Iran J Pediatr. 2020 December; 30(6):e107475. Published online 2020 November 2. doi: 10.5812/ijp.107475. Research Article Effectiveness of Cue-Based Feeding Versus Scheduled Feeding in Preterm Infants Using Comprehensive Feeding Assessment Scales: A Randomized Clinical Trial Farideh Kamran 1 , Ahmad Reza Khatoonabadi 1 , Mahshid Aghajanzadeh 1 , Abbas Ebadi 2, 3 , Yaser Faryadras 4 and Setareh Sagheb 5, 6, * 1 Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran 2 Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran 3 Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran 4 Department of Foreign Languages, Faculty of Literature and Humanities, Kharazmi University, Tehran, Iran 5 Department of Neonatology, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran 6 Mother, Fetus, Neonatal Research Center, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran * Corresponding author: Department of Neonatology, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran. Email: dr.ssagheb@yahoo.com Received 2020 July 17; Revised 2020 September 10; Accepted 2020 September 25. Abstract Background: One of the most critical criteria in making ready an infant for discharge from the neonatal intensive care unit (NICU) is full oral feeding attainment. Objectives: The present study aimed at investigating the effectiveness of cue-based feeding in preterm infants. Methods: A randomized clinical trial study was designed to compare 37 preterm infants at a gestational age of ≤ 34 weeks in the cue-based feeding group (n = 18) and the scheduled feeding group (n = 19). All participants were evaluated by the Preterm Infant Oral Feeding Readiness Assessment Scale (PIOFRAS) and Early Feeding Skill (EFS) scale in four different stages. Outcome measures were weight (grams per day), duration of full oral feeding achievement, duration of hospitalization, postmenstrual age (PMA), and the score of PIOFRAS and EFS. A P-value of less than 0.05 has been considered statistically significant. Results: The duration of full oral feeding achievement was shorter in the cue-based feeding group (3.55 ± 1.24 vs 6.68 ± 2.00, P < 0.001). Infants were discharged earlier in the cue-based feeding group (15.55 ± 5.38 vs 27.10 ± 7.90, P < 0.001). The mean score of PIOFRAS only on the day of discharge in the cue-based feeding group was more than the scheduled feeding group (32.61 ± 1.14 vs 31.90 ± 0.87, P = 0.03). The score of EFS in each dimension was inconsistent in each stage, and differences were observed between two groups in the full oral feeding stage. Conclusions: Although PIOFRAS and EFS demonstrated no difference significantly in most of the stages of achievement in oral feeding between the cue-based feeding group and the scheduled feeding, the process of attainment of oral feeding and discharge from the hospital was more rapid in the cue-based feeding group. Keywords: Infant, Premature, Intensive Care Units, Newborn, Feeding Behavior 1. Background One of the critical criteria for discharging preterm in- fants from the neonatal intensive care unit (NICU) is an achievement of full oral feeding (1). Oral feeding is a com- plicated procedure, which needs coordinating sucking, swallowing, and breathing. In preterm infants, the lack of coordination sucking, swallowing, and breathing, the im- maturity of their neurological, cardio-respiratory, and gas- trointestinal functions leads to delayed oral feeding and prolonged tube feeding (2, 3). Therefore, the preterm in- fants must reach maturity for success in oral feeding pro- cedure. Furthermore, they need to be cared for by an expert caregiver to help the infants attain a delightful experience of feeding with the most intake and the least stress (4, 5). Preterm infant’s problems in the transition from tube to full oral feeding often result in delayed discharge from hos- pital. Moreover, increased length of stay in the hospital has adverse effects, such as increased health care costs and also stress on the mother, infant, and family. Ultimately these problems may cause reduced parent-infant interaction (6, 7). Different interventions have been developed for full oral feeding achievement, including Fucile oral-motor in- Copyright © 2020, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.