Maternal Role in Sensory-motor Stimulation for Oral Feed Establishment in Preterm Neonates: MSMS Trial
Phase: NA
Conditions: Preterm Birth, Tube Feeding, Swallowing Disorder, Maternal Care Patterns
Sponsor: Fatima Memorial Hospital

Cover page 
Title of study 
Maternal role in sensory motor stimulation for Oral Feed Establishment in preterm 
neonates: MSMS trial 
NCT number 
NCT05484726 
Date of document 
21 April 2024 
 
 
 

Maternal role in sensory motor stimulation for Oral Feed Establishment in preterm 
neonates: MSMS trial 
Oral feed establishment is one of the most challenging milestones for preterm neonates. It is 
becoming an emerging challenge for neonatologists with an improvement in the survival of 
preterm neonates. A successful transition from full gavage (tube) feeding to independent oral 
feeding is considered an important milestone of neonatal neurodevelopment maturation. It has 
been estimated that about 40% of preterm neonates face difficulty transitioning from gavage to 
oral feeding (1).  
Tube feeding-related problems are commonly observed in neonates. A literature review regarding 
the safety profile of having a feeding tube shows that it is not risk-free. Major problems enlisted 
are mechanical, functional, nutritional, biological and neurodevelopmental (mental motor delay) 
(2-5).  
According to Heidelise Als’ “Synactive Theory” in growing fetus and neonate, developmental 
maturation is done by integrating neonatal internal physiological status and functional demands 
with multisensory inputs from the environment (6,7). In preterm neonates, synergistic effects of 
combined oral and non-oral sensorimotor (tactile/kinesthetic) interventions have shown promising 
results (8). It helps augment their experience to exercise their innate (sucking) reflex that 
ultimately decreases transition time from introduction to safe full independent oral feeding (9). 
Feeders and grower neonates are ideal for oral stimulation for oral feed establishment. 
The ideal time to start oral feeding in preterm neonates is still debatable. In developing fetus 
shows sucking, swallowing and breathing at 15, 14 and 10 weeks of gestation, respectively (10). 
Feeding development undergoes maturational processes throughout gestation, from non-
coordinated sucking and swallowing movements to fully coordinated suck-swallow-breathe, 
usually occurring after 34 weeks. Unlike the term sucking reflex, preterm neonates have a 
predominant expression pattern of sucking with no suction. Lau et al. demonstrated that around 
30 weeks of post-menstrual age (PMA), healthy preterm neonates could complete their successful 
oral feeding within 20 minutes using an immature sucking reflex (11). 
Family-centred care (FCC) is, in fact, developmentally supportive care that helps develop bonding 
(12).  Intermittent kangaroo mother, as a part of FCC, benefits from maternal-neonatal bonding 
(13). Similarly, the role of maternal involvement in pre-feeding sensorimotor stimulation is a 
hidden corner in research. To our knowledge, not even a single international or national study is 
available in this regard. 
In resource-constrained setups with limited properly trained speech therapists and neonatal 
nurses, mothers can be involved in pre-feeding sensory motor stimulation after training and 
teaching to improve their feeding performance. Within this context, the current study aims to 
determine the following: 1) the maternal role in sensory-motor stimulation for oral feed 
establishment in preterm neonates, 2) determine the effect of sensory-motor stimulation offered 
by the mother on the onset of oral feeding, and 3) the efficiency of mother-mediated stimulation 
techniques on oral feeding compared to trained nurses.  
Keywords 

Prematurity sensory-motor stimulation oral feed establishment, feeding intervention 
Material and methods  
An interventional, prospective, randomized control trial was conducted after ethical approval from 
the Institutional Review Board of Fatima Memorial Hospital (FMH-07-2021-IRB-929-M). The 
authors confirm that this intervention's ongoing and related trials are registered in the 
ClinicalTrials.gov platform–accession number NCT05484726. The study protocol can be 
accessed at https://www.clinicaltrials.gov/ct2/show/NCT05484726.  
Study hypothesised that preterm babies who receive sensory motor stimulation from their 
mothers as compared to trained nurses, are 
 
