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"I wanted to express a very sincere thank you for sharing your clinical expertise and educator excellence with the NICU family here at Lehigh Valley Reilly Children’s Hospital in the Lehigh Valley. The seminar was refreshing, interesting and a valuable tool and strategy to offer our NICU population. The NICU  family inclusive of all the Nurses, Physicians and Therapists look forward to enriching and enhancing the lives of the neonatal population with the use of the PIOMI tool. We all look forward to enriching our professional talents through continued communication and dialogue. A sincere thank you for your time energy and talent."

Brian J. Smith, PT, MHA

Team Lead Pediatric Service Line


Pediatrics and NBSC

LeHigh Valley Reilly Children's Hospital


• 2011 •

First Pilot Study

Lessen, B. (2011). Effect of the premature infant oral motor intervention on feeding progression and length of stay in preterm infants. Advances in Neonatal Care, 11(2), 129-139.

 doi: 10.1097/ANC.0b013e3182115a2a


• 2013 •

Mahmoodi, N., Zareii, K., Mohagheghi, P., Eimani, M., & Rezaei-Pour, M. (2013). Evaluation of the effect of the oral motor interventions on reducing hospital stay in preterm infants. Bihdad, 2(3), 163-166.        

Saehoong, S., Daramas, T., & Pookboonmee, R. (2013). A systematic review of oral stimulation to enhance sucking and swallowing in preterm infants. Ramathibodi Nursing Journal, 19, 293-307. [SYSTEMATIC REVIEW]

• 2014 •

Rearkyai, S., Daramus, T. & Kongsaktrakul, C. (2014). Effect of oral stimulation on feeding efficiency in preterm infants. The Pediatric Journal, 21 (3), 17-23.

Xiao-li, Tang & Jiang-Ian, Yang (2014) Effect of oral motor intervention on premature infants with oral feeding difficulties. Journal of Nursing (Chinese), 13, 42-46.

• 2015 •

Lessen, B., Morello, C. & Williams, L. (2015) Establishing intervention fidelity of an oral motor intervention for preterm infants. Neonatal Network, 34 (2), 71-82.          

Tian, X., Yi, L., Zhang, L., Zhou, J., Ma, L., Ou, Y., … Song, G. (2015). Oral Motor intervention improved the oral feeding in preterm infants: Evidence based on a meta-analysis with trial sequential analysis. Medicine, 94(31), 1-10.

 doi: 10.1097/MD.0000000000001310 [META-ANALYSIS]

• 2016 •

Greene, Z., O’Donnell, C.P.F., & Walshe, M. (2016). Oral stimulation for promoting oral feeding in preterm infants. Cochrane Database of Systematic Reviews, 9, 1-64.

 doi: 10.1002/14651858.CD009720.pub2 [SYSTEMATIC REVIEW]

Linlin, L., Jingli, C., & Guofeng, C. (2016). Effects of oral exercise intervention on breastfeeding of preterm infants after discharge. Journal of Nurses Training, 14, 1266-1269.

Li Linlin, Chen Jingli, Cui Guofeng, et al. (2016) Effects of oral feeding promotion project in preterm infants. Chinese Journal of Modern Nursing, 22(24), 3489-3493.

Osman, Atiat A., Ahmed, Eman S., Mohamed, Hend S., Hassanein, Farok E. & Brandon, Debra (2016). Oral motor intervention accelerates time to full oral feeding and discharge. International Journal of Advanced Nursing Studies, 5 (2), 228-233.

 doi: 10.14419/ijans.v5i2.6797

• 2017 •

Kamitsuka, M. D., Nervik, P. A., Nielsen, S. L., & Clark, R. H. (2017). Incidence of nasogastric and gastrostomy tube at discharge is reduced after implementing an oral feeding protocol in preterm (< 30 weeks) infants. American Journal of Perinatology, 34, 606-613.

 doi: 10.1055/s-0037-1601443

Kim, S.N., Kim, Y.A, Jeon, M.H., Kim, D.S. & Kim, H. I. (2017). A systematic review and meta-analysis of the effects of oral stimulation interventions on the transition from tube to oral feeding in premature infants. Journal of Korean Clinical Nursing Research, 23(2), 151-160.

 doi:  /10.22650/JKCNR.2017.23.2.151 [META-ANALYSIS]


• 2018 •

Arora, K. Goel, S, Manerkar,S. et al. (2018) Prefeeding oromotor stimulation program for improving oromotor function in preterm infants: A randomized controlled trial. Indian Pediatrics, 55 (8), 675-678.

