1540

DEMAND FOR SPEECH THERAPY INTERVENTION

IN NEONATAL UNIT OF A TEACHING HOSPITAL

Demanda para intervenção fonoaudiológica

em uma unidade neonatal de um hospital-escola
Mariana Miranda Fumelli Monti (1), Marilda Baggio Serrano Botega (2),
Maria Cecília Marconi Pinheiro Lima (3), Sabrina Maria Pereira Kubota (4)

ABSTRACT

Purpose: the aim of the present study was to characterize the demand for speech therapy among
newborns with oral feeding difficulties at a neonatal unit of a public teaching school. Methods: a
descriptive, retrospective, cross-sectional study was carried out using data obtained from all charts
of newborns interned between March 2008 and February 2010 who received at least one speech/
hearing evaluation/intervention. Results: two hundred five newborns were treated in the study period,
104 of whom met the inclusion criteria. The sample was predominantly male, composed of premature
newborns with adequate gestational age (mean: 36 weeks) and low birth weight. The most frequent
diagnoses were respiratory disorder, jaundice and cardiovascular disorder. The following were the
predominant reasons for requesting an evaluation by a speech therapist: abnormal oral motor behavior,
evaluation of readiness for oral feeding and difficulties using a cup. Most evaluations were requested
by residents when the newborns had a mean of 28 days of life. A broader set of criteria was used by
the team requesting a speech therapy evaluation in comparison to criteria described in the literature.
Conclusion: the majority of newborns receive oral feeding without a prior evaluation by a speech
therapist, which can lead to situations of risk with regard to safe, efficient feeding.

KEYWORDS: Neonatology; Speech, Language and Hearing Sciences; Feeding

„„ INTRODUCTION difficulties1,2 due to the effect of prematurity, low

birth weight and clinical conditions on the feeding
process.
Advances in medical and hospital technologies
in the past 30 years have contributed to a reduction Speech and hearing therapy in the neonatal period
in neonatal mortality rates, especially in cases is focused on aspects of feeding, the development
of hearing and language and mother-infant interac-
of infants born prematurely and/or with systemic
tions. The aim of assisting in the feeding process
syndromes. This population may exhibit oral feeding
is to promote healthy, efficient feeding in terms of
nutrition, weight gain and the mother-infant bond
(1)
School of Medical Sciences, Universidade Estadual de
and minimize the risk of aspiration and stress1,3,4.
Campinas - UNICAMP, Campinas, São Paulo, Brazil.
This therapy should include an evaluation, the early
(2)
Speech and Hearing Course, School of Medical Sciences,
Universidade Estadual de Campinas - UNICAMP, Campi- detection of uncoordinated sucking-swallowing-
nas, São Paulo, Brazil. breathing and deficient or absent reflexes of the oral
(3)
Speech and Hearing Course, School of Medical Sciences, motor sensory system, orientation of the neonatal
Universidade Estadual de Campinas - UNICAMP, Campi- team regarding feeding issues, stimulation of the
nas, São Paulo, Brazil.
oral motor sensory system, outpatient follow up and
(4)
Neonatal Speech and Hearing Therapy Service, Prof. Dr.
the encouragement of breastfeeding5. The aim of
José Aristodemo Pinotti Women’s Hospital (CAISM), Uni-
versidade Estadual de Campinas - UNICAMP, Campinas, motor sensory stimulation is to facilitate the dietary
São Paulo, Brazil. transition and speed up discharge from hospital in
Conflito de interesses: inexistente cases of intubation or prolonged use of a feeding

