An Exploratory Assessment of Early Feeding Modality and Associated Stomatognathic, Occlusal, and Language Outcomes in Preterm Children: An Observational Cross-Sectional Study.

Background/Objectives: Malocclusion and delayed expressive language are generally managed as separate clinical problems, although both may be influenced by early feeding experiences and stomatognathic development. This study investigated whether neonatal feeding modality was associated with occlusal morphology and expressive language development in preterm children, and explored the relationship between these outcomes. Methods: Forty preterm children (gestational age < 37 weeks) stratified: breastfeeding (Group A, n = 14), tube feeding with structured non-nutritive sucking (NNS) (Group B, n = 13), and total parenteral nutrition without oral stimulation (Group C, n = 13). Seven of 47 children assessed were excluded according to predefined eligibility criteria. Occlusal morphology was independently evaluated by two blinded paediatric dentists (Cohen's κ = 0.91). Expressive language was evaluated using the MacArthur-Bates Communicative Development Inventories and a structured phonological checklist. Group differences were analysed using Kruskal-Wallis and Dunn-Bonferroni tests; associations were examined using Spearman 's rank correlation and multivariable ordinary least squares regression adjusted for sex, area of residence, and socioeconomic status. Results: Significant differences were observed among the three feeding groups in occlusion score, language score, and age at first words (all p < 0.001; ε2 = 0.81-0.90). Occlusion and language scores were strongly associated (Spearman's ρ = 0.986, p < 0.001), and this association remained essentially unchanged after adjustment for demographic covariates (β = 2.10, 95% CI 2.01-2.19, p < 0.001). Occlusal morphology subtypes also differed significantly across groups (χ2(6) = 19.1, p = 0.004). Conclusions: Neonatal feeding modality was associated with both occlusal morphology and expressive language outcomes in this cohort of preterm children. Breastfeeding was associated with the most favorable outcomes, structured NNS with intermediate outcomes, and TPN with the least favorable outcomes. Given the observational design, modest sample size, and potential for residual confounding, findings should be considered exploratory and require confirmation in larger prospective multicenter studies.