Chailangka W, Daramas T, & Kongsaktrakul C. (2018)  Effect of Expressed Breast Milk With Oral Stimulation On Feeding Efficiency in Preterm Infants. Ramathibodi Nursing Journal [Internet]. 24(1), 25-6.

Thakker, P.A., Rohit, H.R., Das, R.B., Thakker, U.P. & Singh, A. (2018) Effect of oral stimulation on feeding performance and weight gain in preterm neonates: A randomized controlled trial. Pediatrics and International Child Health.

 doi: 10.1080/20469047.2018.1435172

Zhang, L., Wang, Y., LE, Q., Wu, L., & Yu, J. (2018) Evidence-based nursing practice of oral movement intervention in premature infants. Chinese Nursing Management, 18(5), 701-705.

• 2019 •

Osman, Atiat, Ahmed, E., Hassanein, F., Mohamed, H., Silva, S. & Brandon, D. (2018) Oral feeding readiness and premature infant outcomes. Journal of Neonatal Nursing, 25 (3) 111-115.

 doi: 10.1016/j.jnn.2018.11.005

Calk, P. (2019) Best practices for oral motor stimulation to improve oral feeding in preterm infants: A systematic review. Annals of Physiotherapy & Occupational Therapy, 2(5). [SYSTEMATIC REVIEW]

Ghomi, H., Yadegari, F., Soleimani, F, Lessen Knoll, B., Noroozi, M. & Mazouri, A. (2019) The effects of premature infant oral motor intervention (PIOMI) on oral feeding of preterm infants: A randomized clinical trial. International Journal of Pediatric Otorhinolaryngology, 120, 202-209.

 doi: 10.1016/j.ijporl.2019.02.005

Lessen Knoll, B., Daramas, T. & Drake, V. (2019) Randomized trial of a prefeeding oral motor therapy and its effect on feeding improvement in a Thai NICU. J Obstet Gynecol Neonatal Nurse, 48(2), 176-188.

 doi: 10.1016/j.jogn.2019.01.003

Mahmoodi, N., Lessen Knoll B., Keykha, R., Jalalodini, A. & Ghaljaei, F. (2019) The effect of oral motor intervention on oral feeding readiness and feeding progression in preterm infants. Iranian Journal of Neonatology, 10 (3),58-63.

 Doi: 10.22038/IJN.2019.34620.1515

Rhooms, L., Dow, K., Brandon, C., Zhao,G. & Fucile, S. (2019). Effect of unimodal and multimodal sensorimotor interventions on oral feeding outcomes in preterm infants: An evidence-based systematic review. Advances in Neonatal Care, 19 (1), E3-E20.

 doi: 10.1097/ANC.0000000000000546  [SYSTEMATIC REVIEW]

• 2020 •

Jaywant, S. & Kale, J. (2020) Comparative study on the effect of oral motor intervention protocols on oral motor skills of preterm infants from a tertiary care hospital in a metropolitan city: Pilot study. International Journal of Contemporary Pediatrics, 7 (7), 1506-1512.

(Measured behavioral state)


Jaywant, S., Dandavate, P., & Kale, J. (2020). Premature infant oral motor intervention (PIOMI) with and without massage therapy on social emotional development in preterm infants. The Indian Journal of Occupational Therapy, 52(3), 95-100.

Skanning, D., Carlsen, E., Brodsgaard, A., Kyhnaeb, A., Pedersen, M., Ravn, S., ... Kronborg, H. (2020) Randomised oral stimulation and exclusive breastfeeding duration in healthy premature infants. Acta Paediatrica, International Journal of Paediatrics, 00:1-8.

Skanning, D., Kronberg, H., Brodsgaard, A., Solmer, R., Pryds, O. &  Carlsen, E.M. (2020). No long-term effect of oral stimulation on the intra-oral vacuum in healthy premature infants. Acta Paediatrica, International Journal of Paediatrics, 00:1-8.

