Developing a Quality Improvement Feeding Program for NICU Patients

NeoReviews ◽  
2022 ◽  
Vol 23 (1) ◽  
pp. e23-e35
Author(s):  
Erika K. Osborn ◽  
Sudarshan R. Jadcherla
Keyword(s):  
Quality Improvement ◽  
Clinical Outcomes ◽  
Preterm Infants ◽  
Tube Feeding ◽  
Practice Variation ◽  
Oral Feeding ◽  
Evidence Based ◽  
Feeding Difficulties ◽  
Feeding Program ◽  
Hospital Stays

Practices in NICUs vary widely, particularly when clinical decisions involve complex tasks and multiple disciplines, which occurs with feeding preterm infants. Neonatal feeding difficulties in preterm infants often lead to prolonged tube feeding and therefore lengthened hospital stays. Education and compliance with evidence-based protocols and guidelines are needed on the initiation of feedings and feeding advancement to transform enteral and oral feeding practices and thus reduce practice variation and improve clinical outcomes.

Identification of a Pivotal Period in the Oral Feeding Progression of Preterm Infants

2018 ◽  
Vol 36 (05) ◽  
pp. 530-536 ◽  
Author(s):  
Sandra Fucile ◽  
Sarah Phillips ◽  
Kelly Bishop ◽  
Meagan Jackson ◽  
Taylor Yuzdepski ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Motor Skills ◽  
Tube Feeding ◽  
Time Frame ◽  
Oral Feeding ◽  
High Risk Population ◽  
Feeding Difficulties ◽  
Oral Motor ◽  
Enteral Tube Feeding ◽  
Degree Of Maturity

Objective Preterm infants are at risk of encountering oral feeding difficulties which impede on the transition to independent oral feeds. The objective of this study was to identify a pivotal period where regressions are most likely to occur during their oral feeding progression. Study Design This is a retrospective study on 101 infants born <35 weeks' gestation. The sample was separated into two groups, infants who experienced a regression during their oral feeding progression and those who did not. A pivotal period was defined as a time frame where setbacks (a decrease in oral feed attempts by one) are most likely to occur at the start (1–2 oral feed attempts per day), middle (3–5 oral feed attempts per day), or end (6–8 oral feed attempts per day) of the oral feeding progression. Result Eighty-two percent of infants experienced setbacks; 45% of all setbacks occurred at the middle time frame (p = 0.03). Infants' degree of maturity and enteral tube feeding intolerances were associated with increased occurrence of setbacks (p = 0.04). Conclusion The midpoint in the oral feeding progression is a pivotal period where setbacks are most likely to occur. This time frame can be used by clinicians to evaluate oral-motor skills for earlier provision of interventions to reduce the occurrence of oral feeding difficulties in this high-risk population.

Pharyngo-esophageal motility reflex mechanisms in the human neonate: Importance of integrative cross-systems physiology

2021 ◽  
Author(s):  
Zakia Sultana ◽  
Kathryn A. Hasenstab ◽  
Sudarshan R Jadcherla
Keyword(s):  
Esophageal Motility ◽  
Tube Feeding ◽  
Oral Feeding ◽  
Primary Role ◽  
Critical Function ◽  
Feeding Difficulties ◽  
Survival And Development ◽  
Human Neonate ◽  
Systems Physiology

Swallowing is a critical function for survival and development in human neonates, and requires cross-system coordination between neurologic, airway, and digestive motility systems. Development of pharyngo-esophageal motility is influenced by intra- and extra-uterine development, pregnancy complications, and neonatal comorbidities. Primary role of these motility reflex mechanisms is to maintain aerodigestive homeostasis under basal and adaptive biologic conditions including oral feeding, gastroesophageal reflux, and sleep. Failure may result in feeding difficulties, airway compromise, dysphagia, aspiration syndromes, and chronic eating difficulties requiring prolonged tube feeding. We review the integration of cross-systems physiology to describe the basis for physiologic and pathophysiologic neonatal aerodigestive functions.

An Evidence-Based Guideline for Introducing Oral Feeding to Healthy Preterm Infants

2003 ◽  
Vol 22 (5) ◽  
pp. 45-50 ◽  
Author(s):  
Gail McCain
Keyword(s):  
Preterm Infants ◽  
Behavioral Assessment ◽  
Oral Feeding ◽  
Evidence Based ◽  
Systematic Observation ◽  
Feeding Method ◽  
Nonnutritive Sucking ◽  
Behavioral Organization ◽  
Infant Neurodevelopment ◽  
Evidence Based Guideline

The ability of a preterm infant to make the transition from gavage to oral nipple feeding depends on the infant’s neurodevelopment in relation to behavioral organization, to a rhythmic suck-swallow-breathe pattern, and to cardiorespiratory regulation. Research-based knowledge about infant neurodevelopment in these three areas has led to the creation of a semidemand feeding method to aid in this transition. The method combines the use of nonnutritive sucking to promote awake behavior for feeding, use of behavioral assessment to identify readiness for feeding, and systematic observation of and response to infant behavior cues to regulate frequency, length, and volume of oral feedings. Semidemand feeding may be individualized for healthy preterm infants. This article discusses both the relevant knowledge about neurodevelopment and the semidemand feeding method itself.

