Oral Feeding Skills Research Articles

Evaluating sucking maturation using two pressure thresholds

BackgroundThe Medoff-Cooper Nutritive Sucking Apparatus (M-CNSA) has been used to objectively measure sucking maturation in preterm infants. The M-CNSA is able to accurately detect sucking pressures less than 20mmHg, however lower pressure thresholds have not previously been used in research. AimsTo determine if differences are observed in the number of sucks and maturation in the number of sucks over time when the minimum pressure threshold used to detect a suck is 7mmHg compared to 20mmHg using the M-CNSA. Study designDescriptive. SubjectsA convenience sample of 171 healthy premature infants born between 29 and 34weeks gestational period who were part of a larger randomized controlled study. Outcome measuresThe number of sucks detected during weekly five-minute oral feeding observations using 7mmHg and 20mmHg. ResultsSignificantly more sucks were detected using the 7mmHg vs 20mmHg threshold at all time points. At both pressure thresholds, the mean number of sucks detected during the five minute feeding observation increased over time. The difference in the number of sucks detected at 7 and 20mmHg did not change over time (p=0.50). ConclusionsUsing the lower threshold of 7mmHg compared to 20mmHg resulted in more sucks detected while consistently measuring improvement in sucking over time. Detection of more sucks and sucks at a lower pressure threshold allows clinicians and researchers to more accurately assess oral feeding skills among premature infants.

Is there an advantage for preterm infants to feed orally in an upright or sidelying position?

Over the last decade, nursing staff and feeding therapists have promoted the upright and sidelying bottle feeding positions as ‘optimal’ for preterm infants. To verify such benefits, very low birth weight infants were randomized to being fed in the customary semi-reclined (control), upright, or sidelying position. The primary outcome was days from start to independent oral feeding. Secondary outcomes included infants' oral feeding skill levels monitored when taking 1,2, 3–5, and 6–8 oral feedings per day. Infants fed in the upright and sidelying groups attained independent oral feeding within the same number of days as control counterparts. There was no difference in the maturation of their oral feeding skills.

Interventions to improve the oral feeding performance of preterm infants

Preterm infants have difficulty oral feeding. We hypothesized that a specific sucking and swallowing exercises vs. no intervention accelerate the attainment of independent oral feeding through a faster maturation of infants' oral feeding skills (OFS). Very low birthweight infants were randomized to a control, sucking and swallowing groups. Sucking consisted of active sucking on a pacifier, and swallowing of placing a milk bolus (0.05-0.2 mL) on the tongue where the bolus rests prior to entering the pharynx. Primary outcome was days from start to independent oral feeding (SOF-IOF). Secondary outcomes included overall transfer (OT, % volume taken/volume prescribed), proficiency (PRO, % volume taken at 5 min/volume prescribed), rate of transfer (RT, mL/min) over the entire feeding and infants' OFS levels. OFS levels were defined by PRO and RT. Days from SOF to IOF vs controls (21 ± 2) were similar for the sucking group (19 ± 2) and shorter for the swallowing group (15 ± 2; p = 0.019). Only the latter infants demonstrated more mature OFS levels than controls. The swallowing exercise is an efficacious intervention in facilitating the attainment of independent oral feeding, but not the sucking exercise. We speculate that the swallowing benefit resulted from an accelerated maturation of infants' OFS levels.

Impact of nonnutritive oral motor stimulation and infant massage therapy on oral feeding skills of preterm infants

We have shown that the provision of a nonnutritive oral motor therapy (NNOMT) or infant massage therapy (iMT) provided singly and in combination vs. no intervention shortens the number of days from start to independent oral feeding in very low birth weight infants. This study hypothesizes that infants who benefited from NNOMT and/or iMT will demonstrate enhanced maturation of their oral feeding skills (OFS) when compared to control counterparts. OFS levels were monitored using a recently developed scale that takes into account their nutritive sucking skills and endurance at time of assessment. It is a simple method that requires only the additional reading of the volume taken 5 minutes into the start of a feeding and information routinely recorded in patients' medical chart. Four OFS levels were identified, characterized by infant's proficiency (% volume taken during the first 5 min/volume prescribed) and rate of transfer monitored over the entire feeding session (ml/min); OFS level 1 being the most immature and 4 the most mature. In parallel with the benefits provided by NNOMT and/or iMT, we demonstrate the direct positive impact these interventions have on accelerating the maturation of infants' oral feeding skills.

