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A Baby's PAL

The nurses call them “growers and feeders”–they’re the premature babies who’ve already done their time in the hospital and are finally ready to go home. Except for one thing—they don’t know how to eat.

Surprisingly, “preemies”—infants born before spending 34 weeks in their mother’s womb—often don’t know how to suck—either bottle or breast—so they’re fed through IV tubes. A baby born at 23 weeks typically will spend 11 weeks in a hospital’s neonatal intensive care unit being fed through an IV before he or she is ready to be discharged. Hospital policy typically won’t let preemies go home until they learn to feed from a nipple (either bottle or breast); the problem is that such infants have never tasted milk or baby formula and have little motivation to learn how.

And, not surprisingly, preemies come with a variety of other complicating factors as well. Babies with underdeveloped lungs—a common preemie characteristic—who’ve had to spend time with ventilator tubes in their mouths often develop an aversion to having anything in their mouths at all, including nipples. Often such babies go home still being fed by tube, and wait months–sometimes up to a year–only to be readmitted to the hospital to try to learn to feed by mouth again. Even if this works, sometimes these still underdeveloped infants will suck on the bottle so hard and fast that they almost quit breathing. In such cases, nurses have little choice but to reinsert the feeding tubes.

It’s a huge problem in neonatal units nationwide, and it came up constantly in meetings that music therapist Jayne Standley had with the parents of preemies while she was working on a study at Tallahassee Memorial HealthCare, a large public hospital near Florida State’s campus. “I thought about (a previous) study with one-month-olds, that told us their brains were already wired to discriminate,” says Standley. “I wondered if music might be reinforcing to these babies, even though they’re premature. What if they could have a pacifier that turns on music and reinforces the sucking response?”

Standley contacted Eitaro Kawaguchi, an electronics engineer within FSU’s Center for Music Research, and described what she wanted—a pacifier connected to a box and a tape player with a pressure meter and a timer. As the babies sucked on the pacifier, any change in air pressure in the nipple would elicit an electrical signal that turned the tape player on or off after a specified period of time, say 10 seconds.Standley soon had a working prototype of the device being tested by tiny subjects in Tallahassee Memorial’s neonatal unit. “It took two-and-a-half minutes for the babies to learn that if they sucked once every nine seconds, they could keep the music on,” Standley says.

Though born with neural networks not quite ready for prime time, the preemies showed they had ample ability to learn. And their only prize for learning to suck with Standley’s device? Lullabies—not food, which came later when the babies proved they had finally mastered the sucking knack.

The resulting invention, patented by FSU, was dubbed PAL, for pacifier-activated lullaby. Last fall, the training device finally won FDA approval for teaching feeding behaviors. PAL is now being developed for marketing as hospitals line up to be among the first to offer it in their neonatal units.

One of Standley’s doctoral students, Jennifer Whipple, focused her dissertation, defended this past fall, on the device. “We know that music and pacifier-sucking can be soothing for infants during painful procedures, so the purpose of my dissertation was to determine if the combination of music and sucking and the element of control over the provision of music that PAL gives to infants would be as or more beneficial.

”Whipple studied 60 pre-term, low birth-weight babies at Atlanta’s Northside Hospital and found that they were able to be calmed much faster than babies using a regular pacifier or nothing at all. Behavior state and stress level were lower and more stable for infants who received PAL therapy than for the other infants. Other FSU studies at TMH found that premature babies feed better and gain more weight after training with PAL.

Florida State has a licensing agreement with Healing HealthCare Systems, a U.S. firm developing PAL as a commercial product. Ohmeda Medical Inc., a division of General Electric Healthcare Worldwide, is set to market and distribute PAL once testing—now underway at Tallahassee Memorial and 50 other hospitals in the U.S.—is completed. – K.M


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