Direct swallowing training and oral sensorimotor stimulation in preterm infants: a randomised controlled trial

2021 ◽  
pp. fetalneonatal-2021-321945
Author(s):  
Ju Sun Heo ◽  
Ee-Kyung Kim ◽  
Sae Yun Kim ◽  
In Gyu Song ◽  
Young Mi Yoon ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Controlled Trial ◽  
Tube Feeding ◽  
Tertiary Hospital ◽  
Oral Feeding ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Randomised Controlled

ObjectiveTo evaluate the effects of direct swallowing training (DST) alone and combined with oral sensorimotor stimulation (OSMS) on oral feeding ability in very preterm infants.DesignBlinded, parallel group, randomised controlled trial (1:1:1).SettingNeonatal intensive care unit of a South Korean tertiary hospital.ParticipantsPreterm infants born at <32 weeks of gestation who achieved full tube feeding.InterventionsTwo sessions per day were provided according to the randomly assigned groups (control: two times per day sham intervention; DST: DST and sham interventions, each once a day; DST+OSMS: DST and OSMS interventions, each once a day).Primary outcomeTime from start to independent oral feeding (IOF).ResultsAnalyses were conducted in 186 participants based on modified intention-to-treat (63 control; 63 DST; 60 DST+OSMS). The mean time from start to IOF differed significantly between the control, DST and DST+OSMS groups (21.1, 17.2 and 14.8 days, respectively, p=0.02). Compared with non-intervention, DST+OSMS significantly shortened the time from start to IOF (effect size: −0.49; 95% CI: −0.86 to –0.14; p=0.02), whereas DST did not. The proportion of feeding volume taken during the initial 5 min, an index of infants’ actual feeding ability when fatigue is minimal, increased earlier in the DST+OSMS than in the DST.ConclusionsIn very preterm infants, DST+OSMS led to the accelerated attainment of IOF compared with non-intervention, whereas DST alone did not. The effect of DST+OSMS on oral feeding ability appeared earlier than that of DST alone.Trial registration numberClinicalTrials.gov Registry (NCT02508571).

Feeding Difficulties in Preterm Infants

2011 ◽  
Vol 3 (6) ◽  
pp. 324-331 ◽  
Author(s):  
Pamela Dodrill
Keyword(s):  
Risk Factor ◽  
Preterm Infants ◽  
Oral Feeding ◽  
Early Feeding ◽  
Feeding Difficulties ◽  
Milk Flow ◽  
Feeding Skills ◽  
Clinical Questions ◽  
Feeding Difficulty ◽  
Therapy Interventions

Preterm infants often display difficulty establishing oral feeding in the weeks following birth. This article aims to provide an overview of the literature investigating the development of feeding skills in preterm infants, as well as of interventions aimed at assisting preterm infants to develop their feeding skills. Available research suggests that preterm infants born at a lower gestational age and/or with a greater degree of morbidity are most at risk of early feeding difficulties. Respiratory disease was identified as a particular risk factor. Mechanisms for feeding difficulty identified in the literature include immature or dysfunctional sucking skills and poor suck–swallow–breath coordination. Available evidence provides some support for therapy interventions aimed at improving feeding skills, as well as the use of restricted milk flow to assist with maintaining appropriate ventilation during feeds. Further research is needed to confirm these findings, as well as to answer remaining clinical questions.

scholarly journals Collaborative quality improvement to promote evidence based surfactant for preterm infants: a cluster randomised trial

BMJ ◽  
2004 ◽  
Vol 329 (7473) ◽  
pp. 1004 ◽  
Author(s):  
Jeffrey D Horbar ◽  
Joseph H Carpenter ◽  
Jeffrey Buzas ◽  
Roger F Soll ◽  
Gautham Suresh ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Preterm Infants ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Evidence Based ◽  
Cluster Randomised

scholarly journals Feeding infants with complex congenital heart disease: a modified Delphi survey to examine potential research and practice gaps

