A Topic Modeling Analysis of Parental Needs for Preterm Infant Feeding Difficulties Using Internet and Social Media Keywords

What Do We Already Know About This Topic?

Prior studies have shown that parents of preterm infants with feeding difficulties encounter significant caregiving challenges and often go through repeated trial and error when searching for accurate online information.

How Does Your Research Contribute to the Field?

This study highlights parental challenges, information-seeking behaviours, and the demand for professional consultation related to difficulties in preterm infants. By analysing caregivers’ needs through big data keyword analysis, the findings capture current trends and provide insights that can inform clinically relevant interventions tailored to parents’ actual needs.

What Are Your Research’s Implications Toward Theory, Practice, or Policy?

The findings can serve as foundational evidence for developing tailored consultation and education programs for parents of preterm infants, establishing reliable information-delivery systems, and designing intervention strategies that enhance emotional support.

Introduction

In South Korea, preterm births account for approximately 9–10% of all neonatal births and have shown a gradual increase.^1,2 Although advances in neonatal intensive care technology has improved the survival rates of premature infants, they remain at risk for a range of challenges, including cardiopulmonary problems, infections, neurological issues, and oral feeding difficulties.^2,3 Consequently, systematic parental education and the development of continuous support systems have become priority tasks for healthcare providers, specialists, and related institutions. ⁴

Oral feeding is a complex sensorimotor behaviour requiring the coordinated functioning of the oral, pharyngeal, laryngeal, and esophageal subsystems. ⁵ Premature infants often struggle to achieve the necessary balance among sucking, swallowing, and breathing because of the immaturity of their respiratory and neurological systems, making safe oral feeding particularly difficult. ⁵ Before discharge, these infants must acquire oral feeding skills, yet for some, feeding problems may persist into childhood and beyond.^4,5 Oral feeding is therefore critical not only for the short-term benefits, such as weight gain and adequate nutrition,, but also for long-term growth and development across the lifetime. ⁶

Providing safe oral feeding to premature infants, however, remains challenging. First, mothers frequently experience confusion, fear, and guilt following sudden preterm delivery, along with anxiety about their infant’s uncertain future. These emotions contribute to frustration and reduced confidence in their ability to feed their child. ⁷ Second, the physiological immaturity of the newborn, coupled with hospitalization in intensive care, makes direct feeding difficult, and even indirect feeding through breast pumping involves burdens related to transportation and storage. ⁸ For parents to successfully provide oral feeding after discharge, structured education is essential. However, as a result of limited access to reliable information, parents may not recognize the importance of oral feeding. Even when they are motivated, they often lack the knowledge and practical skills to manage feeding challenges effectively. ⁹

Feeding difficulties in premature infants are not limited to functional problems, but simultaneously involve parental emotional burden and educational needs. In one longitudinal study of children born prematurely, parents reported affective instability during feeding, the challenge of obtaining accurate information ‘on their own,’ and the technical difficulties of feeding. ¹⁰ Similarly, research has shown that mothers of low birth weight infants have specific educational needs related to feeding techniques, monitoring, and growth assessment. ⁸ Collectively, these findings highlight parents’ strong demand for customized, skills-based education that addresses both their emotional concerns and practical challenges.

Recently, the widespread use of smart media has accelerated the dissemination of information through the mobile Internet and social networking service (SNS). SNS platforms, which connect individuals, groups, and society in real-time capability and acceleration, it spreads issues faster than any other medium. ¹¹ Parents of premature infants increasingly rely on these platforms for information about feeding difficulties and child-rearing more broadly. ¹⁰ However, the abundance of indiscriminate parenting information available online forces parents to spend considerable time identifying accurate resources, and misinformation often compels them to rely on trial and error, further complicating caregiving. ⁸ This underscores the need to examine search trends and the language used in online discussions related to feeding difficulties in premature infants.

Semantic network analysis is a new form of content analysis that applies automated tools to unstructured data by referring to the act of exploring and utilizing meanings hidden within text. ¹² Semantic network analysis is not simply a technique for listing keywords by frequency, but rather a method that visualizes text from big data sources as semantic networks to analyse which topics are most relevant and have connected relationships. ¹² In other words, it involves identifying the hidden intentions of authors from written text word sets and explores what specific words co-occur with other words through analytical work. ¹³ The use of semantic network analysis techniques is deemed appropriate for understanding search trends related to feeding difficulties among parents of premature infants. However, most studies using semantic network analysis have been limited to prior research, and studies using semantic network analysis on the mobile Internet and SNS are difficult to find. Therefore, analysing mobile Internet and SNS search terms related to feeding difficulties in premature infants through semantic networks would enable the identification of relationships between words and the extraction of core concepts, thereby confirming realistic problems related to feeding difficulties in premature infants.^13,14

This study aimed to identify and analyse key keywords appearing on the mobile internet and SNS to better understand parental needs related to feeding difficulties in premature infants. Furthermore, the study sought to suggest subject areas for follow-up nursing interventions after discharge, with the goal of supporting parents in the early detection of feeding problems and in ensuring appropriate nutrition for their infants.