The Development of Oral Feeding Skills in Infants

The Development of Oral Feeding Skills in Infants

Insights into Neonatal Oral Feeding through the Salivary Transcriptome

Background. The development of safe and effective oral feeding skills in the newborn is complex and may be associated with significant morbidities. Our understanding of neonatal oral feeding maturation at the molecular level is limited, providing an opportunity to utilize emerging molecular techniques to accurately assess neonatal oral feeding skills. Objective. To identify key regulatory genes in neonatal saliva involved in successful oral feeding. Methods. Previously, our laboratory identified 9,286 genes in saliva that statistically significantly altered their gene expression as premature newborns gained advanced oral feeding skills. In this report, genes previously identified underwent an updated and targeted pathway analysis with Ingenuity Pathway Analysis (IPA) to identify potential candidate genes involved in successful oral feeding. Genes were considered if they were in the five most significantly up- and down-regulated physiological pathways and were associated with the keywords “feeding”, “digestion” and “development”. Results. There were 2,186 genes that met criteria. Pathways associated with feeding behavior, cranial nerve development, and the development of the nervous, skeletal, and muscular systems were highlighted. Discussion. These data provide important insights into the biological processes involved in oral feeding in the newborn at a molecular level and identify novel pathways associated with successful oral feeding.

The Diagnostic Test Accuracy of Clinical Swallow Assessment for Oropharyngeal Aspiration: A Systematic Review.

Review question/objective The objective of this systematic review is to synthesise the best available evidence on the diagnostic test accuracy (sensitivity and specificity) of Clinical Swallow Assessment (CSA) compared with Video Fluoroscopic Swallow Study (VFSS) in diagnosing oropharyngeal aspiration in children and adults with dysphagia. In this review, VFSS will be the 'Gold Standard' or, reference test and CSA will be the index test. VFSS is the radiographic assessment of swallow function usually performed by a Speech Pathologist and Radiologist. CSA is defined as a non-invasive, non-instrumental assessment of swallow function. It is usually performed by a Speech Pathologist and includes a thorough case history and assessment of oro-motor function. For example, tongue, jaw movement, cough reflex and review of swallow function with a range of food and fluids. A rating is usually provided to describe the level of function and likely presence or absence of aspiration. Based on the CSA findings the Speech Pathologist recommends specific diet and fluid modifications, feeding techniques and positioning techniques to enable safe oral feeding. Inclusion criteria Types of participants Studies will be considered in this review if they include: infants, children or adults with dysphagia. The following definitions will be used within this review: - infant will be defined as < 36 months; - children will be defined as 36 months – 18 years; - adults will be defined as 18 years and over; - dysphagia will be defined as 'a swallowing disorder' 6. The definition uses 36 months as the cut off between infants and children as this is the stage when the infant transitions from sucking patterns used for bottle feeding and early solids and begins to chew solids, self feed and drink from a range of cups consistent with an older child 4. There will be no exclusion of studies based on age or gender. Studies will be excluded that include the population of head and neck cancer (HNC) patients, patients with a tracheostomy in situ and patients with craniofacial anomalies. The primary treatment for HNC patients includes surgery and radiotherapy . Radiotherapy can have a specific impact on swallowing , not necessarily seen in other populations and surgical resections can result in predictable swallowing difficulties . Patients with a tracheostomy in situ and patients with craniofacial anomalies also have known anatomical changes that have a specific impact on swallow function. The clinician undertaking the clinical swallow assessment has access to any anatomical changes following surgery. This is different to other populations whereby information regarding specific neurological and anatomical information is not necessarily available. Focus of the review The focus of this review will be on diagnostic test accuracy (sensitivity and specificity) of Clinical Swallow Assessment (CSA) compared with Video Fluoroscopic Swallow Study (VFSS) in diagnosing oropharyngeal aspiration in children and adults with dysphagia. In this review, VFSS will be the 'Gold Standard' or, reference test and CSA will be the index test. The terms VFSS and Modified Barium Swallow (MBS) refer to the same study. Although this review will use the term VFSS defined as the radiographic assessment of the oral and pharyngeal swallow, MBS studies will also be included. The terms Clinical Swallow Assessment and Bedside Swallow Evaluation also refer to the same diagnostic tool . Clinical Swallow Assessment (CSA) will be used within this review, defined as the non-instrumental, non-radiologic assessment of swallow function by a Speech Pathologist, however studies of Bedside Swallow Evaluation will also be included. Studies that do not use CSA as the index test or do not use VFSS as the reference test will be excluded. In addition, studies of effectiveness, experience or comparison of treatment interventions will be excluded. The diagnostic test accuracy of CSA and VFSS will be compared using: sensitivity and specificity. Where possible, positive and negative predictive values will also be analysed and reported. Sensitivity of a diagnostic test is defined as 'the ability of the test to identify correctly those who have the disease'34. Specificity of a diagnostic test is defined as 'the ability of the test to identify correctly those who do not have the disease' Positive predictive value is defined as the proportion of patients who test positive and actually have the disease in question . Negative predictive value is defined as the proportion of patients who test negative and actually do not have the disease in question .

