nerve stimulationfeedingpediatric rehabilitation |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Bashar W. Badran Dorothea D. Jenkins Daniel Cook Sean Thompson Morgan Dancy William H. DeVries Georgia Mappin Philipp Summers Marom Bikson Mark S. George Mark S. George |
spellingShingle |
Bashar W. Badran Dorothea D. Jenkins Daniel Cook Sean Thompson Morgan Dancy William H. DeVries Georgia Mappin Philipp Summers Marom Bikson Mark S. George Mark S. George Transcutaneous Auricular Vagus Nerve Stimulation-Paired Rehabilitation for Oromotor Feeding Problems in Newborns: An Open-Label Pilot Study Frontiers in Human Neuroscience transcutaneous auricular vagus nerve stimulation transcutaneous vagus nerve stimulation vagus nerve stimulation vagus nerve stimulation feeding pediatric rehabilitation |
author_facet |
Bashar W. Badran Dorothea D. Jenkins Daniel Cook Sean Thompson Morgan Dancy William H. DeVries Georgia Mappin Philipp Summers Marom Bikson Mark S. George Mark S. George |
author_sort |
Bashar W. Badran |
title |
Transcutaneous Auricular Vagus Nerve Stimulation-Paired Rehabilitation for Oromotor Feeding Problems in Newborns: An Open-Label Pilot Study |
title_short |
Transcutaneous Auricular Vagus Nerve Stimulation-Paired Rehabilitation for Oromotor Feeding Problems in Newborns: An Open-Label Pilot Study |
title_full |
Transcutaneous Auricular Vagus Nerve Stimulation-Paired Rehabilitation for Oromotor Feeding Problems in Newborns: An Open-Label Pilot Study |
title_fullStr |
Transcutaneous Auricular Vagus Nerve Stimulation-Paired Rehabilitation for Oromotor Feeding Problems in Newborns: An Open-Label Pilot Study |
title_full_unstemmed |
Transcutaneous Auricular Vagus Nerve Stimulation-Paired Rehabilitation for Oromotor Feeding Problems in Newborns: An Open-Label Pilot Study |
title_sort |
transcutaneous auricular vagus nerve stimulation-paired rehabilitation for oromotor feeding problems in newborns: an open-label pilot study |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Human Neuroscience |
issn |
1662-5161 |
publishDate |
2020-03-01 |
description |
Neonates born premature or who suffer brain injury at birth often have oral feeding dysfunction and do not meet oral intake requirements needed for discharge. Low oral intake volumes result in extended stays in the hospital (>2 months) and can lead to surgical implant and explant of a gastrostomy tube (G-tube). Prior work suggests pairing vagus nerve stimulation (VNS) with motor activity accelerates functional improvements after stroke, and transcutaneous auricular VNS (taVNS) has emerged as promising noninvasive form of VNS. Pairing taVNS with bottle-feeding rehabilitation may improve oromotor coordination and lead to improved oral intake volumes, ultimately avoiding the need for G-tube placement. We investigated whether taVNS paired with oromotor rehabilitation is tolerable and safe and facilitates motor learning in infants who have failed oral feeding. We enrolled 14 infants [11 premature and 3 hypoxic–ischemic encephalopathy (HIE)] who were slated for G-tube placement in a prospective, open-label study of taVNS-paired rehabilitation to increase feeding volumes. Once-daily taVNS was delivered to the left tragus during bottle feeding for 2 weeks, with optional extension. The primary outcome was attainment of oral feeding volumes and weight gain adequate for discharge without G-tube while also monitoring discomfort and heart rate (HR) as safety outcomes. We observed no adverse events related to stimulation, and stimulation-induced HR reductions were transient and safe and likely confirmed vagal engagement. Eight of 14 participants (57%) achieved adequate feeding volumes for discharge without G-tube (mean treatment length: 16 ± 6 days). We observed significant increases in feeding volume trajectories in responders compared with pre-stimulation (p < 0.05). taVNS-paired feeding rehabilitation appears safe and may improve oral feeding in infants with oromotor dyscoordination, increasing the rate of discharge without G-tube, warranting larger controlled trials. |
topic |
transcutaneous auricular vagus nerve stimulation transcutaneous vagus nerve stimulation vagus nerve stimulation vagus nerve stimulation feeding pediatric rehabilitation |
url |
https://www.frontiersin.org/article/10.3389/fnhum.2020.00077/full |
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