Impact of early oral-motor intervention combined with kangaroo mother care on feeding outcomes in extremely preterm infants: Mediation by oral-motor function (NOMAS) and independent risk factor analysis for feeding intolerance.

Infants were grouped by exposure to early oral-motor intervention + kangaroo mother care (at least one 60-minute session by the first oral-feeding training day) versus early oral-motor intervention-only.

Among achievers, early oral-motor intervention + kangaroo mother care reduced the time to reach 50% (ratio 0.90) and 80% (ratio 0.89) oral intake.

Feeding efficiency (mean difference + 0.18 mL/min) and intake ratio (mean difference + 0.022) were significantly higher.

Mediation analysis revealed a significant natural indirect effect through Neonatal Oral-Motor Assessment Scale (OR 0.92), accounting for 26.5% of the total association.