Type and Timing of Oral Motor Interventions Neonatal Therapists Use in the Neonatal Intensive Care Unit

Importance: Oral motor interventions are used in the neonatal intensive care unit (NICU) to support the development of oral feeding skills in preterm infants. Literature regarding which oral motor interventions are used, when they are implemented, and how parents are involved is lacking. Objective: To benchmark evidence of oral motor interventions in the literature against reported use in NICU practice, understand the type and timing of oral motor interventions used, and understand perspectives about implementation of oral motor interventions and family involvement in these interventions. Design: Qualitative study. Setting: Virtual, recorded focus groups and interviews on Zoom. Participants: Convenience sampling was used to recruit neonatal therapists with at least 2 yr experience in the NICU who were currently implementing oral motor interventions. Outcomes and Measures: During semistructured focus groups and interviews, we specifically probed the type of oral motor interventions that clinicians use in the NICU to benchmark them against the interventions found in the literature. Recordings were transcribed and uploaded to NVivo for descriptive analysis. Results: Twelve neonatal therapists participated in focus groups or interviews. Applied oral motor stimulation, nonnutritive sucking, NTrainer® intervention, swallowing exercises, and milk drops were reported to be used in practice and most often were started as early as 29 wk postmenstrual age. Parents were primarily involved in facilitating nonnutritive sucking and providing milk drops. Conclusions and Relevance: Oral motor interventions reported to be used in NICU clinical practice mirror those available in the evidence. This supports ongoing implementation of evidence-based practice for neonatal therapists. Plain-Language Summary: A recent integrative review was completed to understand oral motor interventions used to support the development of feeding skills in preterm infants. The interventions identified in the scientific literature were nonnutritive sucking, applied oral motor stimulation, swallowing exercises, and use of a pacifier that elicits a sensory pulse to stimulate sucking called the NTrainer. However, there was no published information regarding which (if any) of these interventions are actually used in clinical practice and how parents may be involved in their implementation at the neonatal intensive care unit bedside. Therefore, this qualitative study sought to understand oral motor interventions used in clinical practice. All of the interventions identified in the scientific literature were identified as being used in practice, although at varying rates. An additional intervention, milk drops, was also identified. Nonnutritive sucking and milk drops were most commonly used by the study participants and were most commonly taught to parents to implement with their infants. These findings support neonatal therapists’ implementation of evidence-based practice in the clinical setting.