Start taking oral feed at the same time as compared to the control group 
 
Take the same amount of milk at the commencement of oral feeding 
 
Take milk with equal efficiency 
 
Not face more adverse effects 
The study period spans 16 months, from March 2022 to july 2023, in the department of 
Neonatology, Fatima Memorial Hospital, Lahore. We enrolled all preterm neonates of gestation 
age 28 to 34 weeks who were admitted to NICU during the study period after seeking consent 
from parents or guardians. All these neonates were haemodynamically stable, established 
gavage feed, had no respiratory distress, no need for respiratory support except LFNC and did 
not receive any kind of analgesics at time of enrollment.  
However, all those neonates having major anomalies incompatible with life, major malformations, 
syndromic babies, cleft lip and palate, genetic disorders, haemodynamically unstable babies 
including IVH (grade III & IV), haemodynamically significant PDA (HsPDA) requiring antifailue 
therapy, NEC (stage II & III) or anemia requiring blood transfusion. All those neonates with 
adverse events including cough with chocking, breath holding, chocking, aspiration, tachycardia 
HR > 200/min, bradycardia HR < 100/min, apnea > 15 sec, tachypnea RR > 70/min while 
stimulation or feeding were excluded.  
Protocol 
Interventional Study Model: Factorial Assignment  
 
Maternal involvement in perioral sensory-motor stimulation be in three stages  
o Observer status  
o Performing under supervision  
o Independent  
 
Intervention period: 5 days as  
o Training phase (T): T1 and T2 (for mothers by the nurse)  
o Direct feeding phase (D): F1, 2, and 3 (oral feed was offered to neonate)  
 
Stimulation for 7 minutes and 15 minutes before feeding twice a day at 1100 and 1700 hrs. 
 
Two groups  
o Intervention group (GI): by mothers  
o Control group (G II): by staff nurses  
Number of Arms: 2 
Masking: Single (Care Provider) 
The mothers, medical staff involved in general care, nursing staff involved in the intervention, and 
doctors conducting the assessment of oral feeding skills (OFS) were all blinded to allocation. The 
nursing staff was informed at the time of intervention that participating infants received either 
sensory motor stimulation or sham oral stimulation depending on group allocation.  

 
Allocation 
Randomization was done using a random Alloc Software environment. Gestation age-based 
stratification was done using 3 blocks design of 28 to 30, 30+1 to 32 & 32+1 to 34. Random 
allocation of neonates into the intervention or control groups by stratum using lottery method. 
Blinding  
The mothers, medical staff involved in general care, nursing staff involved in intervention and 
doctors conducting the assessment of oral feeding skills (OFS) were all blinded to allocation.  The 
nursing staff was informed at the time of intervention that participating infants received either 
sensory motor stimulation or sham oral stimulation depending on group allocation. 
Sample size  
 
The sample size was 46 (23 each in interventional and control groups) and calculated with a 95%  
confidence level, 10% margin of error and 5% level of significance by taking feeding-related 
problems as 40%. It was done by using openepi.com. 
Initially only 46 neonates were enrolled in study. But later an immense maternal response was 
observed. Mothers were ready to learn and involve in sensory motor stimulation of their neonates. 
Hence, the final total study population size was 97 with 49 in experimental and 48 in control group.  
 
Procedure of intervention 
 
The study intermediation was started not before 30 weeks of postmenstrual age when full 
gavage feeding was established with the addition of supplements.  
 
All mothers in this study was involved in gavage feeding before involvement in the procedure.  
 
Trained nurses tought details of sensory-motor stimulation to mothers in easily 
understandable languages (annexure 1 in (a) English and (b) Urdu). This procedure has 
been adapted from modified from PIOMI and Fucile (14,15). 
 
Stimulation was done for 7 minutes and at least 15 minutes before feeding twice daily at 
1100 and 1700 hrs till full oral feed establishment (expected time 28 days chronological age) 
 
Oral feeding was offered using a bottle with a slow-flow nipple.  
 
Time monitoring for feeding was strictly followed 
 
Infants was fed for a maximum of 20 min, and feeding wias discontinued early if adverse 
events occur.  
 
