Research Article Effect of Four Approaches to Oral Feeding Progression on Clinical Outcomes in Preterm Infants Rita H. Pickler, 1 Barbara A. Reyna, 2 Paul A. Wetzel, 3 and Mary Lewis 4 1 Nursing Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 11016, Cincinnati, OH 45229, USA 2 Neonatal Nurse Practitioner, Children’s Hospital of Richmond at VCU, P.O. Box 985912, Richmond, VA 23298, USA 3 Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, P.O. Box 843067, Richmond, VA 23284-3067, USA 4 Children’s Hospital of Richmond at VCU, P.O. Box 985912, Richmond, VA 23298, USA Correspondence should be addressed to Rita H. Pickler; rita.pickler@cchmc.org Received 17 December 2014; Accepted 7 April 2015 Academic Editor: Kathleen Finlayson Copyright © 2015 Rita H. Pickler et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. e purpose of this study of preterm infants was to test the effect of four approaches to the time of transition from gavage to full oral feedings, time to discharge, and weight gain during the transition. Methods. A randomized experimental design was used with four intervention groups: early start (32 weeks’ postmenstrual age)/slow progressing experience (gradually increasing oral feedings offered per day); early start/maximum experience (oral feedings offered at every feeding opportunity); late start (34 weeks’ postmenstrual age)/slow progressing experience; and late start/maximum experience. Results. e analysis included 86 preterm infants. Once oral feedings were initiated, infants in the late start/maximum experience group achieved full oral feeding and were discharged to home significantly sooner than infants in either early start group. Although not significantly different, these infants also achieved these outcomes sooner than infants in the late start/slow progressing experience group. ere were no differences in weight gain across groups. Conclusions. Results suggest starting oral feedings later in preterm infants may result in more rapid transition to full oral feedings and discharge although not at early postnatal ages. Provision of a more consistent approach to oral feeding may support infant neurodevelopment and reduce length of hospitalization. 1. Introduction Although the preterm birth rate has been declined over the last several years, it continues to hover around 11% [1]. Moreover, despite improved survival of preterm infants and major changes in their care, many common caregiving issues remain, including when to initiate and when and how to advance oral feedings to achieve the best outcomes [2]. us, the transition from gavage to oral feedings remains a clinical challenge for both infants and their caregivers. Successful transition to oral feeding is important as competence at oral feeding is a criterion for hospital discharge [3]. Delay in achieving competence at oral feeding is one of the major reasons for delays in hospital discharge for otherwise phys- iologically stable preterm infants [4–6]. Achieving oral feeding competence takes time, with the transition from gavage to all oral feedings reportedly taking from 10 to 14 days [7]. Although breast feeding may present fewer physiologic challenges than bottle feeding for the preterm infant, most preterm infants are bottle fed (formula or expressed breast milk) at least some of the time while being in the hospital [8]. us, management of oral feedings for preterm infants is a key aspect of hospital care. Currently, there are few evidence-based protocols to guide clinicians as they assist infants in achieving competence at oral feed- ing and those that exist are oſten not based soundly on research evidence. Consequently, already vulnerable infants are subject to a trial-and-error approach to this most complex and critical life-sustaining activity, with potentially harmful short- and long-term effects. Successfully making the transition from gavage to oral feedings requires the infant to coordinate suck-swallow- breathe and maintain autonomic nervous system organi- zation. Competence at oral feeding requires the infant to Hindawi Publishing Corporation Nursing Research and Practice Volume 2015, Article ID 716828, 7 pages http://dx.doi.org/10.1155/2015/716828