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

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.

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Effect of Four Approaches to Oral Feeding Progression on Clinical Outcomes in Preterm Infants

Nursing Research and Practice ◽

10.1155/2015/716828 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Rita H. Pickler ◽

Barbara A. Reyna ◽

Paul A. Wetzel ◽

Mary Lewis

Keyword(s):

Weight Gain ◽

Preterm Infants ◽

Oral Feeding ◽

Early Start ◽

Randomized Experimental Design ◽

Postmenstrual Age ◽

Infant Neurodevelopment ◽

Rapid Transition ◽

Late Start ◽

Length Of Hospitalization

Background. The purpose of this study of preterm infants was to test the effect of four approaches to the time of transition from gavage to full oral feedings, time to discharge, and weight gain during the transition.Methods. A randomized experimental design was used with four intervention groups: early start (32 weeks’ postmenstrual age)/slow progressing experience (gradually increasing oral feedings offered per day); early start/maximum experience (oral feedings offered at every feeding opportunity); late start (34 weeks’ postmenstrual age)/slow progressing experience; and late start/maximum experience.Results. The analysis included 86 preterm infants. Once oral feedings were initiated, infants in the late start/maximum experience group achieved full oral feeding and were discharged to home significantly sooner than infants in either early start group. Although not significantly different, these infants also achieved these outcomes sooner than infants in the late start/slow progressing experience group. There were no differences in weight gain across groups.Conclusions. Results suggest starting oral feedings later in preterm infants may result in more rapid transition to full oral feedings and discharge although not at early postnatal ages. Provision of a more consistent approach to oral feeding may support infant neurodevelopment and reduce length of hospitalization.

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Developing a Quality Improvement Feeding Program for NICU Patients

NeoReviews ◽

10.1542/neo.23-1-e23 ◽

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.

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