Transition From Nasogastric Tube to Oral Feeding: The Role of Parental Guided Responsive Feeding

Abstract

Background and Objective: Strategies to transition preterm infants from tube to oral feeding vary greatly and the transition may take days to weeks. The study objective was to evaluate the effect of parental guided responsive feeding (PGRF) on this transition. Methods: We conducted a randomized controlled trial on infants born at <32 weeks gestation. The PGRF intervention was performed by parents, and included feeding intervals and volumes which were guided by the infants' behavioral cues of hunger and satiety. If a minimum volume was not taken orally, an intermediate volume was supplemented via nasogastric tube. The control group was traditionally fed (TF), with pre-planned volumes of intake and at given scheduled intervals. Results: The study comprised 67 infants (PGRF 32, TF 35). PGRF infants reached full oral feeding within less days (median 2 vs. 8 days, p = 0.001), at an earlier age (median 34.28 vs. 35.14 weeks, p < 0.001), returned to baseline weight gain at 35 weeks (1.77 ± 0.70 vs. 1.25 ± 0.63 g/kg/day, p = 0.002), were discharged earlier (36.34 ± 0.6 vs. 36.86 ± 0.9 weeks, p = 0.001), were more likely to be fed by their parents ( p < 0.001), and experienced less apnea/bradycardia events at 34 weeks (median 3.5 vs. 9 per week p = 0.047) compared to the TF infants. The regression model demonstrated that independent variables predicted 43.7% of the variance of time to full oral feeding [ F (9, 65) = 4.84 p < 0.001]. The only significant variable was feeding group ( B = −6.43 p < 0.001); The PGRF infants were more likely to reach full oral feeding earlier. Conclusion: PGRF is safe, and associated with short-term advantages, higher parental engagement, and earlier discharge. Clinical Trial Registration: Identifier: SHEBA-12-9574-IM-CTIL; “Adjusted Individual Oral Feeding for Improving Short and Long Term Outcomes of Preterm Infants.”

Effect of SINC Feeding Protocol on Weight Gain, Transition to Oral Feeding, and the Length of Hospitalization in Preterm Infants: A Randomized Controlled Trial

“…This result is similar to those reported in previously conducted studies 26,27 . In previous studies with different feeding methods, it was reported that the weight gain of the infants in the experimental group was slower or that there was no difference between the groups 5,9,13–15 . The findings of a Cochrane meta‐analysis study 12 revealed that the weight gain was slower (mean difference of −1.36 g/kg/day lower weight gain; 95% CI, −2.44 to −0.29 g/kg/day) among the responsively fed infants.…”

“…In the present study, the difference between the transition time from gavage to full oral feeding in both groups did not reach statistical significance. Other studies carried out on the evidence‐based feeding protocol showed that the transition time to full oral feeding was shortened, and the results were statistically significant 5,13,14 . Transition time to full oral feeding was found to be shortened by 5 ± 4.2 days in the study performed by McCain et al in 2001, 13 5.9 ± 0.7 days in the 2012 study by McCain et al, 14 and 3.06 ± 3.09 days in the study by Morag et al 5 .…”

“…The standard feeding method involves implementing the planned oral feeding volume at certain time intervals without evaluating the preterm infant's oral readiness cues for feeding. If a feeding approach ignores the behavioral cues of the preterm infant, then it involves risks such as aspiration and negatively affected physiological values 5,9,10 . Therefore, it is extremely important to develop and implement the evidence‐based protocols for feeding the preterm infants.…”

“…If a feeding approach ignores the behavioral cues of the preterm infant, then it involves risks such as aspiration and negatively affected physiological values. 5,9,10 Therefore, it is extremely important to develop and implement the evidence-based protocols for feeding the preterm infants.…”

Oro-Motor Intervention Protocol to Improve Sucking Behavior among Neonates with Immature Sucking: An Experimental Protocol

“…Neonates with feeding difficulty may be in nasogastric tube to avoid such incidence. Traditional methods help in improving feeding pattern in neonates [ 15 16 ].…”