Effects of Environmental Comfort and Oral Motor Stimulation on Comfort and Oral Feeding Readiness in Preterm Infants

Infants assigned to this group will receive a single 5-minute massage intervention before their first oral feeding. The intervention will include gentle, rhythmic tactile stimulation of the back and shoulders, followed by gentle stroking and touch.

A single 5-minute massage session will be administered before the infant's first oral feeding. The intervention will include gentle rhythmic stroking of the back and shoulders, gentle downward stroking of the back, slow rhythmic touch to the shoulder or head area, and gentle hand contact over the abdominal area.

Infants assigned to this group will be exposed to white noise at an intensity of 40-60 dB for 5 minutes before their first oral feeding. No additional care or procedure will be performed during the white noise intervention.

White noise at an intensity of 40-60 dB will be provided for 5 minutes before the infant's first oral feeding. The sound source will be positioned approximately 30-50 cm from the infant's bed. No additional care or procedure will be performed during the intervention.

Infants assigned to this group will receive a single 5-minute oral motor stimulation intervention before their first oral feeding. The intervention will include gentle stimulation of the lips, inner cheeks, palate, gums, and tongue, with non-nutritive sucking when appropriate.

A single 5-minute oral motor stimulation session will be administered before the infant's first oral feeding. The intervention will include gentle stimulation of the lips, inner cheeks, palate, gums, and tongue. Non-nutritive sucking using a sterile finger or pacifier may be provided when appropriate.

Infants assigned to the control group will receive routine neonatal care without an additional study intervention before their first oral feeding.

Infants assigned to the control group will receive routine neonatal care without additional massage, white noise, or oral motor stimulation as part of the study intervention.

Developed by Monique and her colleagues, this is an observation-based scale used to assess the comfort level of premature infants. The scale was adapted into Turkish by Dilek Küçük Alemdar and Fatma Güdücü Tüfekçi (2015) in Turkey, and a validity and reliability study was conducted. The scale consists of a total of 7 items: level of alertness, agitation, crying, physical movement, muscle tone, facial expressions, and heart rate. Each item is rated on a scale of 1 to 5, and the total score ranges from 7 to 35. There are no reverse-scored items on the scale. Factor analysis conducted as part of the construct validity assessment determined that the scale exhibits a unifactorial structure, explaining 57.7% of the total variance. The scale's Cronbach's alpha reliability coefficient was reported as 0.88.

Developed by Cristina Ide Fujinaga and colleagues (2007) to assess how ready preterm infants are for the transition to oral feeding, the scale underwent a clinical validity study in 2013. The Turkish validity and reliability study of the scale was conducted by Çamur and Çetinkaya (2021). The scale consists of a total of 18 items, each of which is scored on a scale of 0, 1, or 2. The total possible score ranges from 0 to 36. There are no reverse-scored items on the scale. The scale covers areas such as behavioral status, oral-motor posture, reflexes, and sucking behavior; while its subdimensions are not explicitly named, they are clinically grouped under five headings: corrected gestational age, behavioral organization, oral posture, reflex assessment, and non-nutritive sucking. In the Turkish adaptation, the optimal cutoff score for the scale was reported as 29, and the Cronbach's alpha internal consistency coefficient was found to be 0.87.

The time to initiation of the first oral feeding in preterm infants will be defined as the duration from the completion of the 5-minute intervention until the start of the first oral feeding. This duration will be recorded in minutes and compared across groups. The first oral feeding will be administered to infants determined by a physician to be ready for oral feeding.