Oral Feeding Readiness in the Neonatal Intensive Care Unit

Oral feeding is a complex sensorimotor process that is influenced by many variables, making the introduction and management of oral feeding a challenge for many health care providers. Feeding practice guided by tradition or a trial-and-error approach may be inconsistent and has the potential to delay the progression of oral feeding skills. Oral feeding initiation and management should be based on careful, individualized assessment of the NICU infant and requires an understanding of neonatal physiology and neurodevelopment. The purpose of this article is to help the health care provider with this complex process by (a) defining oral feeding readiness, (b) describing the importance of oral feeding in the NICU and the physiology of feeding, and (c) providing a review of the literature regarding the transition from gavage to oral feeding in the NICU.

Oral and nonoral sensorimotor interventions facilitate suck–swallow–respiration functions and their coordination in preterm infants

BackgroundPreterm infants are at high risk of encountering oral feeding difficulties. Early sensorimotor interventions may improve oral feeding skills in preterm infants. AimTo further explore the effects of an oral (O), tactile/kinesthetic (T/K), and combined (O+T/K) sensorimotor intervention on preterm infants' nutritive sucking, swallowing and their coordination with respiration. Study designSeventy-five infants (29 [0.3, standard error of mean, SEM] weeks gestation, 49 males/26 females) were randomly assigned to an O group involving sensorimotor input to the oral structures; a T/K group involving sensorimotor input to the trunk and limbs; a combined (O+T/K) group; and a control group. Outcome measuresStage of sucking, suction and expression amplitudes (mmHg), suck–swallow ratio, stability of suck–swallow interval, and swallow–respiration patterns. ResultsThe O group had significantly more advanced sucking stages, and greater suction and expression amplitudes than controls [p≤0.035, effect size (ES) >0.6]. The suck–swallow ratio and stability of suck–swallow intervals did not significantly differ among groups (p≥0.181, ES≤0.3). The three interventions led to fewer swallows bracketed by prolonged respiratory pauses compared to controls (pause–swallow–pause, p≤0.044, ES≥0.7). The T/K and combined (O+T/K) groups had greater occurrence of swallows bracketed by expiration than the control and O groups (expiration–swallow–expiration, p≤0.039, ES≥0.3). ConclusionThe O intervention enhanced specific components of nutritive sucking. All three interventions resulted in improved swallow–respiration coordination. Sensorimotor interventions have distributed beneficial effects that go beyond the specific target of input.

Feeding Issues and Interventions in Infants and Children with Clefts and Craniofacial Syndromes

Problems with oral feeding occur in varying degrees in infants born with cleft lip/palate and/or craniofacial syndromes. The extent of clefting is associated with the severity of feeding problems, and if cleft lip/palate occurs in conjunction with a craniofacial syndrome, additional structural, airway, and neuromotor issues may be present. The infant's feeding and swallowing skills may be significantly impaired, characterized by inefficient oral feeding skills coupled with poor airway protection ability during swallowing. Inadequate airway protection during swallowing has serious implications for the infant's respiratory health as sequelae of chronic aspiration during feeding may include recurrent respiratory illness, pneumonia, and lung damage. Feeding difficulty in nonsyndromic and syndromic cleft lip/palate infants has been documented as source of considerable stress for parents and can have a potential negative effect on the parent-infant bonding process. Therefore, timely identification of feeding problems by the speech pathologist with subsequent intervention and modification in the feeding method is essential, along with provision of early feeding instruction to families. The objective of this article is to review expert opinion and available evidence regarding factors that influence feeding success and efficiency in infants with nonsyndromic and syndromic cleft lip/palate. The types of compensatory strategies or interventions that are effective in alleviation of feeding and swallowing difficulties will be described. Descriptive reports, expert opinion, and available evidence from clinical trials to support the use of feeding interventions in treatment are reviewed.

