A nonexperimental study with a sample of 95 preterm infants was used to develop a model of feeding performance outcomes (proficiency, percent of prescribed volume consumed, and efficiency) using feeding readiness indicators (morbidity, maturity, behavior state at feeding start, and feeding experience). All readiness indicators were related to each other. In particular, there was a strong relationship between maturity and feeding experience. Morbidity only had an effect on efficiency; the most ill infants were less efficient feeders. Behavior state affects all feeding outcomes in a linear fashion; more awake and alert infants had better feeding performance outcomes. The effect of experience and maturity on the outcomes is more complex because of the relationship between the two. Experience has a greater effect as the infant matures, and as the infant matures, the amount of experience increases. Successful feeding requires maturity as well as experience.Once physiological stability has been attained, a major challenge for preterm infants is achievement of oral feeding competence. Although breast-feeding may present fewer physiological challenges to the growing preterm infant, 1 , 2 many preterm infants are bottle-fed either formula or expressed breast milk. 3 For the bottle-fed infant, feeding competence is the achievement of total or complete oral feedings. The American Academy of Pediatrics has included competency at nipple-feeding, either breast or bottle, as a criterion for preterm infant readiness for hospital discharge. 4 Achieving competence at this important task takes time, with the transition from gavage to full bottle-feedings reported to last 10 to 14 days. 5 Longer transition to full bottle-feedings has been associated with increased length of hospital stay.
6Assisting the preterm infant achieve bottle-feeding competence is a primary responsibility of the nursing staff. 7 Despite this responsibility, there continues to be a paucity of information available to support nurses in their decision making regarding preterm infant feeding. In particular, although the mechanics of bottle-feeding have been studied extensively, 8 , 9 there is very little research on the predictors of feeding performance.