P1.201: Cue-Based Oral Feeding Progression Achieves Early Oral Feeding in Extremely Premature Infants

Background: Initiating oral feeding in Extremely Premature Infants (EPI, < 28 weeks gestational age) is an important but challenging milestone due to low muscle tone, poor endurance, and morbidities such as intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and sepsis. Pre-feeding oral stimulation plans are essential for improving outcomes and shortening hospital lengths of stay (LOS). Cue-based oral feeding progression (CB-OFP) involves a behavioral assessment, while volume-based (VB-OFP) focuses on achieving specific milk volumes. We compared two different techniques for oral feeding progression and their impact on oral feeding success and length of hospital stay.

Methods: We conducted a retrospective study of all EPI admitted to two tertiary NICUs, UF Health and Wolfson Children’s Hospital (WCH), from July 2022 to April 2024. We excluded those transferred and with congenital or chromosomal abnormalities. A pre-defined OFP protocol was followed at both hospitals. At UF, using a CB-OFP approach, oral feeding attempts were advanced based on daily assessments by therapists. At WCH, using a VB-OFP approach, infants were advanced to the next phase of OFP protocol once they successfully took 75% of the desired volume for four consecutive shifts. Parametric and non-parametric tests were performed as appropriate.

Results: Of the 134 infants analyzed in this study, 63 followed CB-OFP, while 71 followed the VB-OFP protocol. Infants in the CB-OFP group were more SGA, had a higher 5-minute Apgar score, and a reduced rate of IVH. Severe IVH (grades 3 and 4) did not differ significantly between the groups. CB-OFP was associated with significantly earlier achievement of full oral feeds (37.6 weeks vs. 40.5 weeks PMA, p < 0.0001), and oral feeding initiation occurred earlier in the CB-OFP group (34.5 weeks vs. 36 weeks, p = 0.0006), with infants requiring fewer days to achieve full oral feeding (p = 0.057). After adjusting for NEC, SGA, IVH, and BPD, these findings remained significant by multivariable analysis. The LOS was also shorter in the CB-OFP group (96.07 ± 21.35 days vs. 113.50 ± 23.78 days, p < 0.0001), even after adjusting for confounding factors such as SGA, NEC, IVH, and BPD.

Conclusion: Early oral motor stimulation and cue-based oral feeding progression were associated with reduced LOS and earlier achievement of full oral feeding in EPI. The CB-OFP approach has substantial benefits compared to VB-OFP, such as fewer days to achieve full oral feeding, younger PMA at full oral feeding, and shorter length of stay. As survival of preterm infants steadily rises, it is crucial to address oral feeding as one of the most critical developmental milestones. Future randomized controlled trials are needed to validate these findings further and explore long-term neurodevelopmental outcomes associated with different feeding strategies.