Combined Effects of Prefeeding Oral Stimulation and Infant Massage on Feeding Performance of Preterm Infants in Neonatal Intensive Care Units: A Pilot Study

Research Objectives: Achieving full oral feeding is a crucial milestone for hospital discharge of preterm neonates. Evidence shows the beneficial impact of prefeeding oral stimulation(OS) and infant massage(IM) on feeding progress of preterm infants in the NICU. However, limited research investigated the combined effect of OS and IM on preterm infants facing poor oral feeding. Therefore, we aimed to examine whether combined intervention yields better feeding outcomes than singular OS for preterm infants with oral feeding difficulties.

Design: Participants were stratified by GA ( < 28+0 weeks vs. 28+1~33+6 weeks) and IVH (None vs. Gr.I-II) and then randomly allocated to either OS or combined group. Feeding evaluations were conducted before, during, and after the 10-day intervention by a blinded therapist.

Setting: Level 2-4 NICUs in China Medical University Hospital, Taiwan

Participants: Participants meeting (1)born < 34 weeks, (2)experiencing feeding difficulties(i.e., oral intake ≤80% of prescribed milk volume >15ml) for half or more meals between 34-40 weeks postmenstrual age were recruited.

Interventions: The OS group received 5-min OS twice a day for 10 days, whereas the combined group received one 5-min OS and one 5-min IM per day. 5-min sessions of OS and IM were modified from interventions utilized by Lessen(2011) and Field(1986) respectively.

Main Outcome Measures: (1)Feeding efficiency(FE) (oral intake/prescribed volume, %) in the first 5-min and total feeding.(2)Transfer rate(TR) of milk consumed(ml/min) in the first 5-min and total feeding.(3)Oral transitional time, defined as days from the 1st day of the intervention to full oral feeding.

Results: Twenty-two preterm infants were included in this study, with 11 in each group (Combined vs. OS = 31.9±1.3 vs. 31.9±1.7 weeks of GA). In the initial 5-min feeding, the combined group demonstrated comparable performance to the OS group in both TR (4.1±2.9 vs. 3.3±2.0 ml/min, d=0.33) and FE (39±33% vs. 31±22%, d=0.29). However, over the total feeding period, the combined group performed better, with medium to large effect sizes in TR (4.8±4.0 vs. 2.4±2.1 ml/min, Cohen’s d=0.78) and FE (50±24 vs. 39±26%, d=0.44) than the OS group. No significant finding was observed in the transitional time (7±6.2 vs. 9±5.6 days, d=0.34) between the two groups.

Conclusions: The combined effect of OS plus IM may yield better feeding outcomes for preterm infants with poor feeding performance compared to OS alone. This study is ongoing, and additional data collection is required to validate the current findings.

Author(s) Disclosures: No conflicts of interest or external funding were involved in this research across all sectors.