Effect of the Premature Infant Oral Motor Intervention on Feeding Progression and Length of Stay in Preterm Infants

Preterm infants frequently experience oral feeding difficulties due to underdeveloped oral motor skills and the lack of coordination of sucking, swallowing, and respiration. The infants' ability to consume all feedings orally while maintaining physiologic stability and weight gain is necessary for their discharge. Therefore, difficulty with oral feeding leads to longer hospital stays and higher costs. For example, with more than half a million of premature infants born each year, a 3-day decrease in hospital stay would save more than 2 billion dollars annually. There is a need for evidenced-based interventions that facilitate development of oral-motor skills, leading to improved oral feeding, thus shortening hospital stays and lowering costs. The purpose of this research was to test the newly developed Premature Infant Oral Motor Intervention (PIOMI) beginning at 29 weeks postmenstrual age (PMA), before oral feedings were introduced, to determine whether the prefeeding intervention would result in a shorter transition from gavage to total oral feedings and a shorter length of hospital stay (LOS). The PIOMI is a 5-minute oral motor intervention that provides assisted movement to activate muscle contraction and provides movement against resistance to build strength. The focus of the intervention is to increase functional response to pressure and movement and control of movements for the lips, cheeks, jaw, and tongue. The cheeks (internal and external), lips, gums, tongue, and palate were stimulated per specific protocol with finger stroking. A total of 19 infants from 1 level III NICU born between 26 and 29 weeks PMA: 10 in the experimental group and 9 in the control group. A randomized, blinded, clinical trial was conducted to examine outcomes related to the newly developed PIOMI. Beginning at 29 weeks PMA (and before the introduction of oral feeding), the experimental group received the PIOMI for 5 minutes per day for 7 consecutive days. The control group received a sham intervention to keep staff and parents blinded to the infants' group assignment. Physiological and behavioral stabilities were continually assessed throughout the intervention. A chart review was then conducted to compare the transition from gavage feeding to total oral feedings between the experimental and control group, as well as LOS. The PIOMI was well tolerated by 29-week PMA infants, as evidenced by physiological and behavioral cues. Infants who received the once-daily PIOMI transitioned from their first oral feeding to total oral feedings 5 days sooner than controls (P = .043) and were discharged 2.6 days sooner than controls. This pilot work supports further study on the use of the PIOMI with preterm infants to enhance oral-feeding skills and decrease LOS.

A Novel Approach to Assess Oral Feeding Skills of Preterm Infants

Background: There is no well-defined means to identify the level of oral feeding skills (OFS) in preterm infants. Objective: To determine whether OFS as reflected by the combination of proficiency (PRO, %ml taken during the first 5 min/ml prescribed) and rate of milk transfer (RT, ml/min) correlates with gestational age (GA), oral feeding performance (OT, %ml taken during a feeding/ml prescribed) and days from start to independent oral feeding (SOF-IOF). Our working premises are that PRO is reflective of infants’ actual feeding skills when fatigue is minimal and RT, monitored over an entire feeding session, reflects their overall skills when fatigue comes into play. Methods: Infants (26–36 weeks GA) with prematurity as their principal diagnosis were recruited and monitored at their first oral feeding. GA was divided into 3 strata, 26–29, 30–33, and 34–36 weeks GA. OFS was divided into 4 levels delineated by PRO (≧ or <30%) and RT (≧ or <1.5 ml/min). ANOVA with post-hoc Bonferroni and multiple regression analyses were used. Results: OFS levels were correlated with GA. OT, PRO, and days from SOF-IOF were associated with OFS and GA, whereas RT was only correlated with OFS levels. Conclusions: OFS is a novel objective indicator of infants’ feeding ability that takes into account infants’ skills and endurance. As a clinical tool, it can help caretakers monitor infants’ skills as they transition to oral feeding and identify oral feeding issues arising from immature skills and/or poor endurance.

Suck Predicts Neuromotor Integrity and Developmental Outcomes

AbstractNeonatal motor behavior predicts both current neurological status and future neurodevelopmental outcomes. For speech pathologists, the earliest observable patterned oromotor behavior is suck. Suck production requires effective coordination of an infant's oral sensorimotor system and is subject to a variety of neuromodulatory inputs. Demonstration and practice of coordinated suck serves as a biomarker for oral feeding skills neural integrity and is being assessed for its relation to neurodevelopmental outcomes (speech, cognition, and learning) by research teams in the United States, Europe, Japan, and Brazil. Suck may also serve as an intervention point to prevent feeding disorders and mitigate speech-language delays and disorders.

