Extrinsic Environmental Factors Influencing the Achievement of Independent Oral Feeding in Preterm Infants

Importance Preterm infants frequently experience difficulty with the transition from full tube to independent oral feeding. The influence of extrinsic environmental factors, defined as causes external to the infant, that may affect this transition remains poorly understood. Objective To examine the association between extrinsic environmental factors and attainment of independent oral feeding in preterm infants. Design A retrospective cohort study was conducted. Setting Data were collected from a tertiary care, level II/III neonatal intensive care unit. Guided by the Oral Feeding in Preterm Infants Conceptual Model, extrinsic environmental factors were selected for analysis. Participants A total of 282 preterm infants (31.2 ± 2.4 weeks gestation) were included. Methodology Factors including maternal medical history, type of medical condition, maternal substance use, non-nutritive sucking, skin-to-skin contact, feeding therapy, and days of hospitalization prior to initiating oral feeding were extracted from electronic medical records. Simple linear regressions identified potential external variables, which were entered into a multiple linear regression model. Results In the final multiple linear regression model, maternal medical history, non-nutritive sucking, and skin-to-skin contact were significant predictors of time to independent oral feeding. Maternal age, substance use, feeding therapy, and days in hospital prior to starting oral feeds were not significant. Conclusion and Relevance Maternal health and engagement, reflected in maternal medical history, opportunities for non-nutritive sucking, and skin-to-skin contact, are key extrinsic environmental factors influencing the transition to independent oral feeding. Integrating these maternal factors into occupational therapy management may enhance the attainment of independent oral feeding in preterm infants.