BLOOMINGTON — Using the pinky finger of her right hand, Brenda Lessen stroked Hattie Abrahamsen’s lips, gums, tongue, palate and inside her cheeks.
“I’m trying to increase her range of motion and muscle strength so she’ll learn to suck better,” Lessen explained as she performed her five-minute intervention on the 2-day-old infant born at 36 weeks gestation at OSF St. Joseph Medical Center.
The intervention that Lessen was demonstrating on Hattie is generating interest worldwide.
Lessen, an assistant professor of nursing at Illinois Wesleyan University, has developed the Premature Infant Oral Motor Intervention (PIOMI) for use on premature infants beginning at 29 weeks gestation. PIOMI is a series of eight massages that target the mouth, gums, tongue, palate and cheeks to build muscle and train the brain to prepare premature infants for bottle feeding.
Preterm infants don’t oral feed because their oral motor skills are underdeveloped and they lack the coordination of sucking, swallowing and breathing, Lessen explained. Infants born full term (40 weeks) have developed neurologically enough to coordinate sucking, swallowing and breathing so they can feed.
That’s why infants born prematurely are fed through feeding tubes.
But infants can’t be discharged from the hospital until they can feed orally and gain weight, Lessen said. What that means is that difficulty with oral feeding leads to longer hospital stays and higher costs.
Lessen’s simple, low-tech solution is a five-minute oral motor intervention that activates muscle contraction and builds strength to encourage infants to suck.
A clinical trial of Lessen’s technique found that preterm infants who received the intervention beginning at 29 weeks for five minutes a day for seven days transitioned to oral feeding five days sooner and were discharged from the hospital 2.6 days sooner than infants who received a “sham intervention.”
With more than a half million premature infants born each year, a three-day decrease in hospital stays would save the country $2 billion a year, she said.
That’s why hospitals around the world — from Children’s Hospital of Illinois at OSF Saint Francis Medical Center in Peoria to medical centers in China, Iran, Argentina, Canada, Taiwan, France, Brazil and Thailand — are training their NICU (neonatal intensive care unit) staffs on the technique.
“My observations are that, when the intervention is done, they (preterm infants) are more alert, more responsive and they latch onto the nipple and suck,” said Callie Leach, a speech/language pathologist who specializes in treating premature infants at St. Luke’s University Hospital in Bethlehem, Pa.
“This is a wonderful thing to do prior to feeding to get them to accept the nipple and suck and swallow. Until now, we’ve been gavage(tube)-feeding them.”
The technique alerts, warms up and strengthens an infant’s sensory system, which is used to feed through the mouth, she said.
“I’m very excited about this,” said Leach, among NICU staff trained by Lessen in the technique. “It’s great to have this tool that we can use. It’s worth the time and the training because the baby is going to have better outcomes.”
Hattie was born four weeks early by Caesarean-section because she had intrauterine growth restriction. While Hattie already had breast fed and was doing well, her mother, A.J. Abrahamsen of Normal, agreed to the demonstration, believing it could only help to increase the strength and range of motion of the muscles in and around Hattie’s mouth.
“I believe it’s absolutely incredible what she’s come up with,” said Abrahamsen, a family nurse practitioner student at Saint Francis.
Lessen understands why her technique is generating international attention, but still is taken aback.
“I’m kind of surprised by all the interest,” she admitted in her small IWU office, where her decorations range from a State of Illinois Nurse Educator Fellowship received last year from the Illinois Board of Higher Education to pictures of her daughters. “People have been saying ‘Hey, we’ve been looking for something like this.’”
Lessen, who has a doctoral degree in neonatal nursing science, has taught at several colleges and worked in the NICU at Saint Francis; in nursing management and clinical education at Proctor Hospital, Peoria; and in obstetrics, pediatrics and home health at what was then called BroMenn Regional Medical Center, Normal. She has been teaching nursing for 18 years.
During her doctoral work, Lessen became interested in preterm infant feeding and began to study how to train the brain in a preterm infant whose normal intrauterine development was cut short. About 12.7 percent of births in the United States are preterm, she said. That number — and the survival rate of preterm infants — is increasing, meaning costs are going up, she said.
She began to study and develop an intervention that activates neurons to prepare preterm infants for bottle and breastfeeding. She consulted Debra Beckman, a speech/language pathologist who developed an oral motor program. But Beckman’s program was too long to be tolerated by preterm infants.
So Lessen — using her expertise as a NICU nurse and her research in brain wiring and Beckman’s expertise in oral motor stimulation — developed a program of eight steps that take five minutes. It was the first oral motor intervention specifically for preterm infants and the clinical trial showed that it worked.
As of last week, 12 health centers in the United States and 11 in other countries had trained nurses and therapists on the intervention. In some cases, Lessen has gone to the hospitals to train the staff. Other times, she sends NICU staff a training DVD and packet of material that includes written instructions.
Other studies are being conducted. For example, a study in Tehran, Iran, with an even larger group of preterm infants produced almost identical results to the first study.
Dawn Miller, a speech/language pathologist at Easter Seals’ Bloomington center, was trained in the technique, used it on a full-term infant who hadn’t developed oral motor skills because of a medical condition and believes it was beneficial.
“He did show some increased tolerance to me touching his lips and cheeks and accepted small amounts of baby food on his tongue and lips without crying or being stressed,” Miller said. “That’s progress, but I have no way of showing that it was related to the program.”
As more medical centers use the technique, Lessen’s next step will be a larger clinical trial with an expanded sample size. She wants to determine whether the intervention would benefit infants even as they are learning to feed and infants identified as poor feeders and wants to train parents to use PIOMI techniques on their own children.
“It’s very user-friendly for parents,” said Leach, who is involved in getting another research study started on PIOMI. “Parents of low-birth-weight infants feel helpless. This would give them something they could do at the bedside to help their infants to feed.”