2020 ◽  
pp. 1-12
Author(s):  
Kristin M. Elgersma ◽  
Anne Chevalier McKechnie ◽  
Tipper Gallagher ◽  
Anna L. Trebilcock ◽  
Karen F. Pridham ◽  
...  
Keyword(s):  
Human Milk ◽  
Tube Feeding ◽  
Growth Failure ◽  
The United States ◽  
Delphi Survey ◽  
Oral Feeding ◽  
Complex Congenital Heart Disease ◽  
Feeding Practice ◽  
Evidence Based ◽  
Modified Delphi

Abstract Objective: To determine clinical consensus and non-consensus in regard to evidence-based statements about feeding infants with complex CHD, with a focus on human milk. Areas of non-consensus may indicate discrepancies between research findings and practice, with consequent variation in feeding management. Materials and Methods: A modified Delphi survey validated key feeding topics (round 1), and determined consensus on evidence-based statements (rounds 2 and 3). Patients (n=25) were an interdisciplinary group of clinical experts from across the United States of America. Descriptive analysis used SPSS Statistics (Version 26.0). Thematic analysis of qualitative data provided context for quantitative data. Results: Round 1 generated 5 key topics (human milk, developing oral feeding skills, clinical feeding practice, growth failure, and parental concern about feeding) and 206 evidence-based statements. The final results included 110 (53.4%) statements of consensus and 96 (46.6%) statements of non-consensus. The 10 statements of greatest consensus strongly supported human milk as the preferred nutrition for infants with complex CHD. Areas of non-consensus included the adequacy of human milk to support growth, need for fortification, safety, and feasibility of direct breastfeeding, issues related to tube feeding, and prevention and treatment of growth failure. Conclusions: The results demonstrate clinical consensus about the importance of human milk, but reveal a need for best practices in managing a human milk diet for infants with complex CHD. Areas of non-consensus may lead to clinical practice variation. A sensitive approach to these topics is needed to support family caregivers in navigating feeding concerns.

scholarly journals Simulation-Based Training Improves Student Assessment of Oral Feeding Skills in Preterm Infants

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Courtney Broadfoot ◽  
Julie Estis
Keyword(s):  
Health Care ◽  
Preterm Infants ◽  
Student Assessment ◽  
Oral Feeding ◽  
Feeding Difficulties ◽  
Entry Level ◽  
Undergraduate Nursing ◽  
Clinical Recommendation ◽  
Simulation Based ◽  
Feeding Skills

Advancements in medical technology have contributed to increased rates of preterm birth. Prematurity places infants at high risk for feeding difficulties, however. Early identification and assessment of preterm infant dysphagia is critical to maximize nutrition and hydration, feeding safety, and growth and development. The purpose of this study was to assess the ability of a simulation-based training toolto increase non-health care and entry-level clinical student sensitivity to signs of feeding distress in preterm infants. Data were collected from 60 students (20 masters-level Speech-Language Pathology, 20 undergraduate nursing, 20 undergraduate non-health care) in a pre-test/post-test design. All participants completed a brief simulation training protocol, and accuracy percentages were calculated based on their ability to determine the following: physiological and behavioral signs of feeding distress, oral feeding skill level (OFS), and clinical recommendation for further feeding evaluation. Our results revealed that this simulation-based training improved the identification of behavioral (p < 0.001) and physiological (p < 0.001) signs of feeding distress, OFS level (p < 0.001), and ability to make appropriate clinical recommendations (p < 0.001).This study has identified a successful method to effectively train entry-level clinical and non-clinical students to screen feeding skills in preterm infants. This training approach has the potential to improve identification of feeding distress and to recognize the need for a dysphagia evaluation to optimize clinical outcomes in this fragile population.

scholarly journals Oral Feeding Competences of Healthy Preterm Infants: A Review

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
N. Bertoncelli ◽  
G. Cuomo ◽  
S. Cattani ◽  
C. Mazzi ◽  
M. Pugliese ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Search Strategy ◽  
Survival Rates ◽  
Oral Feeding ◽  
Feeding Difficulties ◽  
Nutritive Sucking ◽  
Feeding Skills

Background.With increasing sophistication and technology, survival rates hugely improved among preterm infants admitted to the neonatal intensive care unit. Nutrition and feeding remain a challenge and preterm infants are at high risk of encountering oral feeding difficulties.Objective.To determine what facts may impact on oral feeding readiness and competence and which kind of interventions should enhance oral feeding performance in preterm infants.Search Strategy.MEDILINE database was explored and articles relevant to this topic were collected starting from 2009 up to 2011.Main Results.Increasingly robust alertness prior to and during feeding does positively impact the infant’s feeding Skills. The review found that oral and non-oral sensorimotor interventions, provided singly or in combination, shortened the transition time to independent oral feeding in preterm infants and that preterm infants who received a combined oral and sensorimotor intervention demonstrated more advanced nutritive sucking, suck-swallow and swallow-respiration coordination than those who received an oral or sensorimotor intervention singly.

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