Sasmal, S., Shetty, A.P. & Saha, B. (2020) Effect of prefeeding oromotor stimulation on preterm infants: A systematic review. International Journal of Health Sciences and Research, 10(12), 93-104.  

• 2021 •

Sumarni, Sutini, T. & Hariyanto, R. (2021) Differences in effectiveness of the Premature Infant Oral Motor Intervention (PIOMI) and oromotor stimulation (OMS) on feeding readiness. Indonesian Nursing and Scientific Journal, 11(01), 29-34.

Sasmal, S., Shetty, A.P. & Saha, B. (2021) Oromotor stimulation and its application in the care of preterm infants. Asian Journal of Nursing Education and Research, 11(20), 169-172. (Descriptive article)

Thabet, A.M & Sayed, Z.A. (2021) Effectiveness of the premature infant oral motor intervention on feeding performance, duration of hospital stay, and weight of preterm neonates in neonatal intensive care unit: Results from a randomized controlled trial. Dimensions of Critical Care Nursing, 40(4), 257-265. doi: 10.1097/DCC.0000000000000475

Majoli, M., DeAngelis, L.C., Panella, M., Calevo, M.G., Serveli, S., Lessen Knoll, B. & Ramenghi, L.A. (2021)

Parent-administered oral stimulation in preterm infants: A randomized, controlled, open-label pilot study. American Journal of Perinatology, June. doi: 10.1055/s-0041-1731452

Guler, S. & Cigdem, Z (2021). Adaptation of premature infant oral motor intervention to Turkish: Methodological study. Turkiye Klinikleri Journal of Nursing Sciences, 13(3), 502-509. doi: 10.5336/nurses.2020-79761

Le, Q., Zheng, S., Zhang, L., Wu,L., Zhou, F., Kang, M. & Lu C. (2021) Effects of oral stimulation with breast milk in preterm infants oral feeding: A randomized clinical trial. Journal of Perinatal Medicine, Dec 22  doi:

Chen, D., Yang, Z, Chen, C, & Wang, P. (2021) Effect of oral motor intervention on oral feeding in preterm infants: A systematic review and meta-analysis. American Journal of Speech-Language Pathology, 30 (5), 2318-2328. (ASHA)

El Mashad Ghada M, El Saied Hanan M, Mekawy Nadia A. (2021) Effect of an early oral stimulation program on oral feeding in preterm neonates. Menoufia Medical Journal,  34(1) 226-230   doi: 10.4103/mmj.mmj_241_19

                                                                                                  • 2022 •

Fatimah, A. & Purwaningsih, D. (2022) Effectiveness of oral motor (PIOMI) on premature infant sucking reflex. Siliwangi Health Journal, 2(3), 841-850.

Aboelmagd, A.N., Mohamed, S.S. & Tawfik, A.H. (2022) Effect of sensory motor stimulation on enhancing oral feeding readiness of preterm neonates. Egyptian Journal of Health Care, 13(3). 1322-1334.

Guler, S., Cigdem, Z., Lessen Knoll, B., Ortabag, T., & Yakuy Y.  (2021).  Effect of the premature infant oral motor intervention (PIOMI) on sucking capacity in preterm infants in Turkey: A Randomized-Controlled Trial. Advances in Neonatal Care, 22.

Jeba, A., Suganthirababu, P., Sosale, S., Alagesan, J., Srinivasan, V. & Sebastian, N. (2022) Neurodevelopmental outcome of very preterm and moderate to late preterm babies at the corrected age of first year. European Journal of Molecular & Clinical Medicine, 9(8), 280-290.

                                                                                                               • 2023 •

Elmira Shokri, Talieh Zarifian, Farin Soleimani, Brenda Lessen Knoll, Ziba Mosayebi, Mahdi Noroozi & Kiana GhasrHamidi. (2022) Effect of premature infant oral motor intervention(PIOMI) combined with music therapy on feeding progression of

preterm infants: a randomized control trial.  European Journal of Pediatrics, 182(10) Oct.


Sasmal, S., Shetty, A.P., Saha, B., Knoll, B., Mukherjee, S.(2023) Effect of prefeeding oromotor stimulation on oral feeding performance of preterm neonates during hospitalization and at corrected one month of age at a tertiary neonatal care unit of India- A randomized controlled trial. Journal of Neonatology. January 1-10.

