Noninvasive Vagus Nerve Stimulation To Enhance Neonatal Feeding

Link to study: Badran et al. 2018

Overview:

Infants born prematurely or who suffer a global hypoxic ischemic encephalopathy (HIE) are at high risk for motor problems, which manifest as feeding delays during their hospital admission. Oromotor dyscoordination is common in these infants, and feeding difficulty is the primary reason for delayed discharge [1]. Many infants who do not master this motor skill before term age (40–42 weeks gestation) will receive a gastrostomy tube (G-tube) for direct gastric feeding. Furthermore, feeding difficulties in infants are associated with later language delays, even in the absence of gross motor impairment [2].

Currently, the only treatment to improve oromotor skills during feeding consists of occupational therapy working with the infant to encourage safe feeding behavior. In other brain injuries, pairing brain stimulation with rehabilitative motor training has shown promise to stimulate activity-dependent neuroplasticity and remodeling of motor cortex [3, 4, 5, 6]. In animal models of CNS injury and adults after stroke, vagus nerve stimulation via implanted cervical electrodes (VNS) improves function when paired with motor activity [3,6, 7, 8]. Recently, transcutaneous stimulation of the auricular branch of the vagus nerve (taVNS) has emerged as a non-invasive form of VNS with minimal side effects [3,6,9].

Our premise is that in babies at high risk for motor problems with feeding delay, brain stimulation via taVNS delivered simultaneously with active sucking from a bottle will enhance cortical plasticity involved in learning oromotor skills, leading to better oral feeding. As a first step, we sought to determine feasibility, and refine and optimize the protocol for delivering taVNS stimulation in neonates. We describe 5 patients who have successfully undergone taVNS paired feedings in a phase 0 study.