Arms and intervention 
 
Study groups for sensory motor stimulation (5 minutes) + pacifier (2 minutes) 
o Intervention group (G1)   :   by mothers  
o Control group (G 2)         :   by staff nurses 
 
Experimental: Intervention group (Group 1)  
 
Maternal involvement was done in three stages for the intervention group as  
o Observer status  
 
T1: Nurses performing all steps while mother observer status  
 
T2: Nurses perform all steps in front of the mother and a pacifier was offered by the 
mother 
o Performing under supervision  
 
D1: Mother performs all steps and oral milk was offered by the nurse while the mother 
observes.  
 
D2: Mother performing all steps and offering oral milk while the nurse is supervising 

o Independent  
 
D3: Mother performing all steps independently 
 
Study groups for sensory motor stimulation  
Assigned intervention perioral sensory motor stimulation Step 1 - 6 over 5 minutes + 
pacifier 2 minutes for total duration of 7 minutes. 
o Step 1: With the help of the index finger, on the external surface of the cheek, make a 
circle starting from the angle of the mouth towards the ear then back 7x each cheek  
o Step 2: While holding both sides of the cheek with help of the thumb and index finger 
repeat step 1 7x each cheek  
o Step 3: Move index finger from one corner to opposite one over both lips separately 7x 
each lip  
o Step 4: Gentle massage and compress the gums from center to back of mouth 7x each 
half of the gum  
o Step 5: Move the finger from front to back on the hard palate while applying gentle 
pressure 7x  
o Step 6: Displace the center of the tongue with gentle pressure 7x  
o Offer pacifier at the end 2 minutes Note: 7x means 7 times 
 
Control group / Sham Comparator (Group II) 
All steps were same as intervention group and was performed by trained staff nurses 
Data Collection 
All relevant maternal and neonatal data (baseline measures) were collected on a specially 
designed proforma.  
 
Baseline measures 
 
 
Maternal demographic and clinical data include  
o Age in years 
o Gravidity / number of pregnancies measured in numbers as primigravida (PG), 2-
3 or ≥ 4) 
o Educational qualification as uneducated, primary, secondary or higher 
o Previous preterm baby measured as yes or no 
o Job status as working-lady or home-maker 
o Diabetes mellitus, hypertensive disorders and anemia as yes or no  
 
Neonatal demographic data includes  
o Gender as male or female 
o Gestation age measured in weeks 
o Mode of delivery as spontaneous vaginal delivery (SVD) or low segment caesarian 
section (LSCS) 
o Birth weight measured in kg  
o Weight for gestation age. It can be appropriate for gestation age (AGA), small for 
gestation age (SGA) or large for gestation age (LGA)  
o Place of birth  as inborn or out-born 
o Neonates with respiratory failure may need respiratory support that was measured 
as  
 
Requirement of invasive mechanical ventilation (IMV) along with duration 
in days as median with IQR 

 
 Non invasive  ventilation (NIV) along with duration in days as median with 
IQR 
 
Oxygen  as low flow nasal cannula (LFNC) along with duration in days as 
median with IQR 
 
Neonates  with prophylactic caffeine therapy given to all neonates < 32 
weeks of gestation age  
 
Respiratory distress syndrome (RDS) was diagnosed on clinical and 
radiological features of reticulo-nodular shadowing 
 
Apnea was diagnosed on basis of breath holding spells for > 20 second 
 
Hemodynamically significant patent ductus arteriosus (HsPDA) diagnosed 
by echocardiography 
 
Necrotizing enterocolitis (NEC) diagnosed using modified Bell’s scoring 
(stage 1) 
 
Feeding intolerance diagnosed as aspirates > 20% of previous feed ± 
abdominal distension of > 2cm from base line 
 
Sepsis (leukocytosis or leukopenia or ANC<150 along with raised CRP and 
platelets <100 and or positive blood culture) 
 
Seizures  
 
Discharge weight in kg  
 
Duration of stay in NICU in days 
 
Neonatal feeding characteristics at time of enrollment in study include 
o Postmenstrual age (PMA) measured in weeks  
o Chronological age (ChA)measured in weeks 
o Time/duration to achieve full gavage/tube feed measured in days  
o Daily milk intake (ml/kg/day) when sensory motor stimulation was started 
o Volume of feed prescribed for each feed (ml) 
 
The outcome measured were documented daily twice a day (11.00 and 17.00 hrs) until 
achievement of full oral feed. Full oral feed was volume of 120-140ml/kg/day taken orally. 
However, to make calculations concise, for both groups, all outcome parameters were 
documented on proforma for fixed time (11.00 am) for D1, D2, D3, D5, D7 and D14.  
 
