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Purpose: This study aimed to develop a new bedside scoring system scale that assesses preterm infants' oral feeding skills (OFS) in the neonatal intensive care unit (NICU). Methods: A literature review and critical appraisal of available oral feeding assessment tools/scores were performed. Subsequently, we developed the "Mansoura Early Feeding Skills Assessment" (MEFSA) scale, an 85-item observational measure of oral feeding skills with three main sections. Forty-one preterm infants who did not receive oral feeding but were clinically stable enough to initiate oral feeding were included in the study. Next, we applied and interpreted the MEFSA to describe and score their feeding skills. Results: Applying the MEFSA resulted in a smooth feeding transition, early start of oral feeding, full oral feeding, and discharge with a shorter period of tube feeding in preterm infants. Conclusion: The MEFSA is a successful bedside scoring system that assesses the OFS of preterm infants in the NICU. [ABSTRACT FROM AUTHOR]