Preterm infants spend much of their time in the neonatal intensive care unit (NICU) learning to orally feed. Attempts to support the preterm infant in acquiring oral skills have evolved greatly over the past decades, including the increasing involvement of speech, physical, and occupational therapists. Interventions have included modified positioning, specialized nipples, external pacing, sensorimotor exercises, oral motor skills programs, and cue-based feeding programs. While many infants seem to have benefited from these methods, a subset of babies continues to require supplemental feeding methods via nasogastric or gastrostomy tube. In particular, infants with aerodigestive complications are at high risk for needing supplemental feeding methods. Additionally, the neurodevelopmental implications of having significant feeding difficulties early on is not fully known. Studies have brought about concerns that children with early oral feeding difficulties may be at risk for the presence of neurodevelopmental delays and continued feeding issues later in childhood. Further research is needed to better understand which infants will struggle with oral feeding, as well as identify appropriate therapeutic options and optimal time periods of implementation.
Stoll B, Hansen NI, Bell EF, et al. Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012. Journal of the American Medical Association 2015;314(10):1039–1051. DOI: 10.1001/jama.2015.10244.
Pineda R, Prince D, Reynolds J, et al. Preterm Infant Feeding Performance at Term Equivalent Age Differs from that of Full-Term Infants. J Perinatol 2020;40:646–654. DOI: 10.1038/s41372-020-0616-2.
Lefton-Greif MA. Impact of Children's Feeding/Swallowing Problems: Validation of a New Caregiver Instrument. Dysphagia 2014;29:671–677. DOI: 10.1007/s00455-014-9560-7.
Martin RJ, Fanaroff AA, Walsh MC. Fanaroff and Martin's Neonatal-Perinatal Medicine. 11th ed. Elsevier, Inc; 2020.
Lau C. Development of Infant Oral Feeding Skills: What Do We Know? Am J Clin Nutr 2016; 103(2):616S–21S. DOI: 10.3945/ajcn.115.109603.
Lau C. Development of Suck and Swallow Mechanisms in Infants. Ann Nutr Metab. 2015; 66 Suppl 5(0 5):7–14. DOI: 10.1159/000381361.
Greene Z, O'Donnell CP, Walshe M. Oral Stimulation for Promoting Oral Feeding in Preterm Infants. Cochrane Database Syst Rev 2016;9(9):CD009720. DOI: 10.1002/14651858.CD009720.pub2.
Park J, Pados BF, Thoyre SM. Systematic Review: What Is the Evidence for the Side-Lying Position for Feeding Preterm Infants? Adv Neonatal Care 2018;18(4):285–294. DOI: 10.1097/ANC.0000000000000529.
Law-Morstatt L, Judd DM, Snyder P, et al. Pacing as a Treatment Technique for Transitional Sucking Patterns. J Perinatol 2003;23(6): 483–488. DOI: 10.1038/sj.jp.7210976.
Fucile S, McFarland DH, Gisel EG, et al. Oral and nonoral sensorimotor interventions facilitate suck-swallow-respiration functions and their coordination in preterm infants. Early Hum Dev 2012;88(6):345–350. DOI: 10.1016/j.earlhumdev.2011.09.007.
Aguilar-Rodriguez M, León-Castro JC, Álvarez-Cerezo M, et al. The Effectiveness of an Oral Sensorimotor Stimulation Protocol for the Early Achievement of Exclusive Oral Feeding in Premature Infants. A Randomized, Controlled Trial. Phys Occup Ther Pediatr 2020;40(4):371–383. DOI: 10.1080/01942638.2019.1698688.
Ghomi H, Yadegari F, Soleimani F, et al. The Effects of Premature Infant Oral Motor Intervention (PIOMI) on Oral Feeding of Preterm Infants: A Randomized Clinical Trial. Int J Pediatr Otorhinolaryngol 2019;120:202–209. DOI: 10.1016/j.ijporl.2019.02.005.
Beckman Oral Motor Website. Available from: https://www.beckmanoralmotor.com/index.php.
Shaker CS. Cue-based Feeding in the NICU: Using the Infant's Communication as a Guide. Neonatal Netw 2013;32(6):404–408. DOI: 10.1891/0730-08188.8.131.524.
Watson J, McGuire W. Responsive versus Scheduled Feeding for Preterm Infants. Cochrane Database Syst Rev 2016;31(8):CD005255. DOI: 10.1002/14651858.CD005255.pub5.
Davidson E, Hinton D, Ryan-Wenger N, et al. Quality Improvement Study of Effectiveness of Cue-Based Feeding in Infants with Bronchopulmonary Dysplasia in the Neonatal Intensive Care Unit. J Obstet Gynecol Neonatal Nurs 2013;42(6):629–640. DOI: 10.1111/1552-6909.12257.
Davidson J, Ruthazer R, Maron J. Optimal Timing to Utilize Olfactory Stimulation with Maternal Breast Milk to Improve Oral Feeding Skills in the Premature Newborn. Breastfeed Med 2019;14(4):230–235. DOI: 10.1089/bfm.2018.0180.
