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Prospective study of non-nutritive sucking and feeding skills in premature infants
  1. Peter M Bingham1,*,
  2. Taka Ashikaga1,
  3. Soraya Abbasi2
  1. 1 University of Vermont, United States;
  2. 2 University of Pennsylvania, United States
  1. Correspondence to: Peter Bingham, Neurology, University of Vermont, 1 S. Prospect St., Burlington, 05401, United States; peter.bingham{at}


Objective: Assess the value of non-nutritive sucking (NNS) measures as predictors of oral feeding performance in comparison to other putative predictors of feeding skills: respiratory support, post-menstrual age (PMA) at birth, and the neonatal oral motor assessment (NOMAS).

Design: Prospective, observational study. Cox proportional hazards and nonparametric rank sum tests to assess the relationship between NNS and feeding outcome measures.

Setting: Neonatal intensive Care Units – rural/academic, urban/tertiary center

Patients: 51 premature infants born between 25 and 34 weeks’ PMA, birthweight 1512.3 ± 499.4 grams.

Interventions: Measurement of non-nutritive sucking; standardized feeding advance schedule; performance of NOMAS; standardized, permissive, oral feeding advance schedule.

Main outcome measures: Transition time from first to full oral feeding, gestational age at full oral feeding.

Results: Higher NNS organization score predicted shorter transition to full oral feeding (p<0.05): infants with a more organized suck pattern reached independent oral feeding 3 days earlier (16 vs. 13 day transition) than infants with more chaotic patterns of suck bursts. Consistency of the suck waves also corresponded with feeding milestones: infants with more regular suck wave pressure deflections became competent oral feeders approximately 3 days earlier than those with irregular suck pressure waves. PMA at birth was inversely associated with PMA at full oral feeding. NOMAS measures were not associated with outcome measures.

Conclusions: Measures of NNS organization and suck consistency constitute useful candidate predictors of feeding performance by premature infants. Results accord with previous findings linking PMA at birth with age at independent feeding.

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