 
Primary Outcome Measure 
o Transition time to full oral feeding is the time interval between commencement of perioral 
sensory stimulation on D1 to establishment of full oral feed in both groups.It was done 
daily till 14th day of perioral sensory motor stimulation. Transition time to full oral feeding 
was the day at which baby was able to take  oral feed of  volume of 120-140ml/kg/day. 
o Improvement (change) in efficiency oral feed establishment in terms of amount and time. 
It was classified into four levels depending upon the level of maturity in ascending order 
as follows:  
 
Level 1: PRO < 30% and RT < 1.5 ml/min  
 
Level 2: PRO < 30% and RT ≥ 1.5 ml/min  
 
Level 3: PRO ≥ 30% and RT < 1.5 ml/min  
 
Level 4: PRO ≥ 30% and RT ≥ 1.5 ml/min 
For our RCT, efficacy was measured as the achievement of L4 for the intervention group 
vs the control group.  

o Adverse outcome monitoring was done for every neonate from first day of enrollment in 
study (D1) till establishment of full oral feed (by D14 expected). These include non-life 
threatening adverse events including cough, tachycardia HR 180-200/min, bradycardia 
HR120 - 100/min, , tachypnea RR 60 - 70/min while maintaining SpO2 of >90% at room 
air  
 
Secondary Outcome Measure:  
o Total volume (TV) taken during each feed 
o Volume taken during the first 5 min (TV5) out of total feed taken orally 
o Rate of transfer (RT) ml/min i.e., how long it neonate takes to finish oral feed. 
o Overall transfer (OT percent) volume taken/total volume prescribed. It shows trend 
towards oral feed establishment. 
o Proficiency (PRO percent) volume taken during the first 5 min/total volume prescribed. 
o SSB (Suck Swallow Breaths) coordination coordinated, developed pattern of suck swallow 
and breathe. It is a subjective assessment.  
Statistical analysis 
The statistical software IBM SPSS Statistics version 21 (SPSS, Chicago, IL) was used for the 
statistical analysis of the data. Appropriate bivariate analysis was performed to identify the 
unadjusted differences between the cases and controls. Categorical variables were expressed as 
frequencies and percentages. According to Shapiro Wilk test all continuous variables were 
asymmetrically distributed. Mann–Whitney U test was used for nonparametric continuous 
variables and were described as medians and inter quartile range (IQR). Fisher exact/Chi square 
test was used to compare categorical variables. Mann- Whitney test was used to compare 
continuous variables. The p-value of < 0.05 was taken as statistically significant.  
 
Results 
During the research period, 1009 newborns were admitted to the Neonatal Intensive Care Unit 
(NICU). Among them, 142 were born prematurely, with gestational ages falling between 28 and 
34 weeks. Out of the preterm neonates, a total of 130 were eligible for the study, as 12 had to be 
excluded for various reasons. These exclusions included 2 cases where mothers experienced 
serious postnatal complications, 1 instance of parental refusal to participate, 1 case with 
incomplete data, and 8 cases that did not meet the inclusion criteria due to different reasons such 
as syndromic features, cleft lip and palate, suspected inborn error of metabolism (IEM), 
intraventricular hemorrhage (grade IV), and hemodynamically significant patent ductus arteriosus 
(HsPDA). Consequently, 130 neonates were included in the study and randomly assigned, with 
65 in each group for intervention and control. Sensory motor stimulation (SMS) was administered 
to 107 of these neonates, and the study was completed with 97 neonates (as illustrated in Figure 
1). 
The sociodemographic  and clinical characteristics of both mothers and neonates are shown in 
Table 1. There were no statistically significant differences between groups regarding maternal 
age, gravidity, education, previous preterm neonates, job status and pregnancy related issues ( 
hypertensive disorder of pregnancy, gestational diabetes, and anemia). Similarly, neonatal 
characteristics regarding gender, mode of delivery, gestation age, birth weight, weight for 
gestation age, place of delivery, need and duration of invasive mechanical ventilation (IMV), non 

