Factors Predicting Oral Breastfeeding Among Early and Moderate to Late Preterm Infants: A Multiple Group Analysis

Objective:This study aimed to examine the predictive factors of oral breastfeeding among preterm infants,comparing early(28-31 week)and moderate to late(32-36 week)gestational age groups,and to develop a hypothesized model based on Ecological Systems Theory. Methods:A cross-sectional study was conducted with 584 mother-infant dyads from neonatal intensive care units(NICU)in Yancheng,China,from August 2024 to February 2025.Predictors included infant factors(readiness oral feeding behavior,functional status),maternal factors(breastfeeding self-efficacy,breast milk sufficiency,social support),and hospital factors(breastfeeding practice,breastfeeding support).Structural Equation Modeling(SEM)was employed to test the hypothesized model across the two groups. Results:Gestational age-specific predictors were identified:Early Preterm(28-31 week):Infant readiness(β=0.17,p<0.01)and functional status(β=0.23,p<0.01)were significant predictors.Moderate-to-Late Preterm(32-36 week):Infant readiness(β=0.29,p<0.01),maternal self-efficacy(β=0.27,p<0.01),and social support(β=0.15,p<0.05)were significant. Hospital factors(practice:β=0.60-0.70,p<0.01;support:β=0.16-0.24,p<0.05)significantly influenced outcomes in both groups.SEM models demonstrated excellent fit(early preterm:RMSEA=0.03;moderate-to-late preterm:RMSEA=0.00). Conclusions:Findings underscore the need for tailored interventions.For early preterm infants,focus should be on enhancing physiological readiness through targeted feeding protocols and kangaroo mother care.For moderate-to-late preterm infants,interventions should bolster maternal self-efficacy and social support via education and counseling.Hospitals should standardize breastfeeding support policies,including lactation guidance and family-centered care,to improve outcomes across both groups.These results advocate for evidence-based NICU protocols and maternal empowerment programs to enhance breastfeeding rates and inform policy in resource-limited settings. Keywords:multiple group analysis，preterm infants,Neonatal Intensive Unit（NICU），Oral breastfeeding,Bronfenbrenner’s Ecological systems theory,readiness oral feeding behavior,functional status,breastfeeding self-efficacy,breastfeeding sufficiency,social support,breastfeeding practice,breastfeeding support.