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 Demand for speech therapy in neonatology  1541
tube as well as to improve nutritional aspects, feeding behavior at the maternity ward of a public
gastrointestinal function and global maturation of teaching hospital.
the newborn6-8.
The literature highlights the following criteria „„ METHODS
for soliciting an evaluation by a speech therapist
in neonatal units: absent or deficient oral reflexes;
exacerbated vomiting reflex; severe irritability; A descriptive, retrospective, cross-sectional
sialorrhea; uncoordinated sucking-swallowing- study was carried out at the Neonatal Unit of the Prof.
breathing; oxygen desaturation; abnormal respi- Dr. José Aristodemo Pinotti Women’s Hospital of the
ratory and heart rates during feeding; nasal or Center for Integral Women’s Health Care, CAISM/
gastroesophageal reflux; unexplainable refusal to UNICAMP, Brazil. This study received approval
feed; malnutrition; dehydration; and lethargy during from the Human Research Ethic Committees of the
feeding5,9. Women’s Hospital (process number 024/2010) and
The effectiveness of speech therapy has been UNICAMP School of Medical Sciences (process
demonstrated in a number of studies through the number 666/2010). Since the data collection involved
association between speech therapy and a shorter information from medical charts, a statement of
hospital stay1. Despite the proven benefits of this informed consent was deemed unnecessary.
type of therapy, many neonatal services do not have Data were obtained from the speech and
a speech and hearing therapist on staff and do not hearing therapy charts of hospitalized newborns
send this risk population for early speech therapy10. who received treatment between March 2008 and
The Prof. Dr. José Aristodemo Pinotti Women’s February 2010. All newborns who received at least
Hospital of the Center for Integral Women’s Health one speech therapy evaluation/intervention in the
Care (CAISM/UNICAMP), is a public teaching neonatal service in this period and who had all
hospital and tertiary reference center for women’s routine data filled in on the speech therapy chart
and newborn health in the state of São Paulo, Brazil, were included in the study.
that was accredited as a Child Friendly Hospital in The speech therapy chart contains the standard
November 2003. Approximately 250 children are form and records of all care offered during hospi-
born in the maternity ward of this hospital every talization and outpatient follow up. The form
month11,12. The neonatal unit includes an intensive contains data on patient identification, condition of
care unit, semi-intensive care unit, rooming-in, the newborn on the day of evaluation and speech
late-rooming in and specialty clinics. The team is therapy evaluation and conduct. The following
composed of different health professionals, including
variables were studied:
two speeches and hearing therapists working on
feeding and hearing, each with a weekly workload of 1) Characterization of the population: sex, gesta-
12 hours. The unit is part of the curriculum of under- tional age at birth, nutritional status, birth
graduate students of speech and hearing therapy weight, Apgar index, diagnostic hypothesis and
of the School of Medical Sciences, Universidade mother’s age;
Estadual de Campinas (UNICAMP), Brazil. 2) Condition of infant on day of evaluation: feeding
Newborns with abnormal feeding are sent for an route, corrected age and weight;
evaluation by a speech therapist. Speech therapy is 3) Speech therapy evaluation: health professional
suggested based on oral motor control, neurophysi- that made the request, reason for evaluation,
ological maturity and clinical condition. This practice place of internment, oral reactions, number of
is in line with the philosophy of the Child Friendly appointments;
Hospital Initiative, which describes the ten steps
4) Speech therapy conduct: prescribed conduct,
for successful breastfeeding aimed at ensuring
discharge from speech therapy and feeding
exclusive breastfeeding in the first six months of life,
route upon discharge from neonatal unit and
as recommended by the World Health Organization.
upon discharge from hospital.
After discharge, children up to one year of age
receive outpatient speech and hearing therapy
whenever needed11. This form of therapy also For the quality control of the data, a review was
occurs with the Association of Parents and Family performed on 10% of the 205 charts. The Epi Info
Members of Hospitalized Infants and the Neonatal 3.5.1program was used to construct the databank
Palliative Care Group (CAISM/UNICAMP). and perform the statistical analysis. The data were
The aim of the present study was to characterize analyzed using descriptive statistics expressed in
the demand for speech therapy among newborns absolute and relative frequency and represented on
interned in the neonatal unit with abnormal oral graphs.

