Research Corner: Infant and maternal factors associated with attainment of full oral feeding (FOF) in premature infants

This newly published paper reminds us that, in the NICU, care is best when it is family-centered. Our most vulnerable preterms and their mothers benefit most when compassionate and thoughtful caregivers consider not only the infant’s co-morbidities but also maternal anxiety, stress, and depression, when assessing premature infants’ oral feeding performance. They influence each other, and should guide our approach to supporting the feeding experience.


Muir, H., Kidanemariam, M., & Fucile, S. (2021). The Impact of Infant and Maternal Factors on Oral Feeding Performance in Premature Infants. Physical & Occupational Therapy In Pediatrics, 1-7.


Aims: To identify infant and maternal factors associated with attainment of full oral feeding (FOF) in premature infants.

Method: A retrospective study was performed on 89 premature infants (<34 weeks gestational age) from a tertiary care neonatal intensive care unit (NICU). Infant and maternal factors were concurrently assessed. Infant factors included gestational age, birthweight, continuous positive airway pressure assistance, mechanical ventilation support, and presence of neonatal morbidities including bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and intraventricular hemorrhages (IVH). Maternal factors included maternal age, first born, twin birth, and presence of mental health conditions including anxiety, stress, or depression.

Results: A total of 89 premature infants were included in the sample. A stepwise linear regression model revealed that infants who received mechanical ventilator support and presence of maternal mental health conditions were significantly associated with time to attain FOF.

Conclusions: Results suggest that oral feeding performance is influenced not only by infant’s medical severity denoted by need for ventilator assistance, but also by presence of maternal anxiety, stress, and/or depression.

Details of conclusion: In terms of infant factors, this study revealed that mechanical ventilation support is associated with time to attain FOF. These study results are supported by others who found that infants with a chronic lung disease who require oxygen therapy or prolonged ventilation, are older by post conceptual age, when bottle feeding is initiated. Although the literature indicates that younger gestational age, lower birth weight, and neonatal morbidities such as BPD, IVH, and NEC are associated with longer FOF attainment these factors were not significant in this study. The lack of significance in GA, BW, and neonatal morbidities is likely because both infant and maternal factors were simultaneously assessed in the stepwise linear regression model which may have impacted the significance of these variables on FOF. Stepwise linear regression model essentially does multiple regression a number of times, each time removing the weakest correlated variable. At the end, the variables remaining are those that best explain FOF. Oral feeding consists of infants’ ability to generate and coordinate suck, swallow, and breathe processes. This entails proper functioning of the oral musculoskeletal, cardiorespiratory, and gastrointestinal systems. Taking the above into consideration, the study findings suggest that infants’ respiratory status, defined by need for mechanical ventilation assistance, has a significant effect on FOF, as it is one of the main systems involved in the oral feeding process. With regards to maternal factors, this study found that the presence of a maternal mental health condition, in particular anxiety, stress, or depression, is negatively associated with attainment to FOF, which corroborates a recent study (Park et al., 2016*). They found that increased maternal psychological distress was associated with decreased use of developmentally supportive feeding behaviors. These results suggest that mothers with psychological distress may be less responsive to the infant signals and needs. The literature suggests that maternal mental health conditions are associated with feeding behaviors but does not directly link this factor to delays in FOF as in this study. The study findings bring to light the importance of considering both infant and maternal factors when assessing premature infant’s oral feeding performance. 

*Park, J., Thoyre, S., Estrem, H., Pados, B., Knafl, G., & Brandon, D. (2016). Mothers’ psychological distress and feeding of their preterm infants. American Journal of Maternal Child Nursing, 41(4). Available through Google Scholar


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