A feeding protocol for healthy preterm infants that shortens time to oral feeding

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

“…NG tubes were removed once an infant could take all feedings orally in a 24 h period without gavage supplementation. 8 In summary, these studies show the effectiveness of an infant cue-based approach to oral feeding initiation and advancement in a 'healthy' population of preterm infants, perhaps by allowing spontaneous awakening and thus increased awake alert time for oral feeding, an important factor for oral feeding success. 15 As studies incorporated smaller and less mature infants, more safeguards (such as limits on intervals between feedings and duration of feedings) were put in place to ensure appropriate weight gain.…”

“…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.…”

“…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. 9 We designed a clinical pathway for oral feeding initiation and advancement that was contingent on behavioral readiness signs and hunger cues and could be managed by the bedside nurse.…”

The development of potentially better practices to support the neurodevelopment of infants in the NICU

“…162 Non-nutritive sucking with pacifier use may facilitate the transition to effective nutritive sucking at 32 to 34 weeks gestation. [163][164][165][166] This may be related to improved strength and coordination of the sucking process 166,167 and pacing of feedings will help with this transition. 168 Non-nutritive sucking has been associated with improved weight gain.…”

Relationship of the First Suck Burst to Feeding Outcomes in Preterm Infants

“…1-3 Nonnutritive sucking (NNS) has been associated with improved behavior state for feeding. 4,5 Although NNS is often used as an indicator that the preterm infant is ready to initiate oral feedings, there is little evidence that this activity is related to feeding outcomes. 6 Less attention has been paid to the relationships between the characteristics of nutritive sucking and feeding outcomes.…”