All preterm neonates of less than 34 weeks' of gestation admitted to the Neonatology and Neonatal Intensive Care unit of an university hospital located in Lyon, France

A multidisciplinary group composed of childcare assistants, nurse guardians, speech therapist, physiotherapist, psychologist, and pediatricians will develop and implement the educational oral feeding program. They will provide the 2-day theoretical session as well as the three 2-hour practical sessions including reviews of video recording preterm neonates during bottle or breast feedings.

The program will focus on non-nutritive sucking for all neonates from 24 up to 34 weeks' of gestation, early oral feeding from 29 weeks' of gestation and oral stimulation for all preterm neonates admitted to the unit. Additionally, all preterm neonates presenting feeding difficulties symptoms will be evaluated weekly by a physiotherapist or speech therapist.

Each program session is composed of 20 nurses or childcare assistants. Six sessions will be organized in total and all nurses and childcare assistants will be trained

The age (real and corrected) of weaning of naso-gastric tube of preterm neonates taken out of hospitalization during the month will be computed by subtracting the date of weaning from the date of birth.

Preterm neonates will be considered as presenting with feeding difficulty symptoms if they present :

• no demonstration of hunger cues and/or,
• Coughing,choking or vomiting during bottle or breast feeding and/or,
• Feed intake exceeding 30 minutes and/or,
• Excitement, discomfort or arching of the back during feedings and/or,
• Gagging or falling asleep during feedings and/or,
• Refusal to feed. The monthly rate of neonates presenting feeding difficulty symptoms will correspond to the total number of neonates presenting feeding difficulty symptoms divided by the number of neonates hospitalized during the month.