‘Supporting our tiniest patients’

A Marcella Niehoff School of Nursing scientist has been awarded a $2.57 million federal grant for her research on how to help extremely premature infants—those born so early they may not be able to breathe, suck, or swallow on their own—learn to eat.

Assistant Professor Thao Griffith’s oral feeding intervention, the Multisensory Early Oral Administration of Human Milk, or M-MILK, targets babies born between 23 and 32 weeks’ gestation. Thirty-nine weeks is considered full term.

Many extremely premature infants face lengthy stays in neonatal intensive care and rely on feeding tubes to survive. M-MILK, through the seemingly simple act of giving them droplets of human milk, aims to help them learn to feed without medical assistance.

“The idea is to support that innate development that they would have had if they were in the womb,” said Griffith, recipient of the five-year grant from the Eunice Kennedy Shriver National Institute of Child Health & Human Development. “The goal is to have them feed like any other baby so they can go home earlier and without the complication of a feeding tube.”

The M-MILK intervention starts on day three of life, when caregivers place milk on the baby’s lips. If the infant responds positively, more milk is given each day in tiny increments. Over time, the baby learns to ingest milk orally and the feeding tube can be removed.

That means potentially less time in the NICU and less stress on the baby.

Karen Saban, the Marcella Niehoff School of Nursing Endowed Chair for Research, called Griffith’s study “groundbreaking research supporting our tiniest patients.”

“Her research has the potential to transform NICU care, helping babies thrive during their most vulnerable days and laying the foundation for lifelong health,” Saban said.

M-MILK is innovative because it’s infant-led and multisensory, supporting brain development during a crucial window of growth and possibly contributing to better health outcomes for the baby.

Saban noted that Griffith secured the grant on her first submission, a rare accomplishment that speaks to the potential of her research. The submission received a high peer-reviewed impact score, which assesses the study’s potential to advance scientific knowledge, that placed it in the top 6 percent of comparable projects nationwide.

“This award demonstrates the real-world impact Loyola Nursing scientists are having,” added Todd Ruppar, associate dean for research and scholarly innovation.

Stress and preterm babies

Griffith compared the experiences of fragile, premature infants with those born healthy and full-term: Instead of going home to a calm environment where they’re swaddled and hugged, extremely premature babies spend most of their time away from their parents in a NICU incubator.

Their surroundings may be loud, bright, and chaotic. And with their underdeveloped sensory systems, even routine procedures like IV insertions or having medical tape placed on their skin can be agonizing.

“They’re poked, they’re prodded. Even being weighed or having their diaper changed can be potentially painful,” she said. “They’re very sensitive to touch, and that makes virtually every procedure a source of discomfort or pain.”

All of that contributes to high stress levels for a baby in the NICU, who may experience hundreds of “acute” events during just the first four weeks of hospitalization, Griffith said. Each event can trigger biological responses including elevated heart rates and cortisol levels.

M-MILK gives infants a pleasurable, consistent experience that can help them learn how to regulate the stress of being in the NICU.

The milk intervention appeals to the infant’s full range of still-developing senses: taste, smell, touch, sight, and sound. Caregivers—preferably mom or dad—gently hold the infant and speak in a soft voice.

“We provide a warm, secure touch. If the infant opens their eyes, we want to be in their gaze so they can see us,” Griffith said. “We designed the intervention to benefit the baby, but we also want to create that meaningful connection between the caregiver and baby. With a feeding tube, you don’t get that.”

Supporting brain growth

The M-MILK intervention comes at a critical time of brain development, when every sensory experience and social interaction can literally leave an imprint on an extremely premature baby’s small, still-smooth brain.

“When you touch the skin of a baby in the NICU, you’re essentially touching the brain,” Griffith said.

The brain begins developing its signature deep grooves and ridges—signs of rapid brain growth and activity—during week 22 of gestation.

That means extremely premature babies go through a period of “neuroplasticity” outside the womb. That’s when the brain is malleable and responds to stimuli by creating new neural pathways.

Like roadmaps, those pathways will guide how the infant perceives and responds to future situations.

“In the NICU, we’re doing things that are necessary but often painful, and we’re unfortunately creating negative neural pathways,” added Griffith, who is conducting her study at Loyola University Medical Center. “But if we have supportive interventions and strategies, we’re guiding the infant to create more positive neural pathways that can help them better regulate stress.”

High-potential research

Results from M-MILK’s pilot study are promising, Griffith said: Within days, many infants learn to expect milk and respond to it by stirring or smacking their lips. Over time, they learn to feed safely—without breathing or choking problems—and more quickly than babies that didn’t go through the intervention.

If M-MILK proves to be effective in the larger, NIH-supported study, Griffith hopes to develop a toolkit that NICUs can adopt.

“My hope is that we can make it a standard of care so all NICU babies can benefit from it,” she said.

Read more stories from the Marcella Niehoff School of Nursing.