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1542  Monti MMF, Botega MBS, Lima MCMP, Kubota SMP

„„ RESULTS than 18 years of age, 40 (38.46%) were between

18 and 25 years, 38 (36.54%) were between 26 and
Two hundred five speech therapy evaluations/ 35 years and 18 (17.31%) were older than 36 years
interventions were performed between March 2008 of age. Figure 1 displays the data on the infants:
and February 2010. One hundred four newborns (55 gestational age, nutritional status, birth weight and
males [52.88%] and 49 females [47.11%] fulfilled the Apgar values.
inclusion criteria. Eight mothers (7.69%) were less

GA NS BW APGAR 1’ APGAR 5’
N % N % N % N % N %
PMNB 76 73.08
FTNB 28 26.92
AGA 58 55.77
SGA 39 37.50
LGA 07 06.73
ELW 17 16.35
VLW 17 16.35
LW 39 37.50
AW 31 29.81
0-5 35 33.65
6-10 69 66.35
0-5 7 06.73
6-10 97 93.27
TOTAL 104 100 104 100 104 100 104 100 104 100
  A – Gestational Age; NS – Nutritional Status; BW – Birth Weight; APGAR 1’ – Apgar in First Minute; APGAR 5’ – Apgar in Fifth
G
Minute; PMNB – Premature Newborn; FTNB – Full-term Newborn; AGA – Adequate for Gestational Age; SGA – Small for Gestational
Age; LGA – Large for Gestational Age; ELW – Extremely Low Weight; VLW – Very Low Weight; LW – Low Weight; AW – Adequate
Weight

Figure 1 – Characterization of newborns according to gestational age, nutritional status, birth weight
and Apgar in the first and fifth minutes

Figure 2 displays the most frequent diagnostic endocrine conditions, and tumors. The criteria used
hypotheses. Cases with less than 10 occurrences to classify the diagnostic hypotheses were based
were categorized as “others”: obstetric trauma, on the clinical protocol of the CAISM/UNICAMP
ocular, skin, orthopedic, genital-urinary and neonatal unit.

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 Demand for speech therapy in neonatology  1543

RD – Respiratory Disorder; J – Jaundice; CD – Cardiovascular Disorder; ND – Neurological Disorder; ID – Infectious Disease; HS

– Hematological Syndrome; MD – Metabolic Disease; AS – Apnea Syndrome; M – Malformation; DC – Digestive Condition; S – Syn-
drome; O – Others

Figure 2 – Most frequent diagnostic hypotheses given by physicians

Regarding condition of the infants on the day of pediatric residents, 18.27% were made by the
evaluation, 65 (62.50%) were oral fed; 27 (25.96%) nursing staff and 1.92% were made by other health
received exclusive oral feeding, 39 (37.50%) made professionals. This separation between physicians,
use of an enteral tube, 37 (35.58%) receive oral residents, healthcare staff and teaching staff was
feeding and an enteral tube and one case made use due to the fact that the study location is a teaching
of parenteral nutrition with oral feeding (mother’s hospital. Thus, the conduct of the residents is the
breast and cup). Among the infants who received result of the advice of teaching staff, which would
exclusive oral feeding, 11 (10.58%) breastfed freely be important to the evaluation of the extent to which
on the day of evaluation. Mean corrected age on the speech and hearing therapy is internalized by health
date of the evaluation was 36 weeks and five days. professionals in training.
The infants were evaluated with a mean of 29 days Figure 3 displays the reasons for requesting
of life. Mean weight on the day of evaluation was speech therapy. Regarding place of internment,
2392.74 g. 98 (94.23%) were in the semi-intensive care unit,
A total 20.19% of the evaluations were five (4.81%) were in the intensive care unit and one
requested by physicians, 59.62% were made (0.96%) was under the rooming-in regimen.

