Background Computerized physician order entry (CPOE) has grown since the early 1990s. While many systems serve adult patients, systems for pediatric and neonatal populations have lagged. Adapting adult CPOE systems for pediatric use may require significant modifications to address complexities associated with pediatric care such as daily weight changes and small medication doses. Objective This article aims to review the neonatal intensive care unit (NICU) CPOE literature to characterize trends in the introduction of this technology and to identify potential areas for further research. Methods Articles pertaining to NICU CPOE were identified in MEDLINE using MeSH terms “medical order entry systems,” “drug therapy,” “intensive care unit, neonatal,” “infant, newborn,” etc. Two physician reviewers evaluated each article for inclusion and exclusion criteria. Consensus judgments were used to classify the articles into five categories: medication safety, usability/alerts, clinical practice, clinical decision Support (CDS), and implementation. Articles addressing pediatric (nonneonatal) CPOE were included if they were applicable to the NICU setting. Results Sixty-nine articles were identified using MeSH search criteria. Twenty-two additional articles were identified by hand-searching bibliographies and 6 articles were added after the review process. Fifty-five articles met exclusion criteria, for a final set of 42 articles. Medication safety was the focus of 22 articles, followed by clinical practice (10), CDS (10), implementation (11), and usability/alerts (4). Several addressed more than one category. No study showed a decrease in medication safety post-CPOE implementation. Within clinical practice articles, CPOE implementation showed no effect on blood glucose levels or time to antibiotic administration but showed conflicting results on mortality rates. Implementation studies were largely descriptive of single-hospital experiences. Conclusion CPOE implementation within the NICU has demonstrated improvement in medication safety, with the most consistent benefit involving a reduction in medication errors and wrong-time administration errors. Additional research is needed to understand the potential limitations of CPOE systems in neonatal intensive care and how CPOE affects mortality.

Oral feeding competency is a milestone most infants must achieve prior to discharge. It is a developmentally complex task that requires integration of multiple sensory inputs, central nervous system maturation, motor coordination, and respiratory stability. While ensuring safety during oral feeding is important to reduce morbidities, we must optimize developmental windows to expedite feeding maturation. Currently, many of the assessments and therapies related to oral feeding skills focus solely on nutritive and nonnutritive sucking. Yet, this essential reflex is only one component of oral feeding. Specific challenges faced by individual newborns are often unique, and delays in development in any one of the many systems involved in oral feeding can lead to prolonged oral feeding maturation. Expanding the field to go beyond targeting oral motor skills to consider all aspects of feeding maturity, inclusive of sensory integration and hunger signaling, is needed to advance care. As technology continues to develop at a rapid pace, the field must compare the efficacy of these clinical and technologic assessments and therapies. In this review, we will address the complexity of neonatal feeding, review assessment tools and interventions for feeding safety and developmental readiness, and propose an individualized, multi-faceted approach to oral feeding evaluation and intervention.

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