Abstract / Summary
His case report aimed to describe clinical outcomes following a combined rehabilitation program incorporating neuromuscular electrical stimulation (NMES), oromotor exercises, and developmental interventions in a PEG-fed, visually impaired preterm infant. The infant was born at 32 weeks of gestation with a birth weight of 1500 g as one of triplets and had visual impairment due to retinopathy of prematurity. Because oral feeding was not possible, nutrition was provided via percutaneous endoscopic gastrostomy (PEG). At baseline, Karaduman Chewing Performance Scale (KCPS) score was 4 and the Preterm Oral Feeding Readiness Assessment Scale (POFRAS) score was 19. The infant also exhibited low oral cavity tone, insufficient laryngeal elevation, and intolerance to oral feeding. Swallowing safety was assessed by an otorhinolaryngologist using fiberoptic endoscopic evaluation of swallowing (FEES); the Penetration–Aspiration Scale (PAS) score was 2, with no evidence of aspiration. The infant received a four-week combined rehabilitation program comprising 20 sessions (five sessions/week), including oromotor exercises, oral sensory stimulation, developmental physiotherapy, and NMES. Each session lasted approximately 60 minutes, including 40 minutes of NMES, and a home program was provided to the family. Following the intervention, the KCPS score improved from 4 to 3, while the POFRAS score increased from 19 to 31. Follow-up FEES performed by the otorhinolaryngologist showed that the PAS score remained at 2, with no evidence of aspiration. Oral cavity tone and laryngeal elevation improved, and tolerance to pacifier use and oral feeding increased. Oral feeding was initiated; however, PEG feeding was continued because oral intake remained insufficient to meet the infant's nutritional requirements. These findings suggest that the combined rehabilitation program, integrating NMES with oromotor, sensory, and developmental interventions, may support the transition toward oral feeding in PEG-fed preterm infants with additional disabilities.