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Nourishing Preemies


Anticipating the birth of her first child, Brea Cox of Lancaster, PA, thought she was prepared. But, things don’t always go as planned.

Her daughter, Paxtyn, was born at 28 weeks and weighed just 1 pound, 12 ounces. She spent the first 61 days of her life in the Neonatal Intensive Care Unit (NICU) at Lancaster General Health’s Women & Babies Hospital, where she received a variety of therapies. Unable to breathe on her own at first, Paxtyn spent time on a ventilator. But what surprised Cox the most was what many of us take for granted: Paxtyn needed help learning how to coordinate sucking, swallowing and breathing – all essential skills for eating.

Paxtyn received help from an FDA-cleared technology called the NTrainer System, which provides appropriate oral stimulation through a pacifier. The system helps premature infants develop proper non-nutritive sucking skills necessary for developing healthy oral feeding skills. In June, Women & Babies became the second Pennsylvania hospital to offer the NTrainer System. To date, the NICU team has trained more than 40 premature infants with the device.

The coordination of sucking, swallowing, and breathing typically occurs in babies during pregnancy at 32-34 weeks gestation. The Women & Babies Hospital admits infants born as early as 23 weeks gestation. The NTrainer System uses a traditional pacifier which is gently pulsed through the use of a computer-controlled air pump, encouraging the baby to suck in an organized pattern to produce a “non-nutritive suck,” what they normally do in the womb beginning as early as the second trimester of development.

“It was something I had never heard of before,” Cox said, of being introduced to the NTrainer System by a physical therapist in the NICU. “But I was definitely on board with trying it.”

Cox and her husband Cory were shown how the device works — it uses a piston to gently pull air from the nipple in an organized rhythm that stimulates the nerves in a baby’s mouth and helps “jumpstart” a suck pattern. Along with helping babies develop proper organized sucking techniques, the NTrainer also provides visual evidence of how the infant is progressing. It generates a graph that can be printed, similar to what you might see on an EKG strip, showing the baby’s sucking pattern.

“It gives parents a visual picture of what’s going on inside a baby’s mouth,” said Mari Cunningham, a physical therapist with the NICU at Women & Babies Hospital.


For Cox, this part was particularly helpful in understanding Paxtyn’s development. “I loved being able to see how much it seemed to help her,” she said. “I liked the visual aspect, where I could see what she was doing and have a better appreciation of the whole process. When she first started on the NTrainer, I could see that her sucking pattern was all over the place, but as the therapists continued working with her, I could really see the improvement.”

And, the NTrainer allowed Cox to bond with her baby in a unique way—something that’s important for parents of preemies who may feel detached from infants who are incubated or attached to monitors and wires.

“If parents are able to be at the baby’s bedside, we’ll have them provide the NTrainer treatment and it’s something they can do for their babies,” said Lois Holsinger, an occupational therapist with the NICU at Women & Babies Hospital. “They can hold their babies, which helps with parent bonding. It’s important for parents to be involved in the care and treatment of their infants in the NICU.”

Cox said she enjoyed holding Paxtyn while she used the device. “I was able to use it with her and I really liked that,” she said. “It was neat that they involved us as parents in her therapy.”

Used for about seven to 10 days prior to nutritive feeding, the NTrainer, according to initial research, also reduces the amount of time babies spend in the NICU, said Holsinger. Babies who have used the therapy are, on average, discharged nine days sooner. “The shorter stay also means less cost to families for care,” she said.

Cox brought her daughter home in September and said Paxtyn continues to thrive.

“She’s doing fantastic,” she said. “She’s been very healthy, and she’s more than eight pounds now. The progress she’s made is unbelievable to me.”

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