invasive ventilation  (NIV) and low flow nasal cannula (LFNC), apnea, RDS, use of caffeine, 
HsPDA, NEC stage 1, feed intolerance, sepsis, and seizures. (Table 1). 
There was also no significant difference in feeding characteristics The feeding characteristics 
assessed were postmenstrual (PMA), chronological (ChA) age, and weight at enrollment, time to 
full gavage feed establishment, amount of milk feed advised for each feed and day on D1, D2,D3, 
D5, D7 and D14. (Table 2). 
Table 3 provides an overview of both the primary and secondary outcomes observed in both study 
groups. When examining the primary outcome measures, there were no significant differences 
observed in terms of the time it took to establish full oral feeding, adverse events, or the 
effectiveness observed during oral assessments. The findings indicate that neonates in the 
experimental group demonstrated oral feeding skills that were comparable to those in the control 
group. These skills were measured in terms of volume (both total and during the initial 5 minutes 
of feeding), feeding rate, overall transfer, proficiency, and the coordination of suck, swallow, and 
breath (Table 3).  
 
 

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Figure 1: Consort diagram 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Assessed for eligibility 142 
Randomization 130 
Excluded 12 
 
2 mothers with postnatal problems  
 
1 parental refusal to participate 
 
1 incomplete data 
 
8 Not meeting inclusion criteria 
Syndromic features 1, IVH (grade IV) 
1cleft lip and palate 1, HsPDA 1, IEM 2 
Intervention gp 65 
SMS Execution 
         53 
SMS Execution 
         54 
Completed  
49 
Not completed 5 
1IVH (IV) 
1NEC  
1 With drawl   
2 protocol violation 
Not completed 5 
1IVH (IV) 
2NEC  
2 protocol violation 
Excluded 11 
. Protocol violation 1 
. Failure to establish gavavge  
  feed by 2 wk ChA 4 
. HsPDA on antifailure therapy 1 
. Continued ventilation 2 
. With drawl by parents 1 
. IVH (II & IV) 1 
. NEC (II & III) 1 
Control gp 65 
Excluded 12 
. Protocol violation 1 
. Failure to establish gavavge  
  feed by 2 wk ChA 2 
. HsPDA on antifailure therapy 2 
. Continued ventilation 3 
. With drawl by parents 3 
. NEC (II & III) 1 
Completed  
48 

Table 1: Maternal and neonatal characteristics 
Characteristics 
Experimental group (n=49) 
Control group (n = 48) 
p-value 
N 
E 
O 
N 
A 
T 
A 
L 
 
Gender (Male) a 
27 (55.1%) 
22 (44.9%) 
0.239 
Gestational age (week) b 
30 (29 – 32) 
31 (29.3 – 32) 
0.543 
Mode of delivery (SVD)  a 
26 (47.3%) 
29 (52.7%) 
0.300 
Birth weight b 
1.29 (1.20 – 1.52) 
1.34 (1.15 – 1.67) 
0.744 
Weight  
for GA  a 
AGA 
27 (47.4%) 
30 (52.6%) 
0.554 
SGA 
16 (51.6%) 
15 (48.4%) 
LGA 
6 (66.7%) 
3 (33.3%) 
Inborn a 
30 (67.6%) 
33 (52.4%) 
0.287 
IMV a 
26 (46.4%) 
30 (53.6%) 
0.231 
Duration of IMV (days) b 
1 (0 – 4) 
2 (0 – 5) 
0.463 
NIV a 
45 (48.4%) 
48 (51.6%) 
0.061 
Duration of NIV (days) b 
3 ( 1 – 7) 
4 (2 – 6.75) 
0.509 
LFNC a 
47 (52.2%) 
43 (47.8%) 
0.209 
Duration of LFNC (days) b 
4 ( 2 – 5) 
3.5 (2 – 5) 
0.716 
Apnea a   
18 (47.4%) 
20 (52.6%) 
0.386 
RDS a 
25 (50.0%) 
25 (50.0%) 
0.539 
Caffeine a 
28 (50.0%) 
28 (50.0%) 
0.535 
HsPDA a 
17 (45.9%) 
20 (54.1%) 
0.309 
NEC (stage I ) a 
9 (42.9%) 
12 (57.1%) 
0.293 
Feeding intolerance a 
20 (44.4%) 
25 (55.6%) 
0.182 
Sepsis a 
43 (51.2%) 
41 (48.8%) 
0.484 
Seizures a 
7 (58.3%) 
5 (41.7%) 
0.394 
M 
A 
T 
E 
R 
N 
A 
L 
 
