Maternal role in sensory motor stimulation for oral feed establishment in preterm neonates: MSMS trial

BackgroundThe transition from gavage to full oral feeding is a critical and challenging milestone for preterm neonates. Sensory-motor stimulation (SMS) has been shown to improve feeding performance; however, evidence regarding mother-administered SMS remains limited.ObjectiveTo compare the maternal-administered versus nurse-administered sensory-motor stimulation on oral feeding outcomes in preterm neonates.MethodsThis prospective, single-blind, parallel-group randomized controlled trial double-blind randomized controlled trial was conducted in a tertiary neonatal intensive care unit between March 2022 and September 2023. Clinically stable preterm neonates of 28 to 34 weeks of gestation were randomized to receive sensory-motor stimulation administered either by trained mothers (intervention group) or trained nurses (control group). The primary outcome was time to achieve full oral feeding. Secondary outcomes included feeding efficiency (Level 4 achievement), feeding proficiency (PRO), rate of transfer (RT), overall transfer (OT), coordinated suck-swallow-breathe (SSB) patterns, and adverse events. Time-to-event outcomes were evaluated using Kaplan-Meier analysis, log-rank testing, and Cox proportional hazards regression, with gestational age adjustment as a sensitivity analysis.ResultsOf 130 randomized neonates, 97 completed the study and were included the per-protocol analysis (experimental group, n = 49; control group, n = 48). Baseline maternal, neonatal, and feeding characteristics were comparable between groups. No significant between-group differences were observed in median time to achieve full oral feeding, RT, OT, PRO, feeding volumes, coordinated SSB patterns, or adverse events. Kaplan-Meier analysis demonstrated similar time to full oral feeding trajectories between groups (log-rank p = 0.984). Cox regression analysis showed no significant association between intervention group and time to full oral feeding (hazard ratio 1.016, 95% CI 0.637-1.619; p = 0.948), with similar results after gestational age adjustment (adjusted HR 1.045, 95% CI 0.655-1.668; p = 0.854).ConclusionMaternal-administered SMS achieved feeding outcomes comparable to nurse-administered SMS in clinically stable preterm neonates. Although not powered for non-inferiority or equivalence, these findings support the feasibility of involving trained mothers in structured feeding interventions and justify larger trials evaluating family-centered neonatal care in resource-limited settings.