We would like to acknowledge the following NIH funding sources: DC016030 and DC019902. We would also like to thank the members of the Speech &#38; Neurodevelopment Lab and the families who participated in our numerous studies.

Northeastern University&#39;s institutional review board has approved studies using the NNS device with human subjects (15-06-29; 16-04-06; 17-08-19). Informed consent was obtained from the children&#39;s caregivers. All research personnel have completed human subject training prior to collecting any data with the NNS device. The SNL team has generated several training resources and protocols for new research personnel to complete prior to data collection using the NNS device. These training sessions include reviewing th...

A Custom-Made Pressure Transducer System to Record Non-Nutritive Suck Bursts

The NNS device has several limitations that are important to acknowledge. Although NNS provides critical insight into feeding9, there is a considerable amount of extrapolation from NNS to feeding performance. Solutions to this limitation have included research teams pairing NNS results with actual feeding observations and comprehensive feeding-related questionnaires for caregivers to more fully capture how NNS relates to feeding18. In addition, an infant can have a well-pat...

Non-nutritive suck (NNS) is one of the first occurring behaviors that an infant can perform with their mouth soon after birth and therefore has the potential to provide meaningful insights into brain development1. NNS refers to sucking movements without nutritional intake (e.g., sucking on a pacifier) and is characterized by a series of rhythmic expressions and suction movements of the jaw and tongue with pause breaks for breathing. Common parameters of NNS have been noted to include an average NNS burst (series of suck cycles) of 6-12 suck cycles with an intra-burst frequency of two sucks per second2; however, NNS features vary among clinical populations3,4 and dynamically change during the first year of life5. These changes are attributed to the growth of the oral cavity and associated anatomy, maturation of feeding skills and neurodevelopment, and experiences. The neural bases of NNS mainly include the suck central pattern generator in the central gray of the brainstem, comprising an intricate network of interneurons and the facial and trigeminal motor neuron nuclei6. A coordinated NNS also relies on intact neural pathways among cortical and brainstem regions to modulate its performance to sensory stimuli7,8, which makes NNS a viable indicator of early neural function and development.
NNS measures are linked to feeding success in premature infants9,10, and both sucking and feeding outcomes have been linked to subsequent motor, communication, and cognitive development11,12,13. In a retrospective study that characterized 23 preschool-aged children with language and motor impairments, 87% had a history of early feeding issues, which included difficulties in sucking11. Nutritive sucking performance immediately following birth and caregiver reports of feeding difficulties were significantly associated with multiple domains of neurodevelopment in children 18 months of age12,14. Interestingly, the sensitivity and specificity of feeding performance were higher than ultrasound assessment of the brain on neurodevelopmental outcome measures12. In another study, sucking/oral motor performance scores assessed via the neonatal oral-motor assessment scale15 in early infancy were associated with motor skills, language, and measures of intelligence at 2 and 5 years of age in a cohort of children born prematurely13,16.
Given that sucking and feeding can be sensitive indicators of neurodevelopmental outcomes throughout childhood, there is a critical need for accessible, accurate, and quantitative assessment of NNS to help identify children at risk for delayed and disordered development to provide early intervention. This need led to the design and research utilization of the Speech &#38; Neurodevelopment Lab&#39;s (SNL) NNS device. This portable device includes a pacifier attached to the end of an easy-to-hold handle, connected to a customized pressure transducer designed in-house, and connected to a data acquisition center (DAC). The DAC connects to a laptop, and the data is recorded via data acquisition and analysis software. The pressure transducer measures pressure changes inside the pacifier and converts it into a voltage signal. The DAC contains converters that change the analog voltage signal to digital values in cmH2O that are visualized and recorded via the data acquisition and analysis software. NNS outcome measures that can be analyzed from the suck signal waveform include NNS duration (how long a suck burst lasts measured in s), amplitude (measured as peak height subtracted by peak-trough in cmH2O), cycles/burst (number of suck cycles within a burst), frequency (intra-burst frequency measured in Hz), cycles (number of suck cycles that occur in a min), and bursts (number of suck bursts that occur in a min).