Methods

Results

Association Keywords Analysis

Data were collected between January 1, 2020, and December 31, 2024, using “preterm infants”, “feeding difficulty”, “feeding disorder”, and “dysphagia” as central keywords. A total of 505 online news articles, 3,288 SNS posts, and 111 YouTube videos were obtained (Figure 1). Data were secured through web crawling, and automated collection procedures were performed according to the search conditions and formats specific to each platform.

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Figure 1.

Systematic data collection and analysis protocol

The raw data were refined through several preprocessing steps, including the removal of HTML tags, special characters, and emojis, elimination of duplicate documents, and filtering of very short sentences. Meaningful words, primarily nouns and compound nouns, were extracted using the Open Korean Text (OKT) morphological analyzer, while general stop words that did not contribute to meaning were excluded.

Based on the extracted morphemes, term frequency-inverse document frequency (TF-IDF) weights were applied to calculate the keyword importance. Using this process, 50 core keywords were identified (Table 1). Latent Dirichlet Allocation (LDA) topic modeling with NetMiner clustered the keywords into topics, from which five major topics were extracted ¹⁷ (Figure 2).

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Table 1.

Associated Word Frequency Relate to Keyword

Keyword	Frequency	Degree centrality	Eigenvector centrality
Breastfeeding	1434	0.544	0.132
Respiration	759	0.477	0.094
Difficulty	692	0.386	0.064
Management	609	0.625	0.121
Treatment	560	0.609	0.128
Development	524	0.514	0.107
formula	430	0.592	0.127
Sucking	370	0.415	0.071
Growth	359	0.491	0.091
Consultation	352	0.411	0.061
Response	350	0.499	0.076
Nutrition	329	0.369	0.062
Weight	323	0.532	0.104
Low birth weight	314	0.360	0.06
Support	294	0.372	0.058
Jaundice	276	0.334	0.05
Function	223	0.369	0.048
Immunity	219	0.365	0.059
Airway	211	0.525	0.083
Intake	211	0.354	0.052

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Figure 2.

Network visualization of LDA topics and associated keywords regarding parental needs.

Discussion

This study analyzed core keywords and network structures related to parental needs regarding feeding difficulties in premature infants, deriving five major themes: (1) initial feeding adaptation and physical response; (2) recognition of feeding problems and professional consultation, (3) medical issues and welfare support linkages, (4) repeated failure experiences referring to persistent difficulties with including with breastfeeding, oral feeding attempts, or feeding tolerance, and informal information seeking, and (5) therapeutic interventions focused on oral motor function.

First, parents expressed strong concern over physical responses such as immaturity in sucking-swallowing-breathing coordination and jaundice during the initial feeding process. These findings reflect that while oral feeding skills in premature infants mature gradually, considerable difficulties are encountered in early stages, ¹⁸ and is consistent with the point that immaturity in oral motor development in premature infants directly affects early feeding adaptation. ⁵ Since immaturity in swallowing function in premature infants can affect not only short-term feeding failure but also long-term growth and development, ¹⁹ initial feeding adaptation problems suggest that they are not merely temporary difficulties, but developmental tasks requiring early assessment and intervention.

Second, parents who recognized feeding problems actively sought professional consultation, driven by anxiety over growth, developmental milestones, and nutrition status. Similar to the findings of Kumar and Mallick ²⁰ experiences of feeding failure heightened demands for healthcare professional intervention. In particular, the emphasis on keywords such as ‘low birth weight,’ ‘Nutrition,’ and ‘Development’ in this study indicates that parents are not limited to the success or failure of feeding but are concerned about long-term growth and neurodevelopmental issues, as in prior studies targeting parents of premature infants. ²¹ Therefore, early feeding function assessment and establishment of professional intervention systems that reflect parental needs can become a core nursing strategy that supports long-term development beyond simply providing nursing care for nutrition intake in premature infants.

Third, parental concerns have expanded over time from basic difficulties regarding feeding skills, to medical and structural issues such as respiratory imbalance, congenital disorders, and low birth weight in infants. Song et al ²² emphasized that feeding difficulties in preterm infants are closely related not only to neurological immaturity, but also to respiratory-swallowing coordination problems, which can affect long-term growth and development. In particular, it has been reported that premature infants with congenital heart disease or chronic respiratory diseases have greater difficulty in maintaining breastfeeding and higher risks of delayed weight gain and complications. ¹⁹ In these situations, parental needs expand beyond simple feeding guidelines for therapeutic management, regular developmental assessments, infant health screening systems, and welfare support linkages. Kumar and Mallick ²⁰ pointed out that the stress experienced by parents in neonatal intensive care unit environments is easily overlooked and raised the necessity for healthcare professionals to provide not only physical care but also social and emotional support. Therefore, keywords such as ‘Respiration,’ ‘Low birth weight,’ and ‘Congenital’ derived from this topic demonstrate that parents urgently demand medical-centered care and institutional resource connections beyond simply the success or failure of feeding.

