The Relationship Between Behavioral States and Oral Feeding Efficiency in Preterm Infants

Adv Neonatal Care. 2017 Feb;17(1):E12-E19. doi: 10.1097/ANC.0000000000000318.


Background: The relationship between behavioral states (alert, sleep, drowsy, and crying) and oral feeding efficiency in preterm infants is not well understood.

Purpose: To determine the relationship between behavioral states and feeding efficiency in preterm infants.

Methods: This correlational study was conducted as a secondary analysis from a randomized controlled trial. Medically stable preterm infants born between 29 and 34 weeks' gestational age participated. Baseline data from the randomized controlled trial (week 0), 1 minute prior to feeding, were used. Behavioral states were coded by 2 blinded coders. Oral feeding efficiency (mL/min) was calculated as the amount of intake over the first 10 minutes of feeding.

Results: Data from 147 infants were included. The proportion of time spent in alert states (β = .76, F = 11.29, P ≤ .05), sleep states (β = -1.08, F = 25.26, P ≤ .05), and crying (β = 1.50, F = 12.51, P ≤ .05) uniquely predicted oral feeding efficiency.

Implications for practice: Comprehensive assessment of behavioral states and infant characteristics for oral feeding readiness is crucial. Alert states are optimal for oral feeding. Forced oral feeding when infants are sleeping should be avoided. Infants in crying or drowsy states prior to feeding should be closely evaluated. Sleeping or drowsy infants may benefit from interventions (eg, oral sensory stimulation, nonnutritive sucking, or multisensory intervention) to support transition to alert states prior to feeding.

Implications for research: Future research should evaluate behavioral states prior to and during feeding and their relationship to oral feeding efficiency.

MeSH terms

  • Crying*
  • Feeding Behavior*
  • Female
  • Humans
  • Infant Behavior*
  • Infant, Newborn
  • Infant, Premature
  • Male
  • Sleep Stages*
  • Sleep*
  • Wakefulness*