Outcomes From an Oral Feeding Protocol Implemented in the NICU

Abstract

The purpose of this study was to compare the clinical outcomes of 2 different oral feeding protocols. The old protocol advanced oral feedings based on established feeding times, whereas the new evidenced-based protocol advanced oral feedings using infant cues. This retrospective study, conducted by reviewing the charts of premature infants born less than or at 34 weeks' gestation, documented the differences between the 2 oral feeding protocols. The medical records were reviewed for 200 premature infants admitted to the neonatal intensive care unit at Children's Hospital of Illinois, Peoria, Illinois. The main outcome variables this study compared were when infants started oral feedings, time to achieve 50% and 100% feedings orally, weight at time of oral feeding, day of life, and postmenstrual age. The percentage of feedings when oral stimulation was ordered, frequency of feeding therapy consultations, length of stay, weight at the time of discharge, and postmenstrual age at the time of discharge were also compared. Infants participating in the new feeding protocol began oral feedings at an earlier postmenstrual age as compared to infants using the old feeding protocol. Participants enrolled in this new protocol did not experience adverse events. They were also able to progress to full oral feedings while maintaining adequate weight, had less need for feeding therapy consultations, and length of stay was not prolonged.

Parâmetros cardiorrespiratórios e sua relação com a idade gestacional e nível de habilidade de alimentação oral de recém-nascido pré-termo

“…Oral feeding (OF) can be initiated when the PTN presents corrected gestational age (CGA) of approximately 34 weeks, a time when the infant begins to acquire efficient coordination between the functions of sucking, swallowing, and breathing (S/S/B) (6)(7)(8) , although more recent studies report that it is already possible to observe coordination between these functions as of the 32 nd week of CGA (9) . Although CGA is important in the decision for oral feeding readiness (10) , it should not be considered a determining factor (11) .…”

Making the Literature Palatable at the Bedside

“…50 The goal is "contingent care giving" whereby oral feeding opportunities match infant readiness cues and skills. 32,46,51 Positive feeding outcomes are associated with positive feeding experiences. 52 We developed a best-practice guideline to promote positive feeding experiences on the basis of the literature and our multidisciplinary experts, but we did not pay sufficient attention to proper implementation and integration of our guideline.…”

“…Understanding the neonate's needs and providing support during acquisition of oral feeding skills have been shown to shorten the length of stay and facilitate readiness for discharge home. 6,30,32 Neonates at this early stage of oral feeding do not have sufficient coordination of nutritive sucking, swallowing, and breathing. External pacing at the breast or bottle will avoid oral pooling or "flooding" by imposing breaks for swallowing and respiratory recovery.…”

“…6,26,32,[41][42][43] Demand or semidemand feedings provide the neonate with opportunities to demonstrate hunger cues and alertness behaviors before nipple feeding. 2,27 The neonate is allowed to control "when" and "how much" for each feeding.…”

Improving Preterm Infant Outcomes

“…The protocol design used for this QI project as shown in Table 1 was based on the oral feeding protocol developed by Drenckpohl et al 18 and was selected on the basis of simplicity of design, the use of evidence-based oral feeding advancement on the basis of success with prior oral feedings, and for projected ease of implementation in the project setting. Nonnutritive sucking was offered for 10 minutes before feedings, and oral feeding progression was dependent on successful progression of oral feeding skills as the infant matured over time.…”