Risk factors and clinical features of feeding intolerance in preterm infants and the effect of multimodal oral–sucking–oromotor training: a single-center retrospective analysis

Abstract

Background: Feeding intolerance (FI) is a common gastrointestinal problem among hospitalized preterm infants that can delay establishment of enteral nutrition and increase the risk of complications. Objective: To identify factors associated with FI and characterize its clinical manifestations in preterm infants, and to evaluate the association between addition of multimodal oral–sucking–oromotor training to routine care and FI incidence and short-term outcomes, including subgroup analyses by weight for gestational age. Methods: We performed a single-center retrospective cohort study that included 649 preterm infants admitted between January 2020 and December 2022. Based on nursing and medical records, infants were classified into an intervention group (n = 320; routine care plus multimodal oral–sucking–oromotor training) and a control group (n = 329; routine care only). The primary outcomes were FI-related endpoints (FI incidence, severity, duration, and days to attainment of full enteral feeding). Secondary outcomes included in-hospital complications, nutritional and growth indices, and neurobehavioral scores. Subgroup analyses were conducted for infants who were appropriate for gestational age (AGA) and small for gestational age (SGA). Multivariable logistic regression was used to identify independent factors associated with FI. Results: The incidence of FI was significantly lower in the intervention group than in the control group (28.1% vs. 40.7%, p < 0.001), with a notably smaller proportion of severe FI. The intervention group also exhibited shorter FI duration, earlier attainment of full enteral nutrition, and superior weight-gain velocity, nutritional biochemical markers and NBNA scores compared with controls (all p < 0.001). In stratified analyses by weight-for-gestational-age, multimodal oral–sucking–oromotor training was likewise associated with more favorable short-term outcomes in both AGA and SGA preterm infants. Multivariable logistic regression identified 1-minute Apgar ≤7, SGA status, delayed first feeding >72 h, mechanical ventilation/respiratory support and early-onset sepsis (EOS) as independent correlates of FI. After adjustment for covariates, higher gestational age, greater birth weight, breastfeeding (adjusted OR = 0.60) and multimodal oral–sucking–oromotor training (adjusted OR = 0.59, 95% CI 0.42–0.82) remained independently associated with a reduced risk of FI. Conclusions: Addition of multimodal oral–sucking–oromotor training to routine care was independently associated with a lower incidence of FI and with improvements in short-term nutritional and growth outcomes in preterm infants; benefits were observed in both AGA and SGA subgroups. SGA status, delayed initiation of first feeding (>72 h), requirement for respiratory support/mechanical ventilation and EOS were independent risk factors for FI.