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Problematic Feeding in Newborn Patient, Stomatological Approach

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Problematic Feeding in Newborn Patient, Stomatological Approach www.medigraphic.org.mx Revista Odontológica Mexicana Facultad de Odontología Vol. 16, No. 4 October-December 2012 pp 285-293 CASE REPORT Problematic feeding in newborn patient, stomatological approach. Case report Alimentación difícil en el paciente neonato, el enfoque estomatológico. Reporte de un caso Américo Durán Gutiérrez,* Érika Berenice Castillo Mancilla,§ Eduardo de la Teja Ángeles,II Jaime A Ramírez Mayans¶ ABSTRACT RESUMEN One of the newborn’s main functions in life is feeding. This vital Una de las funciones vitales en los recién nacidos es la alimenta- mechanism is performed through proper suction and deglutition as ción, mecanismo que se lleva a cabo mediante la correcta succión y well as coordinated respiration. These functions enable the newborn deglución, así como el de la respiración coordinada, que hacen po- to feed properly. Nevertheless, sometimes, we fi nd patients who, sible que el neonato se alimente de forma adecuada. Sin embargo, due to their physical characteristics, genetic syndromes (Treacher- en ocasiones encontramos pacientes que por sus características Collins, Pierre Robin, lip and palate clefts) or neurological físicas, síndromes genéticos como Treacher-Collins, síndrome de characteristics such as psychomotor retardation or arthrogryposis, Pierre Robin, fi sura labio-alvéolo-palatina o neurológicas, retraso are conditioned to difficult feeding. It is therefore important to psicomotor y artrogriposis están condicionados a una alimentación establish a treatment protocol to efficiently treat these patients, difícil, por lo que es importante establecer un protocolo de atención so they don’t end up, as fi rst instance, with gastrostomty cases. It de estos pacientes para que sean atendidos de forma más efi caz is also important to recover functions, to enable feeding after the y no terminen en primera instancia con gastrostomías, así como use of probes and syringes or other devices. A multidisciplinary la reintegración de las funciones para la alimentación posterior al approach is fundamental for these cases. Based on a scientific uso de sondas, jeringas y otros dispositivos, por lo que el manejo literature review of these cases, we present the case of a patient, multidisciplinario es fundamental para estos casos. Apoyándonos presenting Treacher-Collins syndrome. The patient presented también en la revisión de la literatura de estos padecimientos, pre- feeding diffi culties in neo-natal phase. We inform of recommended sentamos el seguimiento de un caso de una paciente con síndrome treatment up to the point of complete reinstatement to normal feeding de Treacher-Collins con problemas para alimentarse en la etapa physiology. We deem necessary to assess the characteristics of neonatal, así como el tratamiento recomendado hasta su completa these patients as well as indications for treatment than cannot be reincorporación a la fi siología normal de la alimentación. Surge la considered conventional. necesidad de dar a conocer las características de estos pacientes y presentar las indicaciones para una atención estomatológica que no puede considerarse convencional. Key words: Diffi cult feeding techniques, genetic syndromes, multidisciplinary. Palabras clave: Técnicas de alimentación difícil, síndromes genéticos, multidisciplinario. INTRODUCTIONwww.medigraphic.org.mx Feeding implies an important challenge when the patient presents genetic syndromes that involve * Physician Attached to Pediatric Stomatological Service at the improper development of craniofacial structures, other Pediatrics National Institute. Specialty Associate Professor. § Former Resident, National Pediatrics Institute. genetic syndromes such as Treacher-Collins, Pierre II Head of Pediatric Stomatology, National Pediatrics Institute. Robin sequence facial-auricular-vertebral spectrum, ¶ Head of the Gastro-nutrition Service, National Pediatrics as well as all syndromes presenting clefts in the lips Institute. or palate (Table I), as well as patients affl icted with This article can be read in its full version in the following page: neurological disorders which might condition a diffi cult http://www.medigraphic.com/facultadodontologiaunam 286 Durán GA et al. Problematic feeding in newborn patient, stomatological approach Table I. Genetic syndromes related to feeding diffi culties. Condition Structural defect Repercussion on feeding process Achondroplasia Limitation of head movements due to Postural complications during feeding process decrease of foramen magnus Alagille Cardiopahies Respiratory diffi culties Antley-Bixler Maxillary hypoplasia, small tongue, Oral breathing, diffi culties in suction cleft palate Apert Cleft palate, dolichocephaly Communication