Gaps in Oral Stimulation Research in Preterm Infants: Beyond Reaching Full Oral Feedings and Length of Hospital Stay

Achieving oral feeding is a key discharge criterion for preterm infants in the neonatal unit. Research on interventions for oral feeding has often focused on achieving outcomes such as faster transition times to oral feeding and reduced length of hospital stay. Oral stimulation interventions developed for preterm infants are popular but are invasive, developmentally questionable, can have associated adverse effects and can be difficult to replicate in vivo. This paper presents a secondary analysis of data generated from two previous Cochrane reviews for oral stimulation in preterm infants to (a) isolate and examine the reporting of adverse events associated with oral stimulation, (b) address the developmental appropriateness of these interventions (c) evaluate parental participation in these interventions. The 28 original Cochrane RCTs were reviewed. Of these 11 stated adverse events as an outcome measure of interest but only 8 of these actually reported on adverse events. All 8 of these studies reported apneas/bradycardias during intervention, 3 reported desaturations, only 2 commented on stress behaviours such as gagging, vomiting, choking. Of the 28 studies only 10 indicated the gestational age that the intervention commenced at ranging from 29 weeks to 36 weeks. Only 6 studies had parental involvement in delivering interventions. This analysis challenges the current narrow outcome measures for infants in neonatal care, particularly in relation to oral feeding related interventions. There is a need for the development of a core outcome set for oral feeding interventions in preterm infants to provide wider outcome measures to reflect the complexities and challenges of establishing safe oral feeding in these infants.