Fourth, repeated feeding failure experiences and informal information seeking demonstrate that as feeding failures accumulate, parents experience emotional anxiety, self-blame, and helplessness; to alleviate these feelings, they depend on informal information networks, such as SNS, communities, and video materials. The emotional burden is intensified for parents of premature infants as a result of uncertainty and failure experiences in the process of learning feeding. ²⁰ Moreover, when parents do not receive formal education about feeding problems, they supplement information through informal channels, and indiscriminate parenting information from these sources actually intensifies parenting stress and confusion, causing conflicts amid information overload. ²¹ This clearly demonstrates the duality of online parenting information regarding information accessibility and error possibilities. Therefore, clinical settings and healthcare systems must reduce the risks arising from dependence on informal information by providing verified educational materials and systematic consultation systems that parents trust.

Finally, oral motor function emerged as the most critical task in feeding premature infants. Coordination of sucking, swallowing, and breathing underpins both physiological stability and growth development progress. ²² Amaizu et al ¹⁹ reported that suck-swallow-breathe coordination develops gradually during the maturation process of oral feeding skills, and pointed out that functional immaturity in premature infants can lead to repeated feeding failures. Moreover, oral sensory stimulation is important for the development of the Central Pattern Generator in premature infants, and therapeutic interventions such as swallowing training and non-nutritive sucking exercises can be effective in promoting development. ²² Indeed, Liao et al ²³ demonstrated that functional characteristics of premature infants can be quantitatively assessed through non-nutritive sucking waveform analysis, and Loeb et al ²⁴ reported that oral sensory training has positive effects on subsequent speech motor development. This evidence explains the phenomenon in which parents attempt to strengthen basic functions and provide repeated education by employing various strategies such as pacifier use, dysphagia rehabilitation, and swallowing training. Therefore, the keywords ‘Sucking,’ ‘Swallowing,’ ‘Respiration,’ and ‘Treatment’' that emerged from this topic demonstrate that both parents and healthcare professionals urgently demand treatment-centered intensive care for the long-term development of premature infants.

The findings of this study demonstrate that the needs of parents of premature infants related to feeding difficulties are expanding beyond basic feeding skills instructions to professional care that supports long-term growth and development. Moreover, the dependence on informal information networks amid repeated failures further highlights the necessity for reliable education and systematic consultation systems. Given these findings, continuous education and consultation in neonatal intensive care units and communities are essential for alleviating parental anxiety and promoting infant development. Therapeutic interventions for oral motor function development are connected not only to short-term feeding success but also to long-term language and motor development. Therefore, to meet the needs of the parents, developing specialists specializing in feeding difficulty interventions and establishing multidisciplinary support systems beyond the general nursing staff should be considered core tasks. Since parental needs regarding feeding difficulties in premature infants urgently require the strengthening of professional interventions, efforts to systematically train personnel with professional competencies in clinical settings and educational institutions are required, which can contribute to achieving the ultimate goal of not only improving the survival rates of premature infants, but also supporting long-term growth and development. This study has several limitations. First, since the data were collected from internet and social media platforms, the findings may be subject to selection bias. Second, the analysis relies on digital discourse rather than direct clinical observations; thus, the results reflect parental perceptions rather than clinical diagnoses. Third, although the data collection protocol was validated by experts, it was not pilot-tested in a formal clinical setting, which may be a limitation of this digital big data analysis. Lastly, future research involving multidisciplinary collaboration with medical professionals is necessary to validate these parental needs against clinical guidelines.

Conclusion

This study analyzed big data from the mobile Internet sources and SNS to analyse the core keywords and network structures of parental needs regarding feeding difficulties in premature infants. Five key themes emerged: initial feeding adaptation and physical response; recognition of feeding problems and professional consultation; medical issues and welfare support linkage; repeated failure experiences and informal information seeking; and therapeutic interventions focused on oral motor function. These findings highlight not only the physical and psychological challenges faced by parents but also their information-seeking behaviours and demand for professional guidance, underscoring the need for clinical approaches that reflect parents’ actual needs.

These findings can be utilized as foundational data for developing tailored consultation and education programs for parents of premature infants, reliable information-provision systems, and intervention strategies to strengthen emotional support. In particular, the finding that repeated failure experiences and informal information-seeking emerged as important needs emphasizes that institutional mechanisms should be established to enable parents to more easily access professional-centered systematic information and multidisciplinary support. Therefore, this study scientifically identified parental needs regarding feeding difficulties in premature infants and presented directions for strengthening clinical practices and policy-level support systems.

However, several limitations should be acknowledged. Because the analysis was based on online data, participant characteristics could not be specified, and differences from actual clinical needs may exist. Furthermore, the analyzed data were limited to specific time periods and platforms, requiring caution in generalization. Future research should conduct quantitative surveys and in-depth interviews to verify parental needs from multiple perspectives and evaluate the effectiveness of practical intervention programs linked to various professional groups, including healthcare professionals, rehabilitation specialists, and social workers. Through this approach, the parental needs of those experiencing feeding difficulties with premature infants can be more precisely reflected, and this is expected to contribute to the establishment of parental support systems at the clinical practice and policy levels.

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