Age b 
29 (26  - 32) 
30 (26.5 – 33) 
0.138 
Gravidity  a 
Primigravida 
20 (43.5%) 
26 (56.5%) 
0.350 
2-3 
22 (59.5%) 
15 (40.5%) 
≥ 4 
7 (50.0%) 
7 (50.0%) 
Education a 
Uneducated 
2 (50.0%) 
2 (50.0%) 
 
0.699 
Primary 
11 (52.4%) 
10 (47.6) 
Secondary 
15 (42.9%) 
20 (57.1%) 
Higher 
21 (56.8%) 
16 (43.2%) 
Previous preterm (yes) a 
42 (52.5%) 
38 (47.5%) 
0.281 
Job status (Housewife) a 
29 (48.3%) 
31 (51.7%) 
0.368 
Hypertensive disorder a 
29 (47.5%) 
32 (52.5%) 
0.290 
DM a 
17 (50.0%) 
17 (50.0%) 
0.555 
Anemia a 
25 (54.3%) 
21 (45.7%) 
0.304 

 
Table 2 : Feeding charteristics 
 
 
 
 
 
 
 
Feeding characteristics 
Experimental group 
(n=49) 
Control group  
(n = 48) 
p-value 
PMA at enrollment (week) 
32 (31 – 33) 
32 (31 – 33) 
0.787 
ChA at enrollment (days) 
13 ( 6 – 14) 
9 ( 7 – 16) 
0.925 
Time to full gavage feed (days) 
7 (5.5 – 13.5) 
7 ( 6 – 14) 
0.726 
Discharge weight (kg) 
1.48 (1.42 – 1.66) 
1.48 (1.43 – 1.75) 
0.698 
Weight at enrollment (kg) 
1.35 (1.25 – 1.54) 
1.35 (1.21 – 1.60) 
0.610 
Duration of stay in NICU (days) 
21 (15 – 29.5) 
30 (16 – 30.75) 
0.848 
Milk Feed (ml/kg/day) 
Milk feed D1 
120 (120 – 120) 
120 (120 – 120) 
0.302 
Milk feed D2 
120 (120 – 140) 
120 (120 – 140) 
0.871 
Milk feed D3 
140 (140 – 140) 
140 (140 – 157.50) 
0.109 
Milk feed D5 
150 (150 – 160) 
160 (150 – 160) 
0.361 
Milk feed D7 
160 (160 – 160) 
160 (160 – 160) 
0.184 
Milk feed D14 
160 (160 – 180) 
160 (160 – 180) 
0.758 
Volume of feed prescribed (ml/feed) 
Volume prescribed D1 
14 (12 – 15.5) 
14 (12 – 16) 
0.670 
Volume prescribed D2 
14 (12 – 17.5) 
12.5 (12.25 – 19) 
0.825 
Volume prescribed D3 
16 (14 – 17.5) 
14 (14 – 20) 
0.569 
Volume prescribed D5 
17 (15 – 19) 
17 (15 – 21) 
0.758 
Volume prescribed D7 
18 (16 – 20.5) 
18 (16 – 22) 
0.614 
Volume prescribed D14 
18 (16 – 22) 
18 (16 – 24) 
0.933 

