Feeding Preterm Infants Schedule or Demand?

Cue-based oral feeding clinical pathway results in earlier attainment of full oral feeding in premature infants

“…The clinical pathway was developed using evidence which suggests that preterm infants are ready to regulate their own feeding as early as 32 weeks of PMA and that cue-based feeding can facilitate oral feeding progression. 1,[6][7][8]13 A study of infants born less than 30 weeks of gestation showed that early introduction of oral feeding could occur at an average of 31 weeks of PMA when initiating oral feedings 48 h after achieving full tube feeds. 5 This earlier introduction of oral feedings accelerated the transition time from tube to all oral feeding.…”

“…6 Similarly, another study of preterm infants <37 weeks of gestation showed that stable preterm infants were able to self-regulate the frequency and amount of their feedings and allow longer sleep times between nursing interventions without compromising growth using a demand feeding protocol. 7 A maximum 5-h time limit between feedings was established and guidelines for minimum fluid and caloric intake were employed as smaller infants were included than in previous studies (down to 1550 g at study entry). Infants who failed to take adequate amounts by nipple for two consecutive feedings, or who required more than 30 min to nipple feed, were automatically fed by gavage at the next feeding.…”

“…Infants who failed to take adequate amounts by nipple for two consecutive feedings, or who required more than 30 min to nipple feed, were automatically fed by gavage at the next feeding. 7 Another study showed that a semi-demand method for transition from gavage to oral feeding in healthy, preterm infants promoted faster attainment of oral feeding (by 5 days) without compromising weight gain. The semi-demand protocol was initiated as early as 32 weeks of postconceptional age once infants were receiving all feedings enterally.…”

“…4,5 Other studies have shown that healthy preterm infants can attain full oral feeding earlier by providing the cues to regulate their own feeding schedule. 1,[5][6][7] While these studies showed that full oral feeding can be achieved at earlier gestational ages by initiating oral feeding earlier and/or by employing infant-determined feeding schedules, they focused on select populations of 'well' preterm infants: some limited entry by weight criteria, 6,7 others failed to include infants with significant oxygen need or history of severe intraventricular hemorrhage. 5,8 Hence, many infants commonly cared for in the NICU have not been studied, are probably at greater risk for delayed progress with oral feedings, and may also benefit from a more individualized approach to oral feeding.…”

Predictors of nutritive sucking in preterm infants

“…Preterm infants generally move through several stages of feeding, beginning with gavage and progressing over time to either breast or bottle feeding. 38 These stages are more often based on traditional practice rather than on empirical evidence. 39 Most neonatal centers initiate bottle feedings before suck-swallow-breathe coordination is present.…”