Impact of Oromotor Stimulation on Transition from Gavage to Full Oral Feeding in Preterm Neonates: A Randomized Controlled Trial

<b><i>Background:</i></b> The premature infant oral motor intervention (PIOMI) has demonstrated benefits in improving oral feeding abilities and reducing hospitalization duration in preterm neonates. However, evidence from rural health care settings, particularly in India, remains sparse. <b><i>Objective:</i></b> This study aimed to evaluate the effect of PIOMI combined with routine neonatal care versus routine care alone on the transition time from gavage feeding initiation to full breastfeeding in preterm neonates. <b><i>Methods:</i></b> A randomized controlled trial was conducted with 202 hemodynamically stable preterm neonates of 28-32 weeks' gestation admitted to the NICU and SNCU of a rural tertiary care center in India. Participants were randomized into an intervention group receiving PIOMI plus routine care-which included Kangaroo Mother Care and non-nutritive sucking-and a control group receiving routine care alone. Neonates were stratified by gestational age into four categories: 28-29, 29-30, 30-31, and 31-32 weeks. The primary outcomes were times to achieve full katori spoon feeding and full breastfeeding. Secondary outcomes included weight gain from day 14 to day 20 of life. <b><i>Results:</i></b> The intervention group achieved initial katori spoon feeding earlier by 0.71 days (95% CI: -1.30 to -0.12; <i>p</i> = 0.017), full katori spoon feeding 6.89 days sooner (95% CI: -8.13 to -5.65; <i>p</i> < 0.001), and full breastfeeding 5.71 days earlier (95% CI: -7.02 to -4.40; <i>p</i> < 0.001) than the control group. Average weight gain between days 14 and 20 was modestly lower in the intervention group by 5.36 g/day (95% CI: -6.48 to -4.25; <i>p</i> < 0.001). <b><i>Conclusions:</i></b> PIOMI significantly shortened the transition from gavage to full breastfeeding in preterm neonates in a rural Indian setting, although with a slight reduction in weight gain during the latter hospital stay period.