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1544  Monti MMF, Botega MBS, Lima MCMP, Kubota SMP

EROF – Evaluation
  of Readiness for Oral Feeding; DB – Difficulty Breastfeeding; DC – Difficulty Cup Feeding; AOMB – Abnormal
Oral Motor Behavior; DBF – Difficulty Bottle Feeding; ASC – Altered State of Consciousness; CLP – Cleft Lip/Palate; S – Syndrome;
AR – Abnormal Respiration

Figure 3 – Reason for requesting evaluation by speech therapist

The speech therapy analysis included oral performed in 55.77%. The evaluation of nutritive
reflexes, nonnutritive sucking and nutritive sucking. sucking was at the mother’s breast in 62.07% of
Figure 4 displays the findings regarding oral cases. The evaluation of feeding using a cup was
reactions. Nonnutritive sucking was performed performed in 32.69% of cases.
in 78.85% of cases and nutritive sucking was

  Absent Present Not evaluated

RR – Rooting Reflex; SuR – Sucking Reflex; SwR – Swallow Reflex; BR – Bite Reflex; GR – Gag Reflex

Figure 4 – Oral reactions at time of evaluation by speech therapist

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 Demand for speech therapy in neonatology  1545
A total of 33.66% of the infants had one speech support, massaging breasts prior to breastfeeding,
therapy session, 23.08% had two sessions, 16.35% translactation, relactation, pauses and milk flow
had three sessions, 9.62% had four sessions control) were indicated in 28.85% of cases.
and 17.31% had five or more sessions. The main Figure 6 displays the data on discharge from
conducts prescribed were to maintain oral feeding, speech therapy. A total of 47.11% received
initiate nonnutritive sucking and maintain the feeding discharge from hospital without receiving discharge
tube (Figure 5). Speech therapy reevaluation from speech therapy and 23.08% received concom-
was indicated in 27.88% of cases and facilitating itant discharge from speech therapy and hospital.
maneuvers (submandibular support, buccinator

Initiate Maintain Suspend/Remove Do not offer

 
NNS – Nonnutritive Sucking; OF – Oral Feeding; TUBE – Orogastric and Nasogastric Feeding Tube; GTT – Gastrostomy
** no cases of gastrostomy

Figure 5 – Therapeutic conduct

D – Discharge from Speech Therapy; ND – Not Discharged from Speech Therapy; NSTC – Follow Up in Neonatal Speech Therapy
Clinic; O – Others

Figure 6 – Data on discharge from speech therapy

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1546  Monti MMF, Botega MBS, Lima MCMP, Kubota SMP

N = 104

Oral Feeding Enteral Tube Gastrostomy Oral Feeding + Others

Enteral Tube

B - Breastfeeding; Tr – Translactation; BF – Bottle Feeding; C – Cup Feeding; Tu – Tube; NGT – Nasogastric Tube; OGT – Orogastric
Tube; GTT – Gastrostomy; O – Others

Figure 7 – Feeding route of infants at discharge from hospital

Upon discharge from hospital, oral feeding is a risk factor for feeding problems in newborns.
predominated followed by mixed feeding (oral + Information obtained during the evaluation of
enteral tube) (Figure 7). swallowing function and breathing control during
feeding can be useful for predicting significant
„„ DISCUSSION neurological disorders in newborns15.
The majority of newborns had a gestational age of
The increase in the number of newborns who less than 37 weeks, which characterizes premature
require neonatal care due to premature birth and birth. Such infants are more likely to exhibit adverse
diseases has led to an increase in the demand for health conditions that can exert a negative effect
evaluations by a speech therapist. A survey of data on the feeding process. Studies have suggested
at a healthcare service is of the utmost important to an association between a younger gestational age
establishing the quality of care, characterizing the and greater risk of the development of oral motor
population treated and determining the efficacy of disorders. Thus, the intervention of a speech thera-
the conduct employed. pists is important to the prevention and rehabilitation
The male sex was predominant among the of correlate abnormalities and should be maintained
newborns in the present investigation, which is in throughout the follow up of cases during the intro-
agreement with findings described in a previous duction of other food consistencies16,17.
study on the evaluation of premature newborns13. The most frequent diagnostic hypotheses were
The most frequent age group among the mothers respiratory disorder, jaundice and cardiovascular
was 18 to 35 years, which accounted for 75% of the disorder. Some of the newborns were not in a
cases. This finding is agreement with the mean age completely stable clinical state at the time of the
of pregnancy among women in southeastern Brazil, first feeding evaluation. Safe, efficient oral feeding
which, according to the most recent census, is 26.6 involves coordinated sucking, swallowing and
years of age14. breathing and requires oral motor control, physical
Regarding Apgar data, 33.65% of the infants effort, cardiovascular effort, stress and adequate
received a score of 5 or less in the first minute oxygen saturation. This underscores the importance
and 6.73% received a score of 5 or less in the fifth of favoring a feeding route that does not place the
minute. Perinatal asphyxia (Apgar between 0 and clinical status of the newborn at risk and offers no
4 in the first minute and/or 0 to 6 in the fifth minute) risk of aspiration18.

