In the complex and delicate realm of neonatal care, ensuring optimal growth and development for high-risk newborns remains a formidable challenge. Particularly vulnerable are preterm infants and those born with congenital diaphragmatic hernia (CDH), conditions that often precipitate severe difficulties in feeding and nutrition. These newborns face significant hurdles in initiating and progressing through enteral and oral feeding stages. Recent insights suggest that these challenges are predominantly due to mechanical dysfunctions in gastrointestinal motility. More intriguingly, this dysfunction appears to be closely linked to delayed or atypical maturation of the autonomous nervous system (ANS), a critical regulator of internal organ function.
The autonomous nervous system, responsible for involuntary physiological processes, plays a pivotal role in regulating gastrointestinal activity. Its proper development is essential for coordinated motility, digestion, and nutrient absorption. In preterm infants and those with CDH, the ANS may develop more slowly or deviate from normal pathways, leading to pernicious effects on feeding capabilities. Given that adequate nutritional intake is fundamental not only for immediate survival but also for long-term health outcomes, addressing this underlying neurodevelopmental problem is paramount.
Adding to the complexity, the development of the ANS is heavily influenced by sensorimotor stimulation, especially during the antenatal period. The womb environment provides a rich tapestry of sensory inputs—touch, proprioception, and movement stimuli—that shape neural development. However, postnatally, particularly for high-risk newborns often requiring intensive care, these sensory experiences diminish considerably. The stark reduction in sensorimotor interaction post-birth hampers the continuation of normal ANS maturation and may exacerbate feeding difficulties.
In response to these challenges, a novel intervention named HAPTOS (Handling Adapted to Postnatal Age with Tactile-Kinaesthetic and Oral Sensorimotor Stimulation) was developed. This sensorimotor stimulation program is designed intricately to improve gastrointestinal functionality by delivering carefully structured tactile and kinaesthetic stimulation alongside oral sensorimotor inputs. By mimicking and augmenting the sensory experiences typically encountered during fetal development, HAPTOS aims to catalyze proper ANS maturation and thereby improve feeding outcomes in these vulnerable infants.
The essence of HAPTOS lies in its targeted approach. It considers the postnatal age and developmental stage of each infant, adapting the handling and sensory stimulation protocols to match the infant’s capacity and tolerance. This nuanced gradation ensures optimal engagement of the ANS without overwhelming the fragile infants. Through gentle touch combined with proprioceptive stimuli and oral sensorimotor exercises, HAPTOS triggers neural pathways governing gastrointestinal motility and functional feeding skills.
A randomized trial, detailed in the study protocol by Nelissen, Christmann, van Gestel, and colleagues, is evaluating the efficacy of this program in a controlled clinical environment. This rigorous investigation serves to verify whether sensorimotor stimulation through HAPTOS can mitigate or reverse the delayed ANS maturation seen in these high-risk infants, thereby enhancing their ability to feed effectively and grow healthily. The trial’s design emphasizes methodological robustness, with comprehensive assessments of functional feeding outcomes, gastrointestinal motility metrics, and neurodevelopmental markers.
Central to this trial is an understanding of the profound link between neurodevelopment and nutritional success in neonatal care. While traditional interventions have focused primarily on mechanical or metabolic support such as feeding tubes and parenteral nutrition, this novel approach addresses the neurophysiological underpinnings of feeding failure. By focusing on the ANS’s maturation and gastrointestinal neuromotor coordination, HAPTOS could redefine therapeutic strategies for high-risk newborns in neonatal intensive care units worldwide.
Moreover, the implications of this research extend beyond immediate feeding and growth outcomes. Long-term consequences of early feeding difficulties include neurodevelopmental deficits and failure to thrive, issues that have longstanding impact on quality of life. Enhancing functional feeding through improved ANS maturation may thus confer broad developmental benefits, supporting cognitive and motor milestones in early childhood.
The scientific rationale behind HAPTOS builds upon an expanding body of literature demonstrating the role of sensory inputs in nervous system plasticity. The neonatal brain, especially in preterm infants, remains remarkably plastic and responsive to external stimuli. Sensorimotor interventions capitalize on this plasticity, offering a non-invasive method to influence neurodevelopment positively. In this light, HAPTOS aligns with emerging paradigms that advocate for early neurodevelopmental care incorporating sensory enrichment.
This approach also highlights the importance of multidisciplinary collaboration in neonatal care, blending insights from neonatology, neurology, physiotherapy, and developmental psychology. The successful application of HAPTOS demands clinicians adept in delicate neonatal handling and therapists knowledgeable in neurodevelopmental stimulation techniques. The integration of these disciplines ensures that interventions are both scientifically grounded and tailored to the unique needs of individual infants.
If proven effective, the HAPTOS protocol could become a cornerstone of neonatal intensive care, introducing a standardized sensorimotor stimulation regimen to promote better feeding outcomes. This would mark a paradigm shift from purely reactive feeding supports toward proactive neurodevelopmental interventions, potentially reducing hospital stays and improving long-term prognosis.
Furthermore, the scalability of the HAPTOS program is promising. With standardized guidelines and training, neonatal units globally could implement sensorimotor stimulation protocols, democratizing access to cutting-edge developmental support. The cost-effectiveness of such non-pharmacological interventions may also ease the burden on healthcare systems while improving patient outcomes.
While exciting, the HAPTOS intervention invites further questions for ongoing research. Future studies will need to explore the optimal timing, dosage, and combinations of sensory stimuli that yield maximal benefits. Additionally, understanding differential responses among various subgroups of high-risk neonates could refine personalized care approaches even further.
The anticipation surrounding the results of this randomized trial is considerable, as it addresses a significant unmet need in neonatal care. With preterm birth rates and congenital anomalies still posing persistent challenges worldwide, innovations like HAPTOS represent hope for more effective and humane treatment strategies.
In sum, the integration of sensorimotor stimulation for improving autonomic nervous system maturation and gastrointestinal function in high-risk newborns is a ground-breaking advance. By enhancing the foundational neurological controls underlying feeding success, this novel approach promises to transform outcomes for some of the most vulnerable patients. As research progresses, the neonatal care community awaits results that could usher in a new era of holistic, neurodevelopmentally informed clinical practice.
Subject of Research: Sensorimotor stimulation to improve gastrointestinal functionality and feeding outcomes in high-risk newborns, focusing on autonomic nervous system maturation in preterm infants and infants with congenital diaphragmatic hernia.
Article Title: Randomized trial evaluating sensorimotor stimulation and functional feeding in high-risk newborns: study protocol.
Article References:
Nelissen, M.L., Christmann, V., van Gestel, M. et al. Randomized trial evaluating sensorimotor stimulation and functional feeding in high-risk newborns: study protocol. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04690-x
Image Credits: AI Generated
DOI: 20 December 2025
