Identification of premature infant states in relation to introducing oral feeding

Abstract

This is the accepted version of the paper.This version of the publication may differ from the final published version.Permanent repository link: http://openaccess.city.ac.uk/19255/ Link to published version: http://dx. Background:Recognising oral readiness signs in infants is vital when planning the introduction of oral feeding. However, with premature infants, this can be difficult to gauge accurately because of immature development.Methods: Twenty three staff from a level 2 neonatal unit participated. A questionnaire elicited knowledge about oral readiness and other factors related to oral feeding with premature infants.Participant knowledge of the written Als (1986) infant state descriptors was completed. A comparison was made of the skills in identification of the various infant states on video without and with written descriptors (Als; 1986). Correlations investigated if years of experience and grade had any relation to accurate infant state identification.Results: There was wide variation in the type of training about premature infant feeding participants had received. Participants (65%) recognized the importance of oral readiness signs in relation to feeding development. A Wilcoxon signed ranks test revealed no significant differences in ability to identify infant states without and with the written Als (1986) descriptors when observing infant video materials. When not using the written descriptors, there was a strong negative correlation between grade and the identification of the [Active sleep] state, (p < 0.01), and a strong positive correlation between grade and the identification of the [Drowsy] state, (p< 0.05). There were no strong correlations between grade and years working when using the written descriptors. Conclusion:Oral readiness signs are important when introducing oral feeding with premature infants. However, accurate identification of oral readiness remains challenging.

Implementing an Evidence-Based Feeding Protocol

“…Available literature about NICU nurses' knowledge and perceptions of evidence-based oral feeding practices indicates that nurses are often aware of best practices and feeding protocols, but not always familiar with the underlying theory and how it applies to their practice 6,30. NICU feeding culture also influences what protocols are used and how well they are followed, contributing to inconsistent approaches to oral feeding of preterm infants 13,30,31. Therefore, it is necessary to strengthen nurses' knowledge of the science behind infant feeding practices, and to use this knowledge to bring about a change in perceptions and attitudes about feeding practices and, in turn, a change in feeding culture through the implementation of evidence-based oral feeding protocols.…”

“…6,30 NICU feeding culture also influences what protocols are used and how well they are followed, contributing to inconsistent approaches to oral feeding of preterm infants. 13,30,31 Therefore, it is necessary to strengthen nurses' knowledge of the science behind infant feeding practices, and to use this knowledge to bring about a change in perceptions and attitudes about feeding practices and, in turn, a change in feeding culture through the implementation of evidence-based oral feeding protocols.…”

“…Available literature about NICU nurses' knowledge and perceptions of evidence-based oral feeding practices indicates that nurses are often aware of best practices and feeding protocols, but not always familiar with the underlying theory and how it applies to their practice 6,30. NICU feeding culture also influences what protocols are used and how well they are followed, contributing to inconsistent approaches to oral feeding of preterm infants 13,30,31.…”

“…Unit-based culture has been cited as a factor influencing use of EBPs in general21 as well as those specific to oral feeding preterm infants either by breast or bottle 10. Lack of awareness of feeding protocols and how they pertain to nursing practice, personal feeding beliefs, use of feeding volume as a measure of success, and a perceived lack of a need to change the “way it's always been done here” are some of the knowledge and culture issues that must be addressed to affect sustained practice change 8,10,30. Changing feeding culture requires that all caretakers, including parents, view feeding as interactive and based on continuous assessment of and appropriate responses to infants' cues, rather than a volume-driven task that can contribute to negative oral feeding experiences 7,14.…”

Prevalence, aetiology, and impact of paediatric feeding disorders in preterm infants admitted to a neonatal intensive care unit in Cyprus

“…Additionally, infants born before 30 weeks GA present with a higher incidence of oral sensorimotor feeding problems at 1 months' corrected age than their term-born peers (Sanchez, Spittle, Slattery, & Morgan, 2016). In addition to prematurity, there are many factors that may impact determination of oral feeding readiness, such as, an infants' ability to maintain physiologic stability and behavioural state, though identification is often challenging amongst NICU staff (Harding, Mynard, & Hills, 2018). Understanding the prevalence of PFDs in preterm infants is important for service planning and provision of early neonatal feeding interventions.…”