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 Demand for speech therapy in neonatology  1547
The majority of newborns (62.50%) had initiated differs significantly from the findings of the present
oral feeding without undergoing a previous evalu- study, in which this reflex was absent in 18.27%.
ation by the speech therapist. This practice could The main actions prescribed by the speech
place the clinical stability of the infant at risk5. At therapist were to maintain the feeding tube and
the neonatal service studied, most requests for initiate the stimulation of nonnutritive sucking. The
evaluation by the speech therapist were made by former underscores the importance of the evalu-
residents of pediatrics, who are directly responsible ation by a speech therapist prior to determining
for the care of the infants, which consequently the feeding route and the latter underscores the
allows the early identification of the need for importance of stimulating nonnutritive sucking for
specialized care. The most frequent reasons for the benefits this practice offers and to diminish
requesting this evaluation on the part of residents internment time. Studies have shown that the stimu-
were abnormal oral motor behavior, evaluation of lation of nonnutritive sucking and oral stimulation can
the readiness for oral feeding, difficulty using a cup contribute to accelerating the onset of oral feeding by
and difficulty breastfeeding. In comparison to data assisting in oral motor development and maturation
described in the literature5-9, the present findings of the newborn, thereby improving breastfeeding
reveal a broadening of the criteria for the referral rates upon discharge19-22. Breastfeeding provides
to a speech therapist, such as the evaluation of a number of advantages and should therefore be
readiness for oral feeding, difficulty breastfeeding, initiated as soon as possible, favoring the transition
difficulty using a cup, abnormal oral motor behavior of the feeding route, the production of mother’s milk
and difficulty bottle feeding. However, the findings and the mother-infant bond23,24.
also reveal a need for a greater awareness on the Reevaluation from the speech therapist was
part of pediatric residents with regard to referring prescribed in 29.76% of the cases, since it was not
infants for the evaluation by a speech therapist prior always possible to define the proper conduct after a
to initiating oral feeding. In a teaching hospital, the single evaluation. In some cases, the use of other
work of speech therapists can also contribute to the utensils, such as a cup, was necessary. In others,
interdisciplinary training of pediatricians in the field the decision was made to evaluate the newborn
of neonatology. when he/she was more alert or more stable, with
Although the speech therapists attend the no clinical complications. In 24.39% of cases,
intensive care unit, semi-intensive care unit, facilitating maneuvers (submandibular support,
rooming-in and late rooming-in, the work occurred buccinator support, massaging breasts prior to
predominantly in the semi-intensive care unit breastfeeding, translactation, relactation, pauses
(94.23%). This finding may be related to the limited and milk flow control) were indicated.
workload of the speech therapists at the neonatal A review study suggests the favorable influence of
services (12 hours a week), which implies predomi- cup use in the transition to breastfeeding in full-term
nantly rehabilitation actions already near the time of newborns, those submitted to cesarean birth and
discharge from hospital. Thus, there is an evident those at the time of discharge 25. None of the three
need to broaden the scope of the action of speech studies in the review found a statistically significant
therapists to other areas of the neonatal service, difference in the duration of breastfeeding following
focusing on the prevention of abnormalities related discharge. The first study analyzed 471 full-term
to the oral motor sensory system. Early care on the infants of mothers who planned to stay in the
part of the speech therapist while the newborn is hospital for five days after childbirth and breastfeed
still in the intensive care unit could contribute toward for at least three months. Breastfeeding frequencies
faster progress in the feeding process and conse- were analyzed in the first five days as well as at
quently earlier discharge from hospital8. two, four and six months of life, comparing the use
The oral reactions encountered differ from those of different complements, cup/spoon and bottle/
reported in a study on the readiness of premature pacifier. No significant differences in breastfeeding
newborns to initial oral feeding, which found the frequency were found between groups. The second
sucking reflex present, albeit weak, in all subjects study analyzed the effects of the use of an artificial
evaluated13. In the present study, 11.54% of the nipple, cup and bottle in 686 full-term and premature
newborns did not exhibit the sucking reflex. This newborns comparing the use of a cup and bottle as
finding may be explained by the fact that the CAISM the form of supplementation and whether there was
is a reference hospital for the care of high-risk an associated habit of early or late pacifier sucking,
newborns, the population of which has more analyzing the duration of exclusive breastfeeding,
serious diagnoses that can interfere in the feeding mixed feeding and total breastfeeding time. No
process. The rooting reflex was absent in 55% of significant differences were found between the
the newborns evaluated in the study cited13, which use of a cup or bottle. The third study involved 303

