Parent-Facilitated Early Oral-Sensory Experience Program: Enhancing NICU Outcomes Through a Family-Centered Feeding Approach - Project Summary/Abstract Preterm infants (≤37 weeks gestational age) account for 10% of U.S. live births, but over 40% of hospital-based infant care costs. A major contributor to prolonged hospitalization is delayed oral feeding skill development, which increases healthcare expenditures and delays family reunification. Approximately 42% of preterm infants experience persistent feeding difficulties into childhood, adversely affecting growth and neurodevelopment. Early intervention to support oral feeding is therefore critical. Parents of preterm infants also experience high levels of emotional stress and reduced parenting confidence, which can impair parent-infant interactions and contribute to suboptimal infant outcomes. Early sensory experiences—such as administering small oral droplets of human milk prior to gavage feeding—have demonstrated immunomodulatory benefits and may promote feeding development. Engaging parents in these early feeding interventions addresses a key gap in early parental involvement in NICU care, enhances bonding, promotes responsive caregiving, and supports emotional well- being. We propose a pilot study to adapt a previously tested nurse-delivered intervention for parent delivery using a structured coaching model grounded in Guided Participation theory. This adapted intervention, the Parent-Facilitated Early Oral-sensory Experience (PEOE) program will be evaluated for feasibility, acceptability and preliminary effects using a quasi-experimental sequential cohort design. Specific aims are to: 1) evaluate the feasibility and acceptability of the intervention, including participation rates, parent satisfaction, and study procedures (eligibility screening, recruitment, enrollment, and retention), and explore infant and parent characteristics that may influence intervention delivery; and 2) conduct preliminary analyses to assess the magnitude and variability of intervention effects and evaluate the appropriateness and sensitivity of key outcome measures to inform future trial design. Infant outcomes will include weekly short-term physiological responses during and after intervention sessions (heart rate [HR], respiratory rate [RR), oxygen saturation [SaO2], and autonomic nervous system [ANS] regulation), captured via bedside monitors. A single oral feeding observation near discharge will assess infants’ ability to regulate both physiologic (HR, RR, SaO2, ANS regulation) and behavioral responses (using the Early Feeding Skills assessment tool). Additional data on feeding skill development, growth, and hospital stay will be extracted from electronic medical records. Parent outcomes will include their ability to co-regulate feeding, assessed through coded videotaped feedings from a single observation near discharge. Emotional well-being and parenting self-efficacy will be measured using reliable self-report questionnaires at enrollment, biweekly during the NICU stay, and/or at discharge. Data analysis will include qualitative and descriptive analyses, as well as linear mixed-effect modeling. Results will inform the design of a future multi-site clinical trial, support intervention refinement, and promote integration of this parent- delivered intervention into standard NICU care.
