Identifying Risk Factors for Post-Discharge Feeding and Swallowing Difficulties in Preterm Infants: Results From a Modified Delphi Consensus

Feeding and/or swallowing difficulties (FSD) are common in preterm infants after discharge and may be associated with growth difficulties, hospital readmissions, and broader developmental vulnerabilities. Although the literature describes multiple potential risk factors, there is limited agreement on which factors should be prioritised when monitoring feeding and/or swallowing concerns after discharge. This study aimed to establish expert consensus on the risk factors prioritised for post-discharge FSD in preterm infants. A modified Delphi design was conducted across three rounds and informed by a preceding scoping review that identified 66 risk factors across infant, caregiver, and social-environmental domains. Thirteen experts with experience in neonatal care participated in Round One, and ratings were collected through an online survey using a seven-point Likert scale. Across the three rounds, the initial 66 items were refined to 33 items in Round One based on perceived relevance and to 21 items in Round Two based on perceived importance. In the final prioritisation round, participants selected their top ten items. Six individual infant-related risk factors reached the predefined consensus threshold for prioritisation: choking episodes, inability to maintain oxygen saturations, impaired suck–swallow–breath coordination, oral-motor difficulties, gastroesophageal reflux, and structural abnormalities. No caregiver or social-environmental factors reached the consensus threshold in the final round, although these factors were retained and evaluated during earlier rounds. The findings provide a consensus-based foundation for focused monitoring and discharge planning for preterm infants and highlight the need for further research into how caregiver and social-environmental factors influence post-discharge feeding outcomes.