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1548  Monti MMF, Botega MBS, Lima MCMP, Kubota SMP

premature newborns with a gestational age less than which occurred at a mean of 28 days of life, with
34 months and mothers who wanted to breastfeed a corrected age of 36 weeks and six days. It is
and compared the use of a cup and bottle with or fundamental to perform evaluations throughout
without the use of a pacifier. The prevalence and internment to monitor the development of oral motor
proportion of exclusive breastfeeding and mixed function. A previous study also found that premature
feeding were determined at three and six months newborns began the transition of the feeding route
and no statistically significant differences were at a mean of 36 weeks of corrected age6.
found between groups. The use of a cup significantly In order for discharge from both speech therapy
increased the prevalence of exclusive breastfeeding and hospital to coincide, the request for the evalu-
upon discharge, but had no effect on the duration. ation should be made as early as possible5.
Another review study demonstrated that infants who However, evaluations were requested late at the
use a cup have better results with regard to physi- neonatal service studied. As a result, the majority
ological stability (heart rate and oxygen saturation) of newborns 53.66% had not been discharged from
and the impact on exclusive breastfeeding upon speech therapy prior to discharge from hospital.
discharge from hospital26. However, the authors This seems to be related to the restricted workload
also suggest that further studies on this issue are of the therapist, which consequently limits early
needed. Despite the divergent data, the use of a cup therapy and an evaluation prior to the onset of oral
as feeding transition method is a common practice feeding. While the work of the speech therapist
at the neonatal service studied herein and is in line has increased at the neonatal service, it could be
with the recommendations of the Child Friendly broadened further. It is therefore fundamental for
Hospital Initiative, which discourages the use of hospitals to have speech therapists in neonatal
artificial nipples. services with a workload that is compatible with the
The data on the feeding route upon discharge needs of the infants. As residents and nursing staff
demonstrate the benefits of speech therapy, which request evaluations by a speech therapist more,
allowed an increase from 10.58% to 40.38% in the actions should be developed to broaden awareness
rate of exclusive breastfeeding. However, this result on the objectives of speech therapy at neonatal
is below the recommendations of the World Health services, thereby contributing to the training of
Organization (exclusive breastfeeding until six these and other health professionals who work with
months of age). The rate of exclusive oral feeding newborns.
upon discharge from hospital was 74.98%, with
40.38% exclusive breastfeeding, 17.30% breast- „„ CONCLUSION
feeding complemented with translactation, cup use
or bottle use, 15.38% bottle use and 1.92% cup use. The population studied was predominantly male
These data are similar to those reported in a previous and had been born prematurely, with a mean gesta-
study carried out at the tertiary level Ribeirão Preto tional age of 36 weeks and low birth weight, but
University Hospital (state of São Paulo, Brazil), adequate for the gestational age. The predominant
in which 28.4% of premature newborns were diagnosis was respiratory disorder. The majority of
discharged with exclusive breastfeeding, 48.3% infants began oral feeding with no prior evaluation
with mixed breastfeeding and 23.2% with artificial by the speech therapist, which may place safe,
feeding. A total of 76.7% were breastfeeding upon efficient feeding at risk and have repercussions on
discharge with or without a formula complement27. the clinical stability of the infant.
In premature newborns with a weight greater than In comparison to data reported in the literature,
1500 g, Czechowski and Fujinaga20 found a 58.3% the present findings reveal a broadening of the
rate of exclusive breastfeeding upon discharge, criteria for the referral to a speech therapist, such as
which is higher than the rate reported herein. the evaluation of readiness for oral feeding, difficulty
The potential factors affecting exclusive breastfeeding, difficulty using a cup, abnormal oral
breastfeeding in a high-risk nursery are related to motor behavior and difficulty bottle feeding.
healthcare services (number of prenatal appoint- The speech therapists worked predominantly in
ments, Child Friendly Hospital Initiative), hospital the semi-intensive care unit and the main conducts
practices (use of a feeding tube, translactation) and prescribed were to maintain oral feeding, initiate
biological aspects, such as low weight. All these nonnutritive sucking and maintain the orogastric
factors hamper exclusive breastfeeding in these feeding tube.
infants28 and help explain the indices found at the The limited workload of a speech therapist at a
CAISM neonatal service. neonatal service compromises the effectiveness of
The largest portion of the infants (33.66%) had this health professional, especially with regard to
only one evaluation from the speech therapist, preventive actions.

