Setting the Stage for Successful Oral Feeding

Abstract

To evaluate the impact of implementing the Supporting Oral Feeding in Fragile Infants (SOFFI) program in a tertiary-level neonatal intensive care unit (NICU) on the oral feeding, growth, and length of stay outcomes of a heterogeneous population of medically fragile infants at discharge and feeding and growth outcomes postdischarge at 3 to 5 months postterm. Data related to feeding, growth, and length of stay from a convenience sample of 81 infants recruited pre-SOFFI training were compared with data for 75 infants recruited post-SOFFI training of the NICU staff. Subjects were not excluded on the basis of level of illness or medical diagnoses. To establish comparability of subject groups, infants were assigned scores using the Neonatal Medical Index. At 3 to 5 months postterm, semistructured parent phone interviews related to feeding and growth at home were conducted (n = 128). Post-SOFFI infants born at less than 37 weeks' gestation achieved full oral feedings in significantly fewer days than pre-SOFFI infants (P = .01). Time to achieve full oral feedings was not significantly different in post-SOFFI infants born at 37 or more weeks' gestation. Growth and length of stay were not significantly different at discharge. At follow-up, parents of post-SOFFI infants reported significantly fewer feeding problems overall (P = .01), less arching (P = .003), less vomiting (P = .006), and fewer infants seeing feeding specialists (P = .03). Results of the study support that NICU implementation of the SOFFI feeding program positively influences feeding outcomes before and following discharge.

Effect of co-morbidities on the development of oral feeding ability in pre-term infants: a retrospective study

“…There is also increasing evidence indicating that oral feeding readiness should be assessed on the basis of acquired developmental and behavioural feeding cues rather than feeding volume and duration 32 . Horner et al 33 examined the efficacy of an intervention directed to support feeding development in medically complex preterm infants. The authors reported a significant reduction in the number of days needed to attain exclusive oral feeding in the infants who were enrolled in the intervention program compared with infants who had received standard care (10.8 vs 19.3 days, p = 0.01).…”

Implementing an Evidence-Based Feeding Protocol

“…While weight gain is an important indicator of infant well-being, outcomes of evidencebased oral feeding initiatives have shown that infants orally fed based on readiness and feeding quality gained weight at least on par with or faster than those whose oral feedings followed a specific schedule. 11,12,41 Our finding of less reliance on weight gain as a criterion to reduce the number of oral feeding attempts in the postimplementation group indicates a change in culture and practice that reflects a Cat nap refers to short break before reattempting oral feeding.…”

“…Similar to other NICU's feeding practices,6,9,31 prior to initiating the IDF protocol we relied on weight gain/loss to make decisions about oral feeding frequency. While weight gain is an important indicator of infant well-being, outcomes of evidence-based oral feeding initiatives have shown that infants orally fed based on readiness and feeding quality gained weight at least on par with or faster than those whose oral feedings followed a specific schedule 11,12,41. Our finding of less reliance on weight gain as a criterion to reduce the number of oral feeding attempts in the postimplementation group indicates a change in culture and practice that reflects a broader understanding of factors to consider when making oral feeding decisions after IDF education and implementation.…”

Psychometric properties of the oral feeding assessment in premature infants scale

“…Feeding methods have also been developed in which the caregiver is guided by the responses of the preterm infant. Methods such as the Supporting Oral Feeding in Fragile Infants (SOFFI) [18][19][20] or the Infant-Driven Feeding Scales IDFS 21 are applied as decision-making algorithms and include both behavioral responses and caregiver interventions in their assessments. The impact of implementing these methods has also recently been evaluated 22,23 .…”