Beker F, Opie G, Noble E, et al. Smell and Taste to Improve Nutrition in Very Preterm Infants: A Randomized Controlled Pilot Trial. Neonatology 2017;111(3):260–266. DOI: 10.1159/000450883.
Muelbert M, Lin L, Bloomfield FH, et al. Exposure to the Smell and Taste of Milk to Accelerate Feeding in Preterm Infants. Cochrane Database Syst Rev 2019;7(7):CD013038. DOI: 10.1002/14651858.CD013038. pub2.
White BR, Ermarth A, Thomas D, et al. Creation of a Standard Model for Tube Feeding at Neonatal Intensive Care Unit Discharge. J Parenter Enteral Nutr 2020;44(3):491–499. DOI: 10.1002/jpen.1718.
Lagatta JM, Uhing M, Acharya K, et al. Actual and Potential Impact of Home Nasogastric Tube Feeding Program for Infants Whose Neonatal Intensive Care Unit Discharge is Affected by Delayed Oral Feedings. J Pediatr 2021 Jul;234:38–45.e2. Preprint. Posted online March 27, 2021; DOI: 10.1016/j.jpeds.2021.03.046.
Warren MG, Do B, Das A, et al. Gastrostomy Tube Feeding in Extremely Low Birthweight Infants: Frequency, Associated Comorbidities, and Long-Term Outcomes. J Pediatr 2019;214:41–46. DOI: 10.1016/j.jpeds.2019.06.066.
Jadcherla SR, Khot T, Moore R, et al. Feeding Methods at Discharge Predict Long-Term Feeding and Neurodevelopmental Outcomes in Preterm Infants Referred for Gastrostomy Evaluation. J Pediatr 2017;181:125–130. DOI: 10.1016/j.jpeds.2016.10.065.
McFarland DH, Tremblay P. Clinical Implications of Cross-System Interactions. Semin Speech Lang 2006;27(4):300–309. DOI: 10.1055/s-2006-955119.
Adams-Chapman I, Bann CM, Vaucher YE, et al. Association between Feeding Difficulties and Language Delay in Preterm Infants using Bayley III. J Pediatr 2013;163(3):680–685. DOI: 10.1016/j.jpeds.2013.03.006.
Adams-Chapman I, Bann C, Carter SL, Stoll BJ, NICHD Neonatal Research Network. Language Outcomes among ELBW Infants in Early Childhood. Early Hum Dev 2015;91(6):373–379. DOI: 10.1016/j.earlhumdev.2015.03.011.
Crapnell TL, Woodward LJ, Rogers CE, et al. Neurodevelopmental Profile, Growth, and Psychosocial Environment of Preterm Infants with Difficult Feeding Behavior at Age 2 Years. J Pediatr 2015;167(6):1347–1353. DOI: 10.1016/j.jpeds.2015.09.022.
Medoff-Cooper B, Shults J, Kaplan J. Sucking Behavior of Preterm Neonates as a Predictor of Developmental Outcomes. J Dev Behav Pediatr 2009;30(1):16–22. DOI: 10.1097/DBP.0b013e318196b0a8.
Zhang X, Zhou M, Yin Y, et al. The Predictive Value of Early Oral Motor Assessments for Neurodevelopmental Outcomes of Moderately and Late Preterm Infants. Medicine 2017;96(50):e9207. DOI: 10.1097/MD.0000000000009207.
Yi YG, Oh BM, Shin SH, et al. Association of Uncoordinated Sucking Pattern with Developmental Outcome in Premature Infants: A Retrospective Analysis. BMC Pediatr 2019;19(1):440. DOI: 10.1186/s12887-019-1811-1.
Lainwala S. Delayed Achievement of Oral Feedings is Associated with Adverse Neurodevelopmental Outcomes at 18 and 26 Months Follow-Up In Preterm Infants. Am J Perinatol 2019. DOI: 10.1055/s-0039-1681059.
Patra K, Greene M. Impact of Feeding Difficulties in the NICU on Neurodevelopmental Outcomes at 8 and 20 Months Corrected Age in Extremely Low Gestational Age Infants. J Perinatol 2019;39(9): 1241–1248. DOI: 10.1038/s41372-019-0428-4.
Jadcherla SR, Peng J, Moore R, et al. Impact of Personalized Feeding Program in 100 NICU Infants: Pathophysiology-Based Approach for Better Outcomes. J Pediatr Gastroenterol Nutr 2012;54(1):62–70. DOI: 10.1097/MPG.0b013e3182288766.
Jadcherla SR. Impact of Process Optimization and Quality Improvement Measures on Neonatal Feeding Outcomes at an All-Referral Neonatal Intensive Care Unit. J Parenter Enteral Nutr 2016;40(5): 646–655. DOI: 10.1177/0148607115571667.