Manuaba, I. & Dharm, B. (2023) Feeding therapy in preterm infants (Case Report). SPMRJ Surabaya Physical Medicine and Rehabilitation Journal 5(1).  doi:10.20473/spmrj.v5i1.33905 

Chavez, D. & Hallely, E. (2023) Oromotor intervention of the premature infant (PIOMI) vs traditional oromotor therapy (TOMT) in the acquisition of sucking in preterm newborns. UNAL Universidad Autonoma de Neuvo Leon, Digital Academic Repository. [Thesis -Pediatric Specialty-Neonatologist] 


Pineda, R., Kellner, P., Guth, R. et al. (2023) NICU sensory experiences associated with positive outcomes: An integrative review of evidence from 2015–2020. J Perinatology  [SYSTEMATIC REVIEW-NEURODEVELOPMENT]


Rigopoulou Z., Mihopoulos, A., &  Perdikaris, P. (2023) Methods and problems in the transition of premature infants to oral feeding: A review of the literature.   International Journal of Biological and Pharmaceutical Sciences Archive, 05(01), 001–016. [LIT REVIEW]     

Pani,, T.P., Meena, S.K., & Jain, N. (2023) Effect of oral stimulation in improving feeding performance of pre-term infants in NICU: A systematic review. International Journal of Pediatrics and Neonatology.5(1):78-82. [SYSTEMATIC REVIEW]

Munoz-Gomez, E., ingles, M., Molla-Casanova, S., Sempere-Rubio, N., Serra-Ano, P., & Aguilar-Rodriguez, M. (2023) Effects on an oral stimulation program on feeding outcomes in preterm infants: A  systematic review and meta-analysis. Physical & Occupational Therapy in Pediatrics. May.  [SYSTEMATIC REVIEW & META-ANALYSIS]

Ghazi S, Faramarzi R, Boskabady A, Lessen-Knoll B, Ghaemi H, Taghipur A et al . (2023) Prolonged oral motor stimulation treatment was effective for breastfeeding achievement in full term infants with feeding problems. Iranian Rehabilitation Journal; 21 (2): 251-262.   10.32598/irj.21.2.1754.1

Jyoti, Kodi, S.M., & Deol, R. (2023) Effect of premature infant oral motor intervention on oral feeding and weight gain: A systematic review and meta‑analysis. Iran J Nurs Midwifery Res; 28:225‑34. DOI 10.4103/ijnmr.ijnmr_341_21  [META ANALYSIS on PIOMI ONLY studies)

Izzaturrohmah, S., & Zubaidah, Z. (2023). Implementation of preterm infant oral motor stimulation intervention (PIOMI) on very low birth weight preterm baby. Nurse and Health: Jurnal Keperawatan, 12(1), 20-29.

Kukhartseva M.V., Bobrova A.M., Ryumina I.I., Narogan M.V. (2023) Oral stimulation as a part of developmental care in the

practice of a neonatologist. Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2023; 11 (2):

30–8. DOI: (in Russian)


Ciochetto CR, Bolzan GP, Gonçalves DDS, Silveira FPHD, Weinmann ARM. (2023) Effects of Kangaroo Care on the development of oral skills and achievement of exclusive oral feeding in preterm infants. Codas. Aug 4;35(5):e20220070.

Chun-Chi Huang, Yea-Shwu Hwang, Yung-Chieh Lin, Mei-Chih Huang (2023)  Effects of oral stimulation on feeding readiness of preterm infants: A randomized controlled study. Journal of Neonatal Nursing, August: online: 1-6.

Bandyopadhyay, T. Maria, A. & Vallamkonda, N. (2023) Pre-feeding premature infant oral motor intervention (PIOMI) for transition from gavage to oral feeding: A randomized controlled trial. Journal of Pediatric Rehabilitation Medicine, 16(2). 361-367.

