Effect of Fucile Oral Motor Stimulation Protocol on Feeding Performance in Preterm Infants: Systematic Review and Meta-Analysis

Background: Full oral feeding (FOF) is a critical milestone in preterm infants, often delayed because of immature feeding coordination. The Fucile oral motor stimulation protocol aims to address these challenges and enhance feeding progression. To evaluate the effectiveness of the Fucile oral motor stimulation protocol in reducing the transition time to FOF, shortening hospital stays, and improving feeding-related outcomes in preterm infants. Methods: A systematic review and meta-analysis was conducted following the PRISMA guidelines (PROSPERO: CRD42022369514). Databases, including PubMed, Scopus, Web of Science, CENTRAL, and CINAHL (1990-2024), were searched. Randomized controlled trials comparing the Fucile protocol with control interventions in preterm infants (<37 weeks of gestation) were included. Outcomes included transition time to FOF, hospital stay length, weight at discharge, and milk transfer rate. Risk of bias (RoB 2) and evidence certainty (Grading of Recommendations Assessment, Development, and Evaluation) were evaluated. Results: Nineteen trials (1,031 infants) showed that the Fucile protocol significantly reduced transition time to FOF (mean difference [MD]: -5.77 days; 95% confidence interval [CI]: -6.64 to -4.90) and hospital stay duration (MD: -6.47 days; 95% CI: -8.41 to -4.53) with moderate-certainty evidence. Conclusion: The Fucile protocol accelerates feeding milestones and reduces hospital stays for preterm infants, providing moderate-certainty evidence to support its clinical use. However, methodological limitations, including small sample sizes and risk of bias, underline the need for larger, high-quality trials to confirm these findings and refine clinical guidelines. These results suggest the potential of integrating oral motor stimulation into neonatal intensive care unit practices to enhance feeding outcomes and optimize care for preterm infants.