Feeding of low birth weight infants

Optimal feeding of low birth weight (LBW) infants improves their immediate survival and subsequent growth and development. Being a heterogeneous group comprising term and preterm neonates, their feeding abilities, fluid and nutritional requirements are quite different from normal birth weight infants. A practical approach to feeding a LBW infant including choice of initial feeding method, progression of oral feeds, and nutritional supplementation based on her oral feeding skills and nutritional requirements is being discussed in this protocol. Growth monitoring, management of feed intolerance, and the essential skills involved in feeding them have also been described in detail.

Maturation of oral feeding skills in preterm infants

Safe and successful oral feeding requires proper maturation of sucking, swallowing and respiration. We hypothesized that oral feeding difficulties result from different temporal development of the musculatures implicated in these functions. Sixteen medically stable preterm infants (26 to 29 weeks gestation, GA) were recruited. Specific feeding skills were monitored as indirect markers for the maturational process of oral feeding musculatures: rate of milk intake (mL/min); percent milk leakage (lip seal); sucking stage, rate (#/s) and suction/expression ratio; suction amplitude (mmHg), rate and slope (mmHg/s); sucking/swallowing ratio; percent occurrence of swallows at specific phases of respiration. Coefficients of variation (COV) were used as indices of functional stability. Infants, born at 26/27- and 28/29-week GA, were at similar postmenstrual ages (PMA) when taking 1-2 and 6-8 oral feedings per day. Over time, feeding efficiency and several skills improved, some decreased and others remained unchanged. Differences in COVs between the two GA groups demonstrated that, despite similar oral feeding outcomes, maturation levels of certain skills differed. Components of sucking, swallowing, respiration and their coordinated activity matured at different times and rates. Differences in functional stability of particular outcomes confirm that maturation levels depend on infants' gestational rather than PMA.

Assessment and Management Considerations for Oral Feeding of the Premature Infant on the Neonatal Intensive Care Unit

Assessment and Management Considerations for Oral Feeding of the Premature Infant on the Neonatal Intensive Care Unit

Oral Feeding in the Preterm Infant

After completing this article, readers should be able to: 1. Describe the sequential development of sucking, swallowing, and respiration. 2. Delineate the limitation of an infant’s oral feeding skills at specific times of development to provide realistic expectations for oral feeding performance. 3. Define oral feeding success in preterm infants. 4. Use the current knowledge of preterm infants’ oral motor skills to facilitate and enhance their performance. 5. Enumerate the potential short- and long-term consequences of an infant’s oral feeding aversion for the patient, family, and health professional. Oral feeding issues in preterm infants are a growing concern for neonatologists because attainment of independent oral feeding is one of the prerequisites for hospital discharge. With the increase in survival of infants born continuously more preterm, understanding such issues has a certain urgency. Concerns do not pertain only to difficulties encountered by neonatologists during the birthstay hospitalization, but also by pediatricians and pediatric gastroenterologists who attend to long-term feeding difficulties/disorders, such as oral feeding aversion. Indeed, greater than 40% of patients followed in feeding disorder clinics are former preterm infants. Research over the last decade has begun to shed light on the development of oral feeding skills in these infants as they mature, which has increased understanding of their limited skills at varying postmenstrual ages. Such knowledge is crucial in clinical practice insofar as expectations of these infants’ oral feeding performance must take into account the ever-changing level of maturity of their skills. This article focuses on the development of sucking, swallowing, and respiration (as it pertains to oral feeding) and the coordination of these three functions. Additional factors, separate from infant feeding skills, also are discussed because they can affect oral feeding performance. This review examines information gathered from bottle feeding because more extensive research has been conducted on bottle feeding than on breastfeeding. However, …