Sheikh-Mohamed,S.O., Wilson, H. & Fucile, S. (2023) Interventions to enhance achievement to independent oral feeds in premature infants: A scoping review. Physical & Occupational Therapy in Pediatrics, Oct 22, Online. [SCOPING REVIEW]


Singh P, Malshe N, Kallimath A, Garegrat R, Verma A, Nagar N, Maheshwari R, Suryawanshi P. (2023) Randomised controlled trial to compare the effect of PIOMI (structured) and routine oromotor (unstructured) stimulation in improving readiness for oral feeding in preterm neonates. Front Pediatr.;11:1296863.

Bolzan, G.P., Ciochetto, C.R., Lessen Knoll, B., Silveira, F.P.H., & Weinmann, A.R.M. (2023). (Book Chapter) Programa de intervenção motora oral para recém-nascidos pré-termo (PIOMI). In F. Zimmermann (Ed.), Construindo a Fonoaudiologia neonatal no Brasil (1st ed., pp. 138-151). Book Toy.  [Oral Motor intervention program for preterm newborns (PIOMI). In “Building Neonatal Speech Therapy in Brazil”] 

Tsai,Y.-L.;Hsieh,P.-C.; Chen,T.-Y.;Lin,Y.-C. (2023) Effects of complete oral motor intervention and nonnutritive sucking alone on the feeding performance of premature infants: A systematic review and meta-analysis. Children,11, 4. children11010004 [SYSTEMATIC REVIEW & META-ANALYSIS]

Bozkaya, A,  Gunes, A.O, Berber Çiftci, Hilal & Davutoglu, S. (2023) The efficacy of oral motor interventions on feeding outcomes in newborns with hypoxic-ischemic encephalopathy who received therapeutic hypothermia. The Turkish Journal of Pediatrics. Nov/Dec 65. pp 949-958.  10.24953/turkjped.2023.349     

Naz, S., Afzal, M & Mukhtar, M. (2023). Effect of Oral motor stimulation on early transition from tube to oral feeding in preterm infants. International Journal of Multicultural Education. 25. 194-202. 10.5281/zendo.7090896.

Greene, Z., O’Donnell, C.P.E., & Walshe, M. (2023). Oral stimulation for promoting oral feeding in preterm infants. Cochrane Database of Systematic Reviews. 6(CD009720). (Update of 2016 review.)

                                                                                                               • 2024 • 

Ghazi, S., Faramarzi, R., Lessen Knoll, B., Taghipour, A., Hajebi S. & Sobhani-Rad, D.  (2024) Comparing the effects of 5-minute premature infant oral motor intervention with 15-minute Fucile treatment in term infants with feeding difficulties: A multi-arm randomised clinical trial. International Journal of Speech-Language Pathology, Online Mar 20, 2024.

Naderifar, E., Tarameshlu, M., Salehi, R, Ghelichi, L, Bordbar, A, Moradi, N, & Lessen Knoll, B. (2024)  A single-subject study to consider the PIOMI combined with kinesio-tape in premature infants with feeding problems. Medical Journal of the Islamic Republic of Iran.38(1): 251-257.

Eusse-Solano, P.A., Beleno Rico, I.P., Jervis-Jalabe, D. & Alvis-Guzman, N. (2024) Cost effectiveness analysis of premature infant oral motor intervention (PIOMI) in the neonatal intensive care unit (in Colombia, 2022.  Value in Health, 17(6), EE278; S108


39 RCTs on PIOMI

1 on cost effectiveness of PIOMI

1 fidelity study on PIOMI

1 case study literature review on PIOMI

7 meta-analysis & 12 Systematic Reviews that included PIOMI

1 quasi experimental study

1 Literature Review

2 Descriptive articles

3 Case Design studies

1 Book Chapter

Total: 67




                                                               Related publications co-authored with Brenda Lessen Knoll:


Isazadeh R, Moradi N, Malakian A, Naderifar E, Dastoorpoor M, Knoll BL. (2022)  Mothers' involvement in assessing feeding skills of premature infants. Int J Pediatr Otorhinolaryngol. Apr;155:111069.

Louyeh, Z.S., Naderi Far, M., Faghihi, H., Lessen Knoll, B. & Mahmoudi, N. (2020). Comparing the effect of breast milk odor and incubator cover on nutritional adequacy of premature infants: A quasi-experimental study. Medical Surgical Nursing Journal, 9(2), e99993.


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