Table 2.

Summary of studies on the preterm Infants’ cues during breastfeeding

Author/year/country/language	Objectives/framework	Research Design /Sample	Instrument/developer	Results	Conclusion and gap
Lin et al. (2013) Taiwan, article in Chinese	Comparing preterm infants’ behavioral cues between breastfeeding and bottle feeding	-Observational study using feeding videotaped -Involving seven breastfeeding and seven bottle-feeding preterm infants -Infants born at 25-32 weeks of gestational age -Setting = NICU	-The Preterm Infants Cues Coding System (PFCCS) -The original version was developed by Lin (2005)	-The feeding behavioral cues were divided into hunger, self-regulatory, stress, and satiety cues -The breastfeeding preterm infants have more hunger cues than bottle-feed peers (p = .013) -The breastfed infants had fewer stress cues than their bottle-feeding peers (p = .041)	-The breastfed infants demonstrated fewer stress cues than the bottle-feeding -Need more samples for future research
Giannì et al. (2017) Italy, article in English	To investigate implementation of the Infants Driven Scale in NICU and to find the threshold in relation to belated feeding independency	-A prospective, observational, single-center study -A consecutive sample of 47 infants born at ≤32 weeks of GA between July 2015 and March 2016 -Setting: NICU	-The modified instrument from Infant Driven Scale (IDS) (Newland et al., 2013)	-The mean Postmenstrual Age (PMA) at feeding independence was 35.6 ± 1.34 weeks -The IDS score ≤8 at 32 weeks of postmenstrual age was related to a delay of 1.8 weeks in feeding independence achievement	-The IDS was an appropriate instrument for evaluating preterm infants’ readiness for oral feeding and early screening for delayed feeding -The implementation IDS approach in another country should be investigated
Nyqvist et al. (1996) Sweden, article in English	Describing the behavior of a very preterm infant before and after the mother was advised about behavioral cues during breastfeeding	-Descriptive case report study involving one preterm infant born at 29 weeks of gestation in a breastfeeding session -A breastfeeding session relates to an event when the infant is tied to the breast, whether the infant exhibits conditioning toward the breast -Infant’s cues are any infant’s mouth activity to the breast	-The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) -Need certification for NIDCAP observer -A model developed by Als (1995)	After two days of treatment, the preterm infant showed more wakefulness and more efficient sucking	The NIDCAP checklist is a mental checklist for assessment and advice
Nyqvist et al. (1999) Sweden, article in English	Observing the development of preterm infants’ responses to the breast	-The observational study used direct observation during breastfeeding -Involving 71 single born baby at 26.7–35.9 weeks’ GA)	-The Preterm Infant Breastfeeding Behavior Scale or PIBBS (Nyqvist et al., 1999)	-At 28 weeks’ GA, babies revealed adequate rooting, grip areola, and clasp -At 32 weeks’ GA, babies show recurred blows of ≥10 sucks and maximum bursts of ≥30 sucks -Healthful sucking emerged from 30.6 weeks -Sixty-seven babies were breastfed at dismissed care -On average PMA of 36.0 weeks (33.4–40.0 weeks), fifty-seven babies capable of full breastfeeding	Cardiorespiratory stability, preview maturation condition, age, or weight, were considered for preterm infant’s breastfeeding initiation