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Inadequate oral feeding as a barrier to discharge in moderately preterm infants



The objectives describe the frequency that inadequate oral feeding (IOF) is the reason why moderately preterm (MPT) infants remain hospitalized and its association with neonatal morbidities.

Study design

Prospective study using the NICHD Neonatal Research Network MPT Registry. Multivariable logistic regression was used to describe associations between IOF and continued hospitalization at 36 weeks postmenstrual age (PMA).


A total of 6017 MPT infants from 18 centers were included. Three-thousand three-seventy-six (56%) remained hospitalized at 36 weeks PMA, of whom 1262 (37%) remained hospitalized due to IOF. IOF was associated with RDS (OR 2.02, 1.66–2.46), PDA (OR 1.86, 1.37–2.52), sepsis (OR 2.36, 95% 1.48–3.78), NEC (OR 16.14, 7.27–35.90), and BPD (OR 3.65, 2.56–5.21) compared to infants discharged and was associated with medical NEC (OR 2.06, 1.19–3.56) and BPD (OR 0.46, 0.34–0.61) compared to infants remaining hospitalized for an alternative reason.


IOF is the most common barrier to discharge in MPT infants, especially among those with neonatal morbidities.

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The National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the National Center for Advancing Translational Sciences provided grant support for the Neonatal Research Network’s Moderate Preterm Registry through cooperative agreements. While NICHD staff did have input into the study design, conduct, analysis, and paper drafting, the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations




Dr. LE conceptualized and designed the study, drafted the initial paper, and approved the final paper as submitted. Drs. MC, BS, RG, and WM critically revised the initial proposal, reviewed the data and reviewed and revised the paper and approved the final paper as submitted. Drs. AD, AL, BS, EB, WC, CA, SD, PS, SS, KVM, BV, MW, and Miss Newman served on the committee that developed and managed the Moderate Preterm Registry; each of them reviewed and revised the paper and approved the final paper as submitted. Dr. SS carried out the initial data analyses, reviewed, and revised the paper, and approved the final paper as submitted.

Corresponding author

Correspondence to William F. Malcolm.

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Conflict of interest

The authors declare that they have no conflict of interest.

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*A complete list of non-author contributors appears in Appendix 1.

Appendix 1: Collaborators

Appendix 1: Collaborators

The following members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development are non-author contributors.

Alpert Medical School of Brown University and Women and Infants Hospital of Rhode Island (U10 HD27904)–Martin Keszler, MD; Angelita M. Hensman, MS RNC-NIC BSN; Elisa Vieira, RN BSN.

Case Western Reserve University, Rainbow Babies and Children's Hospital (U10 HD21364, M01 RR80)–Anna Marie Hibbs, MD; Nancy S. Newman, RN; Bonnie S. Siner, RN.

Children's Mercy Hospital (U10 HD68284)–William E. Truog, MD; Eugenia K. Pallotto, MD MSCE; Howard W. Kilbride MD; Cheri Gauldin, RN MSN CCRC; Anne Holmes RN MSN MBA-HCM CCRC; Kathy Johnson RN, CCRC.

Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical Center, and Good Samaritan Hospital (U10 HD27853, UL1 TR77)–Brenda B. Poindexter, MD MS; Kurt Schibler, MD; Suhas G. Kallapur, MD; Cathy Grisby, BSN CCRC; Barbara Alexander, RN; Estelle E. Fischer, MHSA MBA; Lenora Jackson, CRC; Kristin Kirker, CRC; Jennifer Jennings, RN BSN; Sandra Wuertz, RN BSN CLC; Greg Muthig, BA.

Duke University School of Medicine, University Hospital, University of North Carolina, and Duke Regional Hospital (U10 HD40492, UL1 TR1117, UL1 TR1111)–Ronald N. Goldberg, MD; Joanne Finkle, RN JD; Kimberley A. Fisher, PhD FNP-BC IBCLC; Matthew M. Laughon, MD MPH; Carl L. Bose, MD; Janice Bernhardt, MS RN; Cindy Clark, RN.

Emory University, Children’s Healthcare of Atlanta, Grady Memorial Hospital, and Emory University Hospital Midtown (U10 HD27851, UL1 TR454)–David P. Carlton, MD; Ellen C. Hale, BS RN CCRC; Yvonne Loggins, RN; Diane I. Bottcher, RN MSN.

Eunice Kennedy Shriver National Institute of Child Health and Human Development–Rosemary D. Higgins, MD; Stephanie Wilson Archer, MA.

Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children at Indiana University Health, and Eskenazi Health (U10 HD27856, UL1 TR6)–Greg Sokol, MD; Dianne E. Herron, RN.

Nationwide Children’s Hospital and the Ohio State University Medical Center (U10 HD68278)–Leif D. Nelin, MD; Sudarshan R. Jadcherla, MD; Patricia Luzader, RN; Nehal A. Parikh, DO MS; Marliese Dion Nist, BSN; Jennifer Fuller, MS RNC; Julie Gutentag, BSN; Marissa E. Jones, RN MBA; Sarah McGregor, BSN RNC; Elizabeth Rodgers, BSN; Jodi A. Ulloa, MSN APRN NNP-BC; Tara Wolfe, BSN.

RTI International (U10 HD36790)–Dennis Wallace, PhD; Kristin M. Zaterka-Baxter, RN BSN CCRP; Margaret Crawford, BS CCRP; Jenna Gabrio, BS CCRP; Sarah Kandefer, BS; Jeanette O’Donnell Auman, BS.

Stanford University and Lucile Packard Children's Hospital (U10 HD27880, UL1 TR93)–David K. Stevenson, MD; M. Bethany Ball, BS CCRC; Melinda S. Proud, RCP.

University of Alabama at Birmingham Health System and Children’s Hospital of Alabama (U10 HD34216)–Namasivayam Ambalavanan, MD; Monica V. Collins, RN BSN MaEd; Shirley S. Cosby, RN BSN.

University of California—Los Angeles, Mattel Children's Hospital, Santa Monica Hospital, Los Robles Hospital and Medical Center, and Olive View Medical Center (U10 HD68270)–Uday Devaskar, MD; Meena Garg, MD; Teresa Chanlaw, MPH; Rachel Geller, RN BSN.

University of Iowa and Mercy Medical Center (U10 HD53109, UL1 TR442)–Tarah T. Colaizy, MD MPH; Dan L. Ellsbury, MD; Jane E. Brumbaugh, MD; Karen J. Johnson, RN BSN; Donia B. Campbell, RNC-NIC; Jacky R. Walker, RN.

University of New Mexico Health Sciences Center (U10 HD53089, UL1 TR41)–Kristi L. Watterberg, MD; Robin K. Ohls, MD; Conra Backstrom Lacy, RN; Sandy Sundquist Beauman, MSN RNC-NIC; Carol Hartenberger, MPH, RN CCRC.

University of Pennsylvania, Hospital of the University of Pennsylvania, Pennsylvania Hospital, and Children's Hospital of Philadelphia (U10 HD68244)–Barbara Schmidt, MD; Haresh Kirpalani, MB MSc; Sara B. DeMauro, MD MSCE; Noah Cook, MD; Aasma S. Chaudhary, BS RRT; Soraya Abbasi, MD; Toni Mancini, RN BSN CCRC; Dara Cucinotta.

University of Rochester Medical Center, Golisano Children's Hospital, and the University of Buffalo Women's and Children's Hospital of Buffalo (U10 HD68263, UL1 TR42)–Satyan Lakshminrusimha, MD; Ronnie Guillet, MD PhD; Ann Marie Scorsone, MS; Julianne Hunn, BS; Rosemary Jensen; Holly I.M. Wadkins, MA; Stephanie Guilford, BS; Ashley Williams, M.S. Ed.

University of Texas Southwestern Medical Center at Dallas, Parkland Health & Hospital System, and Children's Medical Center Dallas (U10 HD40689)–Myra Wyckoff, MD; Luc P. Brion, MD; Diana M. Vasil, RNC-NIC; Lijun Chen, PhD RN; Lizette E. Torres, RN.

University of Texas Health Science Center at Houston Medical School and Children's Memorial Hermann Hospital (U10 HD21373)–Kathleen A. Kennedy, MD MPH; Jon E. Tyson, MD MPH; Julie Arldt-McAlister, RN BSN; Carmen Garcia, RN CCRP; Karen Martin, RN; Georgia E. McDavid, RN; Sharon L. Wright, MT (ASCP).

Wayne State University, University of Michigan, Hutzel Women’s Hospital, and Children’s Hospital of Michigan (U10 HD21385)–Athina Pappas, MD; John Barks, MD; Rebecca Bara, RN BSN; Shelley Handel, AD; Diane F White, RT; Mary Christensen, RT; Stephanie A. Wiggins, MS.

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Edwards, L., Cotten, C.M., Smith, P.B. et al. Inadequate oral feeding as a barrier to discharge in moderately preterm infants. J Perinatol 39, 1219–1228 (2019).

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