Early evolution of oral feeding skills in very preterm infants: impact of an oral stimulation protocol assessed by cot-side suckometer: a pilot study

Oral feeding acquisition is frequently delayed in very preterm infants, potentially affecting hospital discharge timing and longer-term feeding competence. Evidence supporting oral stimulation interventions remains heterogeneous, with few objective longitudinal assessments available. We aimed to evaluate the feasibility of cot-side assessment of non-nutritive sucking (suckometry) for assessing sucking maturation and to characterise early sucking performances before and after implementation of a structured oral stimulation protocol. We conducted a prospective quality improvement (QI) pre-post uncontrolled pilot study in a single-centre level III neonatal unit among infants born at 27-32 weeks' gestational age. Sucking performance was measured weekly from the first postnatal week until full oral feeding autonomy using a novel cot-side suckometer. Clinical characteristics and sucking performances were compared before and after protocol implementation. Seventeen infants were included (11 before, 6 after protocol). Median gestational age was 29.7 weeks and birth weight 1320 g (comparable between groups). Cot-side suckometry proved feasible from the first postnatal days. Approximately 73% of non-stimulated infants exhibited an early decline in sucking performance (a ~ 40% reduction, primarily affecting suction and compression bursts), whereas stimulated infants demonstrated progressive improvement (an approximately 120% increase). Conclusion: Cot-side suckometry provides feasible objective assessment of sucking maturation in very preterm infants. Oral stimulation was associated with more favourable sucking development, warranting further evaluation in larger trials. What is Known: • Very preterm infants commonly experience delayed transition to oral feeding due to immature suck-swallow-breathe coordination • Oral stimulation and non-nutritive sucking interventions are widely employed, but systematic reviews highlight inconsistent evidence regarding optimal protocols and clinical benefits What is New: • A novel cot-side suckometer enables reliable objective assessment of sucking maturation from the earliest postnatal days in very preterm infants • Implementation of oral stimulation was associated with prevention of early performance decline and progressive sucking enhancement Trial registration: NCT07632066 (06/02/2026).