Table 3 : Study outcome  
Outcome 
Experimental gp ( n=49) 
Control gp ( n=48) 
p-value 
Time to full oral feed (days) 
10 ( 7 – 13) 
9 (7 – 13) 
0.531 
Adverse 
events 
D1 
36 (53.7%) 
31 (46.3%) 
0.234 
D2 
14 (50.0%) 
14 (50.0%) 
0.563 
D3 
12 (50.0%) 
12 (50.0%) 
0.570 
D5 
2 (100%) 
0 (00%) 
0.253 
D7 & 14 
0 (00%) 
0 (00%) 
NA 
L4 Efficacy 
on 
D 1 -3 
0 (00%) 
0 (00%) 
NA 
D5 
12 (57.1%) 
9 (42.9%) 
0.331 
D7 
16 (51.6%) 
15 (48.4%) 
0.528 
D14 
35 (49.3%) 
36 (50.7%) 
0.434 
Volume 
Taken 
 Each 
 feed  
D1 
2.0 (2.0 -7.0) 
2.0 (2.0 -7.0) 
0.803 
D2 
5.0 (2.0 - 9.0) 
3.0 ( 2.0 – 7.0) 
0.558 
D3 
7.0 ( 3.0 – 11) 
4.0 (3.0 – 10.0) 
0.540 
D5 
8.0 (5.0 – 15) 
6.5 (5.0 – 15) 
0.521 
D7 
9.0 ( 7.0 – 18) 
7.5 (7.0 – 20) 
0.951 
D14 
15 (13 – 20.5) 
15.5 (14 – 22) 
0.737 
Volume  
taken  
in first 
 5 mins  
D1 
2.0 (1.0 – 4.5) 
2.0 (1.25 – 4.0) 
0.938 
D2 
3.0 (2.0 – 6.0) 
3.0 ( 2.0 – 5.0) 
0.988 
D3 
3.0 ( 2.0 – 7.0) 
3.0 (2.0 – 7.0) 
0.723 
D5 
5.0 ( 4.0 – 9.0) 
5.0 ( 4.0 – 8 .0) 
0.817 
D7 
7.0 (5.5 – 11) 
7.0 ( 6.0 – 10) 
0.895 
D14 
10 ( 9.0 – 12.5) 
10 ( 9.0 – 10) 
0.618 
RT % 
D1 
0.42 ( 0.24 – 0.85) 
0.42 ( 0.28 – 0.70) 
0.835 
D2 
0.70 (0.59 – 1.0) 
0.71 (0.70 – 1.0) 
0.663 
D3 
0.70 (0.40 – 1.0) 
0.70 (0.40 – 1.0) 
0.941 
D5 
0.83 (0.50 – 1.45) 
0.90 (0.50 – 1.2) 
0.645 
D7 
1.0 (0.68 – 1.6) 
1.0 (0.67 – 1.7) 
0.584 
D14 
1.6 (1.10 – 2.1) 
1.6 (1.10 – 2.1) 
0.913 
OT% 
D1 
21 ( 15 – 36) 
21 ( 15.3 – 36) 
0.936 
D2 
36 ( 15 – 44) 
35.7 (15 – 36) 
0.422 
D3 
43.8 (21 – 55.5) 
43.8 (21 – 50) 
0.551 
D5 
48 (33 – 65) 
48 ( 33 – 65) 
0.700 
D7 
60 ( 46 – 73.5) 
56 ( 46 – 100) 
0.950 
D14 
91 ( 87 – 100) 
95.5 (87.9 – 100) 
0.521 
PRO% 
D1 
16 ( 7.8 – 24) 
16 ( 9.2 – 21) 
0.948 
D2 
21.6 ( 15 – 32.5) 
21 ( 15 – 27) 
0.847 
D3 
23 ( 14 – 37) 
19.5 (14 – 31) 
0.499 
D5 
30 ( 25 – 39) 
29 ( 24.5 – 39) 
0.629 
D7 
39 ( 33 – 49.5) 
39 ( 32 – 46) 
0.872 
D14 
56 ( 50 – 60) 
55.8 ( 46 – 56) 
0.630 
Neonates 
SSB 
coordinated 
feeding 
D1 
23 (51.1%) 
22 (48.9%) 
0.538 
D2 
33 (55.0%) 
27 (45.0%) 
0.180 
D3 
33 (50.8%) 
32 (49.2%) 
0.746 
D5 
40 (51.9%) 
37 (48.1%) 
0.381 
D7 
39 (52.0%) 
36 (48.0%) 
0.383 
D14 
49 (50.5%) 
48 (49.5%) 
NA