A biomimetic ducted nipple reveals gestational age‐dependent deficits in suction generation in a neonatal pig model

Vollständiger Abstract

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Abstract All infant mammals must suckle in order to effectively acquire milk from a nipple. Yet, not all infants are able to do so. Preterm infants in particular face significant feeding challenges, often failing to establish successful breastfeeding due to complex neurophysiologic challenges. Unlike the cisternic structure of conventional commercial bottle nipples, often modeled after ruminant anatomy, human and porcine maternal nipples are ducted structures that require intraoral suction for milk release. To investigate how this structural difference impacts feeding success across gestational age, we used a validated infant pig model and high‐speed biplanar fluoroscopy (100 fps), synchronized with intraoral pressure recordings to compare suckling mechanics between term and preterm neonates feeding on either a cisternic or a suction‐dependent ducted (biomimetic) nipple. We found a profound gestational‐age‐dependent divergence in performance. The ducted nipple was successful for term infants because it paralleled natural breastfeeding and replicated its biomechanics by reducing the ability to express milk, thereby enhancing suction generation. While both term and preterm infants positioned the ducted nipple further into the mouth, preterm infants failed to adjust their tongue kinematics to compensate for this change. This inability led to minimal suction generation and poor milk acquisition. The lack of kinematic compensation in preterm infants isolates a critical physiological adaptability deficit, stemming from both neurological (lack of flexible seal adjustment/disordered coordination of the suck‐swallow‐breathe sequence) and anatomical constraints related to an inadequate seal on the nipple. Future research must explore these deficits' interactions to understand suckling physiology and develop targeted interventions for this population.