Influence of the Premature Infant Oral Motor Intervention (PIOMI) on Breastfeeding

Preterm infants will be recruited from the Neonatal Intensive Care Unit (step down unit) after receiving referral for oromotor intervention or breastfeeding from the treating physician. Once referral is obtained the infant’s caregivers will be contacted and provided with the patient information sheet and consent form, along with a detailed explanation of the study. After consent is obtained from the primary caregiver, the infant will be recruited in the study. Randomization will not be attempted as it is a quasi experimental study and it is not feasible to randomize. Infants referred for oromotor stimulation will be part of the intervention group and the ones referred for breastfeeding will be part of the control group. The demographic data will be collected and pre intervention data (EFS) will be administered by the secondary investigator who will be blinded to reduce bias. The control group will receive standard care (breastfeeding support given by the nursing staff) and the intervention group will receive PIOMI (a structured intervention specifically designed for stable preterm infants developed by Brenda Lessen Knoll which includes cheek stretch, lip roll, lip curl, midblade tongue pressure, lateral tongue pressure, gum massage and non nutritive sucking) from the primary investigator. Infants in both groups may be breastfeeding as well as on formula feeds, however, the infant must be able to tolerate at least one breastfeeding trial in a day. Both groups will be assessed till they achieve 4 successful breastfeeding attempts in a day. The Early Feeding Skills Assessment Scale (EFS) will be administered every alternate day till the infant is able to breastfeed 4 times a day successfully. Once the infant can breastfeed 4 times a day, the intervention will then be stopped and the post intervention EFS score will be recorded by the secondary investigator for the intervention group. Once the infants in the control group achieve 4 direct breastfeeding attempts their EFS scores will be assessed and recorded as well. The outcomes measured will be, scores on the EFS and the days taken to achieve 1 and 4 successful direct breastfeeds. The pre-intervention and post-intervention EFS scores will tell us about the effectiveness of the intervention (PIOMI). This process may last from a few days to weeks depending on the infant’s response.