Date of Completion


Embargo Period



Premature infant, oral feeding, feeding readiness, breastfeeding, bottle-feeding, neonatal intensive care unit

Major Advisor

Regina Cusson

Associate Advisor

Jacqueline McGrath

Associate Advisor

Xiaomei Cong

Field of Study



Doctor of Philosophy

Open Access

Campus Access


Care is provided in the Neonatal Intensive Care Unit (NICU) for infants who are born premature (prior to 37 weeks gestational age) and those requiring advanced nursing and medical care. Breastmilk is the best nutrition for infants and breastfeeding the premature infant in the NICU is often challenging. This dissertation provides an overview of oral feeding initiation in the premature infant with special consideration on the importance of breastmilk and breastfeeding. Within this dissertation are two literature reviews; one that evaluates current practice in oral feeding initiation and one that examines factors that impact breastfeeding after NICU discharge. Each review provides essential information on the state of oral feeding and how factors can impact breastfeeding success. The final research chapter is an original study that explored the impact of direct-breastfeeding in the NICU with breastfeeding and health outcomes after discharge. When combined, these three chapters create a greater understanding of feeding the premature infant in the NICU and the importance of direct-breastfeeding in this high-risk population. The information within this dissertation will help NICU providers to understand oral feeding the premature infant, to anticipate potential barriers to breastfeeding, and to acknowledge the role of direct-breastfeeding on the ultimate goal of continued breastfeeding. The overarching purpose of this dissertation is to discover the evidence behind oral feeding initiation in premature infants while analyzing factors that affect breastfeeding duration after NICU discharge.