The Effects of Pre-feeding Oral Stimulations and Non-nutritive Sucking on Physical Growth and Independent Oral Feeding of Preterm Infants

Document Type : Original Article


1 Aliasghar Hospital, Iran University of Medical Sciences, Tehran, Iran

2 Maternal Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran

3 Akbarabadi Hospital, Iran University of Medical Sciences, Tehran, Iran


Background: Breastfeeding failures and oral feeding problems in preterm infants result in long-term health complications. In this study, therefore, we aimed to evaluate the effect of oral stimulation along with non-nutritive sucking (NNS) on independent oral feeding initiation and weight gain in preterm infants.
Methods: This prospective randomized clinical trial was carried out at Aliasghar Hospital in Tehran, Iran, 2014. A total of 50 26-32 weeks gestational age hospitalized infants, who were fed through tubes, were recruited in the study. The newborns were randomized into A, B and C groups. In the A and B groups, the neonates were stimulated through oral stimulation as well as non-nutritive sucking for 5 or 10 days, while in the group C, no especial intervention was performed. Infants' mean daily weight gain, the number of days until initiation of oral feeding, oral feeding progression, the number of days until reaching full oral feeding and date of discharge were recorded. The obtained data were analyzed and compared in the three groups using SPSS version 16.0.
Results: Of all the participants, 25 cases (55.55%) were male. Mean gestational age at birth and mean birth weight were 28.64±1.93 weeks and 1337.11±185.07 grams, respectively. In the group A, newborns' weight at reaching four and eight oral feedings per day and their weights at discharge were significantly higher than the other two groups (P=0.016, 0.001 and 0.001, respectively). Mean daily weight gain in the group A was higher (84.2850 g) than the other groups (69.5814 vs. 64.2677 g). However, ANOVA results showed that this difference was not significant (P=0.108). Moreover, independent samples t-test indicated that this difference between groups A and C was significant (P=0.049).
Conclusion: In clinically stable preterm neonates, oral stimulation and should be implemented to increase their weight; however, further studies are required to address this issue.


  1. Liaw JJ, Yang L, Katherine Wang KW, Chen CM, Chang YC, Yin T. Non-nutritive sucking and facilitated tucking relieves preterm infant pain during heel-stick procedures: a prospective, randomized controlled crossover trial. Int J Nurs Stud. 2012; 49(3):300–9.
  2. Fucile S, Gisel E, Lau C. Oral stimulation accelerates the transition from tube to oral feeding in preterm infants. J Pediatr. 2002; 141(2):230-6.
  3. Fanaro S. Feeding intolerance in the preterm infant. Early Hum Dev. 2013; 89 Suppl 2:S13-20.
  4. Lyu TC, Zhang YX, Hu XJ, Cao Y, Ren P, Wang YJ. The effect of an early oral stimulation program on oral feeding of preterm infants. Inter J Nurs Sci. 2014; 1(1):42-7.
  5. Bache M, Pizon E, Jacobs J, Vaillant M, Lecomte A. Effects of pre-feeding oral stimulation on oral feeding in preterm infants: a randomized clinical trial. Early Hum Dev. 2014; 90(3):125-9.
  6. Harding C, Frank L, Dungu C, Colton N. The use of nonnutritive sucking to facilitate oral feeding in a term infant: a single case study. J Pediatr Nurs. 2012; 27(6):700-6.
  7. Pinelli J, Symington A. Non-nutritive sucking for promoting physiologic stability and nutrition in preterm infants. Cochrane Database Syst Rev. 2005; (4):Cd001071.
  8. Harding C, Frank L, Van Someren V, Hilari K, Botting N. How does non-nutritive sucking support infant feeding? Infant Behav Dev. 2014; 37(4):457-64.
  9. Coker-Bolt P, Jarrard C, Woodard F, Merrill P. The effects of oral motor stimulation on feeding behaviors of infants born with univentricle anatomy. J Pediatr Nurs. 2013; 28(1):64-71.

10. Bernbaum JC, Pereira GR, Watkins JB, Peckham GJ. Nonnutritive sucking during gavage feeding enhances growth and maturation in premature infants. Pediatrics. 1983; 71(1):41-5.

11. Gaebler CP, Hanzlik JR. The effects of a prefeeding stimulation program on preterm infants. Am J Occup Ther. 1996; 50(3):184-92.

12. Field T, Ignatoff E, Stringer S, Brennan J, Greenberg R, Widmayer S, et al. Nonnutritive sucking during tube feedings: effects on preterm neonates in an intensive care unit. Pediatrics. 1982; 70(3):381-4.

13. Rocha AD, Moreira ME, Pimenta HP, Ramos JR, Lucena SL. A randomized study of the efficacy of sensory-motor-oral stimulation and non-nutritive suckingin very low birthweight infant. Early Hum Dev. 2007; 83(6):385-8.

14. Greene Z, O’Donnell C, Walshe M. Oral stimulation techniques in preterm infants-International research challenges. J Neonatal Nurs. 2013; 19(4):168-74.

15. Hill AS. The effects of nonnutritive sucking and oral support on the feeding efficiency of preterm infants. Newborn Infant Nurs Rev. 2005; 5(3):133-41.