Factors Associated with Delayed Transition From Oro/Nasogastric Tube Feeding to Oral Feeding in Preterm Infants: A Retrospective Study

Abstract

Background: Successful transition from tube feeding to independent oral feeding is an important developmental milestone in preterm infants and is closely related to physiological maturation, neurological integrity, respiratory stability, and overall clinical condition. Prematurity may interfere with the coordination of sucking, swallowing, and respiration, while neonatal morbidities may further prolong dependence on oro/nasogastric tube feeding.

Objective: To identify clinical, perinatal, respiratory, neurological, infectious, metabolic, hematological, cardiac, maternal, gastrointestinal, and obstetric factors associated with prolonged oro/nasogastric tube feeding in preterm infants.

Methods: A retrospective observational study was conducted among preterm infants admitted to the Neonatal Intensive Care Unit of the Obstetric and Gynecological University Hospital “Koço Gliozheni,” Tirana, Albania, between January and December 2025. A total of 289 preterm infants born at 24 to <37 weeks of gestation met the study criteria. Data were retrospectively extracted from clinical records and included demographic and perinatal characteristics, birth weight, gestational age, Apgar scores, mode of delivery, respiratory support, neonatal diagnoses, maternal factors, and feeding-related variables. The primary outcome was duration of oro/nasogastric tube feeding. Linear univariable regression analyses were performed separately for infants aged 24–<34 weeks and 34–<37 weeks.

Results: Of the 289 infants included, 159 (55.0%) were male and 130 (45.0%) were female. Mean gestational age was 33.29 weeks. Low birth weight was present in 178 infants (61.6%), very low birth weight in 40 (13.8%), and extremely low birth weight in 15 (5.2%). Overall, 67.1% of infants required oro/nasogastric tube feeding.Birth weight, 1-minute Apgar score, 5-minute Apgar score, and gestational age were significantly associated with duration of tube feeding in the 24–<34-week group. In the 34–<37-week group, birth weight was significantly associated with tube-feeding duration, whereas Apgar scores and gestational age were not statistically significant.Duration of oxygen requirement was strongly associated with prolonged tube feeding in both gestational-age groups, with standardized β coefficients of 0.854 and 0.772, respectively. Mechanical ventilation, synchronized intermittent mandatory ventilation, HOOD oxygen, and CPAP were also significantly associated with longer tube-feeding duration.Respiratory insufficiency was associated with prolonged tube feeding in both groups. Bronchopulmonary dysplasia, hyaline membrane disease, pneumothorax, and bilateral pneumonia were significant predictors in selected groups. Neurological disorders were significant in both groups, with ventriculomegaly significant in the younger group and seizures significant in the older group. Neonatal sepsis and neonatal infection were associated with longer tube-feeding duration. Hematological and metabolic disorders, particularly anemia of prematurity, anemia, and thrombocytopenia, were also significant. Cardiac disorders were significant in the 34–<37-week group.

Conclusions: Prolonged oro/nasogastric tube feeding in preterm infants is associated with a complex interaction of maturational and clinical factors. Respiratory support and duration of oxygen requirement appear particularly important. Lower birth weight, lower gestational age, lower Apgar scores, neurological disorders, infection, and hematological abnormalities were also associated with prolonged tube feeding. Early identification of infants at increased risk may support individualized feeding assessment and timely multidisciplinary intervention.