The effect of combined stimulation with maternal breast milk odor and non-nutritive sucking on the time of achieving independent oral feeding in premature infants

zahra Khodagholi, Talieh Zarifian, Farin Soleimani, Maryam Khoshnood shariati, Enayatollah Bakhshi



Background and Objectives

Given the positive effects of stimulation with maternal breast milk odor and non-nutritive sucking on premature infants’ feeding skills, the present study was conducted to examine the effect of combining two stimuli, including non-nutritive sucking and maternal breast milk odor, on the time of achieving independent oral feeding in premature infants.

Materials and Methods

The present clinical trial was conducted at Mahdieh and Shohada-e Tajrish Hospitals of Tehran in 2016. A total of 32 neonates with a fetal age of 28-32 weeks for whom gavage feeding was started entered the study and were divided into a group of non-nutritive sucking combined with olfactory stimuli and another group of non-nutritive sucking only. The stimulations were performed in both groups at the first five minutes of gavage, three times per day, over ten consecutive days. Weight gain, the time of achieving frequent oral feeding and chronological age at the time of discharge from the hospital were recorded as measures of the effectiveness of the interventions. The results of the interventions were analyzed and compared in SPSS-18.

Findings and Conclusion

Non-nutritive sucking combined with maternal breast milk odor leads to a lower post-menstrual age at the first oral feeding, independent oral feeding and discharge from the hospital in premature infants, but has no effects on their daily weight gain and weight at the time of discharge. These results show the effectiveness of combining maternal breast milk odor and non-nutritive sucking as two separate stimuli in achieving oral feeding and earlier discharge from the hospital.


Breast milk odor, preterm infant, oral feeding, nonnutritive sucking, Length of Stay

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sadeghzadeh M, Khoshnevisasl P, Parvaneh M, Mousavinasab N. Early and Late Outcome of Premature Newborns with History of Neonatal Intensive Care Units Admission at 6 Years Old in Zanjan, Northwestern Iran. Iranian journal of child neurology. 2016;10(2):67.

Yildiz A, Arikan D, Gözüm S, Taştekın A, Budancamanak İ. The effect of the odor of breast milk on the time needed for transition from gavage to total oral feeding in preterm infants. Journal of Nursing Scholarship. 2011;43(3):265-73.

Wolf LS, Glass RP. Feeding and swallowing disorders in infancy: Assessment and management: Psychological Corporation; 1992.

Harding CM, Law J, Pring T. The use of non-nutritive sucking to promote functional sucking skills in premature infants: an exploratory trial. Infant. 2006;2(6):238-40.

Lessen BS. Effect of the premature infant oral motor intervention on feeding progression and length of stay in preterm infants. Advances in Neonatal Care. 2011;11(2):129-39.

Blondheim O, Abbasi S, Fox WW, Bhutani VK. Effect of enteral gavage feeding rate on pulmonary functions of very low birth weight infants. The Journal of pediatrics. 1993;122(5):751-5.

Fucile S, Gisel E, Lau C. Oral stimulation accelerates the transition from tube to oral feeding in preterm infants. The Journal of pediatrics. 2002;141(2):230-6.

Edwards L. Non-nutritive sucking and the preterm infant. 2011.

Asadollahpour F, Yadegari F, Soleimani F, Khalesi N. The Effects of Non-Nutritive Sucking and Pre-Feeding Oral Stimulation on Time to Achieve Independent Oral Feeding for Preterm Infants. Iranian journal of pediatrics. 2015;25(3).

Harding C. An evaluation of the benefits of non-nutritive sucking for premature infants as described in the literature. Archives of disease in childhood. 2009;94(8):636-40.

Harding C, Frank L, Dungu C, Colton N. The Use of Nonnutritive Sucking to Facilitate Oral Feeding in a Term Infant: A Single Case Study. Journal of Pediatric Nursing. 2012;27(6):700-6.

Younesian S, Yadegari F, Soleimani F. Impact of Oral Sensory Motor Stimulation on Feeding Performance, Length of Hospital Stay, and Weight Gain of Preterm Infants in NICU. Iranian Red Crescent Medical Journal. 2015;17(7).

Sullivan RM, Toubas P. Clinical usefulness of maternal odor in newborns: soothing and feeding preparatory responses. Neonatology. 1998;74(6):402-8.

Badiee Z, Asghari M, Mohammadizadeh M. The calming effect of maternal breast milk odor on premature infants. Pediatrics & Neonatology. 2013;54(5):322-5.

Bingham PM, Abassi S, Sivieri E. A pilot study of milk odor effect on nonnutritive sucking by premature newborns. Archives of pediatrics & adolescent medicine. 2003;157(1):72-5.

Bingham PM, Churchill D, Ashikaga T. Breast milk odor via olfactometer for tube-fed, premature infants. Behavior research methods. 2007;39(3):630-4.

Shamsi a, Movahed Z, Pouraboli B, Iranmanesh S. The Effect of olfactory stimulation with breastmilk smell on the duration of feeding transitional time from gavage to oral feeding and hospital stay in premature infants hospitalized in neonatal-care unit 2014.

Jones J, Kassity N, Duncan K. Complementary care: Alternatives for the neonatal intensive care unit. Newborn and Infant Nursing Reviews. 2001;1(4):207-10.

Porter RH, Makin JW, Davis LB, Christensen KM. Breast-fed infants respond to olfactory cues from their own mother and unfamiliar lactating females. Infant Behavior and Development. 1992;15(1):85-93.

Raimbault C, Saliba E, Porter RH. The effect of the odour of mother's milk on breastfeeding behaviour of premature neonates. Acta Paediatrica. 2007;96(3):368-71.

Nyqvist KH, Sjödén P-O, Ewald U. The development of preterm infants’ breastfeeding behavior. Early human development. 1999;55(3):247-64.

Pinelli J, Symington A. Non-nutritive sucking for promoting physiologic stability and nutrition in preterm infants. Cochrane Database Syst Rev. 2005;4.

Vakilian K, Ranjbaran M, Khorsandi M, Sharafkhani N, Khodadost M. Prevalence of preterm labor in Iran: A systematic review and meta-analysis. International Journal of Reproductive BioMedicine. 2015;13(12):743.



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