The Effect of Oral Motor Intervention (PIOMI) and Combined Kangaroo Care Applied to Preterm Babies on Weight Gain, Oral Feeding Skills, Transition to Full Oral Feeding and Discharge Time: Randomized Controlled Study

The most important responsibility for the transition to oral feeding in the early period falls on neonatal intensive care nurses. Neonatal intensive care nurses should evaluate premature babies' readiness for feeding and use evidence-based practices in this regard. Studies show that there are different applications (piomi, fucile, etc.) in oral motor stimulation that provides a single sensory input. One of the most commonly used applications is the PIOMI (Preterm Infant Oral Motor Intervention) application developed by Lessen et al. (2011). PIOMI has been shown to shorten the duration of transition to oral feeding and hospital stay, helps in weight gain, increases sucking capacity and transition from breast to breastfeeding. It is stated that it accelerates the duration. However, PIOMI; such as massage therapy, breastfeeding, oral support and non-nutritive sucking, music therapy. A limited number of studies show that combined use is more effective, and more research is needed in this area.

One of the methods that accelerates the transition to oral feeding in preterm babies and is effective in physiological stability and neuromotor development is kangaroo mother care. No research has been found in the literature examining the effect of kangaroo care and PIOMI application on the oral feeding process of preterm babies when applied in combination. Additionally, no study has been found that evaluated the maturity of oral feeding skills and early feeding skills in which PIOMI and kangaroo care were combined. In this context, research; It will be carried out to examine the effects of oral motor intervention (PIOMI) and combined kangaroo care applied to preterm babies on weight gain, oral feeding skills, transition to full oral feeding and discharge time.

The research is a randomized controlled trial. The research will be carried out in the Neonatal Intensive Care Unit of Isparta City Hospital between March 2024 and March 2025. Neonatal Intensive Care Unit consists of Level 3 with 12 beds, Level 2 with 8 beds, mother-baby adaptation room with 10 beds, 3 isolation rooms and 1 breastfeeding room. There is a breastfeeding nurse at the clinic during the day (8-16) and provides breastfeeding education to mothers. At other times (16-08), each nurse provides breastfeeding counseling to the parents of the baby for whom she/he is responsible for care. Mothers express their milk in the breastfeeding room and hand it over to the nurses, writing the name, date and time on it. Receiving the milked milk to the clinic, storing it and preparing it by heating it. It is carried out in accordance with the Ministry of Health and Food and Drug Administration (FDA). This milk is monitored by each patient's own nurse, and excess milk is put in the freezer. The milk to be used is placed in the milk cabinets in the rooms, and the milk is withdrawn day and night by the nurses according to the doctor's request, before feeding, in accordance with the time, and is heated using the bain-marie method and given to the babies. There is no written protocol in the clinic regarding the transition and maintenance of oral feeding of newborns. Oral feeding is initiated by the joint decision of the neonatal physician and neonatal nurse, taking into account the postmenstrual week, physiological parameters and individual conditions of the newborns. In oral feeding of preterm babies, syringes are generally used and babies are fed in a semi-elevated position.

The data of the research will be collected with the "Informed Volunteer Consent Form", "Baby Introduction Form", "Early Feeding Skills Assessment Tool" and "Nutrition Tracking Chart".

There are three groups in the research: PIOMI, PIOMI+kangaroo care and control group.