Long-term oral sensitivity and feeding skills of low-risk pre-term infants

This study examined the oral sensitivity and feeding skills of low-risk pre-term infants at 11–17 months corrected age. Twenty pre-term infants (PT) born between 32 and 37 weeks at birth without any medical comorbidities were assessed. All of this PT group received supplemental nasogastric (NG) tube feeds during their birth-stay in hospital. A matched control group of 10 healthy full-term infants (FT) was also assessed. Oral sensitivity and feeding skills were assessed during a typical mealtime using the Royal Children's Hospital Oral Sensitivity Checklist (OSC) and the Pre-Speech Assessment Scale (PSAS). Results demonstrated that, at 11–17 months corrected age, the PT group displayed significantly more behaviours suggestive of altered oral sensitivity and facial defensiveness, and a trend of more delayed feeding development than the FT group. Further, results demonstrated that, relative to the FT group, pre-term infants who received greater than 3 weeks of NG feeding (PT>3NG) displayed significantly more facial defensive behaviour, and displayed significant delays across more aspects of their feeding development than pre-term infants who received less than 2 weeks of NG feeding (PT<2NG). The information from this preliminary study suggests that low-risk pre-term infants, particularly those who receive supplemental NG feeding for greater than 3 weeks, may be at risk for displaying long-term altered oral sensitivity and facial defensiveness, as well as feeding delays. These observations warrant further investigation on this topic.

Preterm infants' behavioural indicators of oxygen decline during bottle feeding.

During the time when preterm infants' oral feeding skills are developing they often experience physiological instability and need assistance from caregivers to maintain adequate oxygenation. Assisting infants to maintain optimal oxygenation during oral feeding requires an understanding of how they express and aim to self-regulate their oxygen status. The purpose of this study was to identify potential behavioural indicators of declining oxygenation during preterm infant early bottle-feeding. The design was explorative. Data were collected from a secondary analysis of 20 videotapes of preterm infant bottle feedings which included concurrent oxygen saturation data. In this analysis infant behaviours and quality of breathing were coded and compared across three periods: high oxygen saturation, immediately preceding an oxygen desaturation event, and during an oxygen desaturation event. Infants gave limited behavioural indicators of declining oxygenation. Immediately prior to a desaturation event, they had an increase in eye flutter and were typically sucking and apnoeic. During a desaturation event, they typically relaxed their arms/hands and stopped sucking. Reliance on preterm infant behavioural cues will be insufficient for detection of oxygen desaturation during oral feeding. Attention to changes in breath sounds and to the pattern of sucking are potentially important intervention strategies for the prevention of and appropriate response to oxygen decline during feeding. Sucking pauses may be a time when preterm infants aim to regulate their breathing pattern and thereby increase oxygenation. Interventions that focus on detection and minimization of apnoea during feeding, and which aim to protect infant sucking pauses, may reduce the number and severity of desaturation events preterm infants experience during bottle feeding.

Occurrence of oxygen desaturation events during preterm infant bottle feeding near discharge.

The purpose of this study was to examine the occurrence, severity, pattern, and moderators of oxygen desaturation during preterm infant bottle feeding near the time of discharge from the neonatal intensive care unit (NICU) when fed by mothers. Twenty-two very low birthweight (VLBW) infants [birthweight 1155+/-293 g, gestational age (GA) 28.1+/-2.0, postconceptional age (PCA) 36.5+/-1.6 weeks] were videotaped being bottle-fed by their mothers. Most infants (86%) were discharged within 6 days of the study. Oxygen saturation was continuously monitored and infant feeding behaviors were coded. Oxygen desaturation events (SpO(2)<90%) were identified and analyzed. Infants averaged 10.8 events during feeding (range 1-28, S.D. 8.9) and spent, on average, 20% of their feeding time (range 0-70%, S.D. 17.98%) with oxygen levels below 90%. One hundred forty of the desaturation events (59%) were classified as mild (SpO(2) 85-89), 47 events (20%) were classified as moderate (SpO(2) 81-84), and 51 events (21%) were classified as severe (SpO(2)</=80). Events were evenly distributed across infants' feeding time. Receiving supplemental oxygen, beginning the feeding with a higher baseline SpO(2), and being of older PCA predicted lower percentage of feeding time with SpO(2) below 90% (R(2)=0.57). Receiving supplemental oxygen and beginning the feeding with a higher baseline SpO(2) predicted less number of desaturation events during the feeding (R(2)=0.44). Despite similar baseline SpO(2) levels, infants who were on supplemental oxygen had 50% less oxygen desaturation events and spent 33% less time with SpO(2) less than 90%. VLBW infants continue to have desaturation events during feeding when fed by their mothers near the time of discharge. Further research is needed to understand the effect of hypoxemia on the preterm infant's development of oral feeding skills, to study the effects of supplemental oxygen during feeding, and to further develop interventions to minimize desaturation during feeding.