39 - Longitudinal Assessment of Nutritive Sucking Metrics for Early Risk Stratification in Hypoxic-Ischemic Encephalopathy

Publication Number: 1032.39

Amy Barnett, Cook Children's Medical Center, Fort Worth, TX, United States; Mozhde Askari, Cook Childrens Health Care System, Fort Worth, TX, United States; Amanda K. Crandall, University of Michigan, Ann Arbor, MI, United States; Julie Lumeng, University of Michigan Medical School, Ann Arbor, MI, United States; Sabrina Shandley, Cook Children's Medical Center, Fort Worth, TX, United States; David Riley, Cook Childrens, Fort Worth, TX, United States; Yvette R. Johnson, Cook Children's Hosp Nest Clinic, Fort Worth, TX, United States; Ioannis Ntoumanis, Cook Children's Health Care System, Fort Worth, TX, United States; Christos Papadelis, Cook Children's Health Care System, Fort Worth, TX, United States

Background: HIE is a significant cause of neonatal brain injury with 20−40% of survivors experiencing neurodevelopmental impairments. Early identification is crucial for timely intervention, but standard diagnostic tools like MRI and ultrasound are limited by cost, sedation needs, and timing issues relative to therapeutic hypothermia. This necessitates the search for accessible alternatives. Infant sucking, an early, complex behavior offers a highly accessible and non-invasive window into central nervous system function, suggesting its potential as a prognostic tool.

Objective: This study investigates whether objective, quantitative metrics of infant nutritive sucking can serve as sensitive, non-invasive, and early biomarkers of neurological dysfunction in infants with Hypoxic-Ischemic Encephalopathy (HIE). We hypothesized that HIE infants would show poorer sucking performance and distinct developmental trajectories compared to neurotypical controls, supporting early risk stratification.

Design/Methods: We conducted a longitudinal observational cohort study including 49 neurotypical control infants and 10 term-born neonates with HIE (8 moderate, 2 severe). Nutritive sucking was assessed at 1, 2, 4, and 6 months of age during bottle feeding using the FDA-approved nfant® feeding system. Quantitative metrics included sucking amplitude, smoothness, irregularity, and frequency. Data analysis utilized a mixed ANOVA (Group × Time).

Results: Analysis revealed significant Group × Time interactions for smoothness (F = 6.213, p = 0.014), amplitude (F = 4.865, p = 0.029), and frequency (F = 5.407, p = 0.023), confirming distinct developmental windows. Crucially, at 1 month, sucking smoothness was significantly lower in HIE infants compared to controls (p = 0.032), establishing early differentiation. While both cohorts demonstrated significant developmental progression (e.g., controls improved by 22% vs. HIE by 18%), the HIE group exhibited a reduced overall rate of skill acquisition.

Conclusion(s): Quantitative analysis of infant sucking behavior provides a sensitive, objective, and non-invasive assessment of neurodevelopmental status in infants with HIE. Smoothness at 1 month emerges as a highly sensitive early biomarker of neurological dysfunction. The progression observed in the HIE infants highlights substantial neuroplasticity potential. Incorporating objective sucking assessments, specifically smoothness at 1 month, into neonatal care can enhance early risk stratification and support more targeted, timely interventions, ultimately improving long-term developmental outcomes.