Andrea Valles, a neonatal logopedic (speech therapist), writes this post about the logopedic treatment of premature newborns.
On November 14, 2024, LactApp held a specialized training in neonatal logopaedics, focused on logopaedic treatment applied to the premature newborn. This course, aimed at speech therapists (logopedists) and health professionals, focused on the importance of early intervention and how logopedics can improve the oral feeding of premature infants, a group particularly vulnerable to alterations in their oral and motor functions.

Early intervention

The training emphasized the importance of early intervention, as premature infants often present with oral muscle weakness, difficulty coordinating sucking, swallowing, and breathing, and oral aversions caused by prolonged use of nasogastric and orogastric tubes. Unlike full-term infants, premature infants are at a distinct disadvantage in acquiring these processes effectively due to their incomplete development at birth.

The tools

During the session, tools and strategies were offered that allow logopedists to work on orofacial stimulation and on improving the coordination of sucking, swallowing, and breathing. The professionals learned techniques that, in addition to facilitating the first oral feedings, also favor the oral muscle strengthening necessary for the transition to direct feeding at the breast, which guarantees positive and safe experiences for babies. These included the PIOMI method, a 5-minute technique where the little finger is used to stimulate the mouth and surrounding areas in premature babies, even for those born as young as 29 weeks of pregnancy. On the other hand, the Fucile Orofacial Stimulation Program was also developed to improve sucking, swallowing, and breathing in premature infants through a series of tactile and motor stimulation techniques in the oral cavity.

Evaluation scales to assess development

Similarly, various scales used to assess the development and needs of preterm infants were discussed, including the NOMAS, the COCANP, and the EFSA. These tools are essential for health professionals, as they allow a detailed and systematic assessment of key aspects of preterm infant care. The NOMAS (Neonatal Oromotor Assessment Scale) focuses on classifying infants with dysfunctional or disorganized suction-deglutition based on jaw and tongue mobility characteristics, while the COCANP (Observational Questionnaire of Feeding Behaviors in Preterm Neonates) focuses on feeding behaviors, and identifies the ideal time to initiate orofacial stimulation, as well as the initiation of the first oral feedings. The EFSA (Early Feeding Skills Assessment) assesses risk factors that may influence the health and development of premature and full-term infants. Together, these scales provide a comprehensive view of the health status of newborns, allowing speech-language pathologists and healthcare professionals to implement early and personalized interventions to improve their prognosis and quality of life.

Significantly, scales such as NOMAS, COCANP, and EFSA are not the only tools used in the Neonatal Intensive Care Unit (NICU). We also have other key scales complementing the comprehensive assessment of preterm infants. These include the LATCH, which assesses the effectiveness of breastfeeding and the infant’s ability to breastfeed; the PIBBS (Premature Infant Behavioral Rating Scale), which is used to observe and rate the behavioral responses of newborns; and the POFRAS (Oral Feeding Readiness Assessment Scale), which allows for objective and accurate assessment of oral feeding issues in the infant. In addition, the NeoEAT is another important tool for assessing feeding ability in preterm infants, especially in their transition to oral feeding. These scales, together with those previously mentioned, provide a multidimensional approach to monitoring the health and developmental condition of preterm infants in the NICU, allowing more personalized and appropriate care to their specific needs.

Finally, we must recognize that applying assessment scales and intervention in preterm infants requires specific and rigorous training. Scales must be administered by trained professionals to ensure their validity and effectiveness, as their correct interpretation and use are essential for the proper development of infants. Similarly, speech-language pathologists (logopedists) who wish to specialize in working with preterm infants should obtain accreditation in specific techniques, such as the PIOMI Method, to ensure that their interventions are safe, effective, and adapted to the needs of this vulnerable population. Continuing education and accreditation in these areas are key to optimizing outcomes and providing quality care for premature infants.

Andrea Valles

Neonatal and pediatric speech therapist Andrea specializes in special educational needs, early care, and orofacial motor skills.
You can find her in the LactApp Barcelona Clinic and @logopedia_neonatal.