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 Demand for speech therapy in neonatology  1549

RESUMO

Objetivo: caracterizar a demanda e intervenção fonoaudiológicas realizadas em recém-nascidos e

lactentes que apresentaram alterações no processo de alimentação por via oral, na Unidade Neonatal
de um hospital-escola de caráter público. Métodos: trata-se de um estudo retrospectivo, descritivo e
de corte transversal. Foi realizada a coleta de dados por meio de consulta a todos os prontuários fono-
audiológicos de recém-nascidos e lactentes internados no período entre março de 2008 e fevereiro
de 2010, que receberam ao menos uma avaliação/intervenção fonoaudiológica. Resultados: foram
atendidos nesse período 205 recém-nascidos e lactentes internados. Destes sujeitos, 104 atenderam
aos critérios de inclusão na pesquisa. A população predominante foi do sexo masculino, composta de
recém-nascidos pré-termo, adequados para idade gestacional, baixo peso ao nascimento, em média
com 36 semanas de idade gestacional, com diagnósticos mais frequentes de distúrbio respiratório,
síndrome ictérica e/ou distúrbio cardiovascular. Dentre os motivos de encaminhamento para avalia-
ção fonoaudiológica predominaram: alteração no comportamento motor oral, avaliação da prontidão
para alimentação por via oral e dificuldades no uso do copo. As avaliações foram solicitadas, em sua
maioria, por médicos residentes quando os recém-nascidos estavam, em média, com 28 dias de
vida. Verificou-se ampliação dos critérios de encaminhamento da equipe para avaliação fonoaudio-
lógica, quando comparados aos critérios descritos na literatura. Conclusões: esse trabalho permitiu
caracterizar a população, a demanda e a intervenção fonoaudiológicas em uma unidade neonatal.
Verificou-se que a maioria dos recém-nascidos e lactentes ainda recebe alimentação por via oral sem
avaliação fonoaudiológica prévia, o que pode gerar situações de risco para uma alimentação segura
e eficiente.

DESCRITORES: Neonatologia; Fonoaudiologia; Alimentação

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Received on: March 13, 2012

Accepted on: November 06, 2012

Mailing address:
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Bairro Mansões Santo Antônio
Campinas – SP – Brazil
CEP 13087-510
E-mail: marianam.monti@gmail.com

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