of nasal cavity with oral cavity Beckwith-Wiedemann Macroglossia Airway obstruction Cornelia de Lange Mandibular hypoplasia, neurological Diffi culty in breathing, diminished born refl exes disorders Down Hypotonia Lesser strength to perform suction Epidermolisis bullosa Mucosa fragility Bullae formation due mother’s breast or pacifi er EFAV Upper or lower jaw unilateral or bilateral Lack of circum oral sealing hypoplasia Freeman-Sheldon Orbicularis oris muscle dysplasia Lesser strength to perform suction Holoprosencephaly Agenesis of the premaxilla Lack or circum oral sealing Hay-Wells Cleft palate Communication between oral and nasal cavities Hunter Tonsillar hypertrophy, macroglossia Breathing diffi culties KlippelFeil Fusion of the cervical spine Diffi culties in reaching proper posture for feeding process Moebius Sixth and 7th cranial pair nuclei agenesis Circum oral muscles lack motility Osteogenesis imperfect Bone fragility Risk of fractures when performing suction Patau FLAP Communication between oral and nasal cavities Pierre Robin Micrognatia, glossoptosis, FLAP Breathing diffi culties, communication between oral and nasal cavities Prader-Willi Psychomotor retardation Alteration of innate refl exes Rubinstein-Taybi Psychomotor retardation, cleft palate, Alteration of innate refl exes, communication tongue hypomobility between oral and nasal cavities, swallowing diffi culties Seckel Micrognatia,www.medigraphic.org.mx glosoptosis, FLAP Breathing diffi culties. Communication between oral and nasal cavities Treacher-Collins Micrognatia, cleft palate Breathing diffi culties. Communication between oral and nasal cavities Cardio-facialvelum Velum-palate insuffi ciency, disorders of Breathing and swallowing diffi culties the 12th cranial pair. Cardiopaties William-Beuren Macroglossia, hypotonia, RPM Breathing, suction and deglutiton diffi culties, alteration of born refl exes Revista Odontológica Mexicana 2012;16 (4): 285-293 287 feeding process. A multidisciplinary approach is In the newborn, feeding is guaranteed by the therefore fundamental to achieve full adaptation or presence of the aforementioned adaptive reflexes, reinstatement to feeding basic functions. as well as those reflexes targeting the protection of Until the XVIII century, almost all live newborns airways (extrusion, bite, vomit and cough). At the 4th were breast-fed, either by their mother or a nurse. or 5th month of life, this refl ex action undergoes a shift Breastfeeding was vital for newborn survival.1 towards a voluntary conduct pattern. This is due to the Establishment of breastfeeding depends on a growth of the facial and oral structures, to the maturation learning and adaptation process between mother of the nervous system, and to the repetition of oral and infant. The first breastfeeding experiences, that experiences as a function of the feeding process.2 All is to say, the first oral experiences of the infant are the aforementioned facts pertain to a healthy newborn. vital to the later development of the breastfeeding process. FEEDING IN SPECIAL CHARACTERISTICS Proper feeding depends on the mother, the infant, PATIENTS technique and environmental factors present at that particular time. They can result in success or represent Oral dysfunctions are disorders of the proper suction- a risk for the infant’s survival.2 deglutition pattern. They can be primary or secondary At birth, identification of the infant’s adaptive dysfunctions. Primary dysfunctions are a consequence refl exes such as suction, deglutition and search are of immaturity, of individual anatomical characteristics needed to initiate the process of feeding. Search that hinder proper fi t. Defects in the fi rst and second reflex is the infant’s automatic reaction when his branchial arch result in the lack of fundamental cheek is being caressed. It consists on turning the structures which enable feeding, they can also give head towards the stimulated side, and beginning to rise to neurological alterations.7,8 These neurological suckle.3 Suction is probably the most important event alterations can be transitory or permanent, and they during breast-feeding. Through this mechanism hinder the newborn’s position during the process the infant transfers milk from the breast to the oral of suckling, forcing the infant into acquiring atypical cavity. At the same time it triggers a series of refl exes postures.9 Secondary oral dysfunctions arise when the (oxytocin and prolactin release) which regulate newborn modifi es his original deglutition-suction pattern synthesis and flow of milk. This becomes evident in order to avoid facial pain (use of forceps) or due to when observing proper pressure of the lips, as well certain deleterious habits such as the use of a pacifi er as generation of negative pressure to bring fl ow to and nursing bottle during the neonatal period.2 the oral cavity.4
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