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Case</td>
			<td>Pelican</td>
			<td>1560</td>
			<td></td>
		</tr>
		<tr>
			<td>Data Acquisition and Analysis Software/LabChart</td>
			<td>ADInstruments</td>
			<td>8.1.25</td>
			<td></td>
		</tr>
		<tr>
			<td>Data Acquisition Center (PowerLab 2/26)</td>
			<td>ADInstruments</td>
			<td>ML826</td>
			<td></td>
		</tr>
		<tr>
			<td>Laptop</td>
			<td>Dell</td>
			<td>Latitude 5480</td>
			<td></td>
		</tr>
		<tr>
			<td>Pressure Calibrator</td>
			<td>Meriam Process Technologies</td>
			<td>M101</td>
			<td></td>
		</tr>
		<tr>
			<td>Soothie Pacifier</td>
			<td>Phillips Avent</td>
			<td>SCF190/01</td>
			<td></td>
		</tr>
		<tr>
			<td>Syringe</td>
			<td>CareTouch</td>
			<td>CTSLL1</td>
			<td></td>
		</tr>
	</tbody>
</table>

non-nutritive suck parameters measurements using a custom pressure transducer system

The non-nutritive suck (NNS) device is a transportable, user-friendly pressure transducer system that quantifies infants' NNS behavior on a pacifier. Recording and analysis of the NNS signal using our system can provide measures of an infant's NNS burst duration (s), amplitude (cmH2O), and frequency (Hz). Accurate, reliable, and quantitative assessment of NNS has immense value in serving as a biomarker for future feeding, speech-language, cognitive, and motor development. The NNS device has been used in numerous research lines, some of which have included measuring NNS features to investigate the effects of feeding-related interventions, characterizing NNS development across populations, and correlating sucking behaviors with subsequent neurodevelopment. The device has also been used in environmental health research to examine how exposures in utero can influence infant NNS development. Thus, the overarching goal in research and clinical utilization of the NNS device is to correlate NNS parameters with neurodevelopmental outcomes to identify children at risk for developmental delays and provide rapid early intervention.

Author Spotlight: Implications of Non-Nutritive Sucking on Speech Emergence and Infant Development

Non-Nutritive Suck Parameters Measurements Using a Custom Pressure Transducer System

My research examines the cross section of sucking, feeding and speech emergence across environmental, maternal, physiological and genetic factors and across patient populations. I seek to determine how factors influence sucking, feeding and speech emergence with the goal of providing targeted assessments earlier for infants who experience sucking and feeding delays. Our research has established the first standardization of NNS at specific time points in the first year of life and how characteristics of NNS change across the sample.We have shown that aspects of NNS relate to neurodevelopmental outcomes and vary across clinical populations of infants. In both research and clinical settings, very few assessment tools exist for quantifying infant NNS. Our protocol bridges this gap by providing a quantitative, physiologically-based system to assess infant NNS that is transportable and can be utilized in a variety of clinic and research-based settings.Data in our lab shows that infant non-nutritive suck is a sensitive indicator of exposures in utero and is linked with subsequent neurodevelopmental outcomes. Ultimately, my goal is to attain enough data to change public policy and allow for a non-nutritive suck screen for all infants soon after birth, much like a newborn hearing screen. Results have consistently demonstrated that quantitative NNS measurement is a sensitive biomarker of neurodevelopment.This has led to more specific research questions regarding how NNS relates with subsequent communication and neuromotor outcomes and attempts to uncover the underlying mechanisms that link these domains. Future research with the NNS device will focus on describing NNS performance in clinical populations. If we can distinguish typical versus atypical NNS behavior with the device, this would significantly help its clinical utility by identifying children at potential risk for future issues with feeding or oral motor development.

The NNS device has been used in numerous published studies that incorporate NNS outcome measures17,18,19. In the example data shown in Figure 7, bursts have been manually identified with the following criteria: more than one suck cycle per burst, cycles having at least an amplitude of 1 cmH2O, and suck waveforms within 1000 ms of each other. Once bursts are identified, the custom Macro ou...

Read this Scientific Article Protocol about Author Spotlight: Implications of Non-Nutritive Sucking on Speech Emergence and Infant Development at JoVE.com

The non-nutritive suck (NNS) device can easily collect and quantify NNS features using a pacifier connected to a pressure transducer and recorded through a data acquisition system and laptop. Quantification of NNS parameters can provide valuable insight into a child's current and future neurodevelopment.

The non-nutritive suck (NNS) device is a transportable, user-friendly pressure transducer system that quantifies infants' NNS behavior on a pacifier. ...

Non-Nutritive Suck Parameters Measurements Using a Custom Pressure Transducer System

Abstract