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A cross-sectional analysis of infant-driven and traditional feeding outcomes for neonatal intensive care unit infants

Journal of Perinatology volume 41, pages 1865–1872 (2021)Cite this article

Subjects

Abstract

Objective

The goal of this study was to assess the impact of infant-driven feeding (IDF) compared to traditional feeding protocols in promoting earlier successful feeding outcomes.

Study design

We performed a cross-sectional analysis of infants admitted to a level three neonatal intensive care unit (NICU) over a 2-year period. We compared infants fed with the traditional protocol to those under the IDF protocol.

Results

Infants in the IDF group were younger at first feed (p < 0.001). There was no difference in age at nasogastric (NG) tube removal or at discharge, length of stay, or percentage breastfeeding at discharge. There were no differences in outcomes within two subgroups born at <35 and <32 weeks gestation, respectively.

Conclusion

The IDF program led to earlier initiation of oral feeding. However, this did not lead to earlier NG tube removal or discharge, a shorter length of stay, or increase in the rates of breastfeeding.

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Fig. 1: Schema depicting subjects included and excluded during the in the traditional and IDF feeding methods.

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References

  1. Jadcherla S, Wang M, Vijayapal A, Leuthner S. Impact of prematurity and co-morbidities on feeding milestones in neonates: a retrospective study. J Perinatol. 2009;30:201–8.

    Article  Google Scholar 

  2. Kirk A, Alder S, King J. Risk factors for poor oral feeding progression in premature infants. J Investigative Med. 2006;54:S98.

    Article  Google Scholar 

  3. Park J, Knafl G, Thoyre S, Brandon D. Factors associated with feeding progression in extremely preterm infants. Nurs Res. 2015;64:159–67.

    Article  Google Scholar 

  4. Gelfer P, McCarthy A, Turnage, Spruill C. Infant driven feeding for preterm infants: learning through experience. Newborn Infant Nurs Rev. 2015;15:64–7.

    Article  Google Scholar 

  5. Settle M, Francis K. Does the infant-driven feeding method positively impact preterm infant feeding outcomes? Adv Neonatal Care. 2019;19:51–5.

    Article  Google Scholar 

  6. Underwood MA. Human milk for the premature infant. Pediatr Clin North Am. 2013;60:189–207.

    Article  Google Scholar 

  7. Bu’Lock F, Woolridge MW, Baum JD. Development of co‐ordination of sucking, swallowing and breathing: ultrasound study of term and preterm infants. Developmental Med Child Neurol. 1990;32:669–78.

    Article  Google Scholar 

  8. Weber F, Woolridge MW, Baum JD. An ultrasonographic study of the organisation of sucking and swallowing by newborn infants. Dev Med Child Neurol. 1986;28:19–24. https://doi.org/10.1111/j.1469-8749.1986.tb03825.x.

    Article  CAS  PubMed  Google Scholar 

  9. Paul K, Dittrichová J, Papousek H. Infant feeding behavior: development in patterns and motivation. Dev Psychobiol. 1996;29:563–76. 10.1002/(SICI)1098-2302(199611)29:7<563::AID-DEV2>3.0.CO;2-S.

    Article  CAS  Google Scholar 

  10. Whetten CH. Cue-based feeding in the NICU. Nurs Women’s Health. 2016;20:507–10. https://doi.org/10.1016/j.nwh.2016.08.006.

    Article  Google Scholar 

  11. Lau C. Development of oral feeding skills in the preterm infant. Arch Pediatr. 2007;14S35–41. https://doi.org/10.1016/s0929-693x(07)80009-1.

  12. Whyte RK. Neonatal management and safe discharge of late and moderate preterm infants. Semin Fetal Neonatal Med.2012;17:153–8. https://doi.org/10.1016/j.siny.2012.02.004.

    Article  PubMed  Google Scholar 

  13. Mizuno K, Ueda A. The maturation and coordination of sucking, swallowing, and respiration in preterm infants. J Pediatr. 2003;142:36–4.

    Article  Google Scholar 

  14. Berseth CL. Gastrointestinal motility in the neonate. Clin Perinatol. 1996;23:179–90.

    Article  CAS  Google Scholar 

  15. Breton S, Steinwender S. Timing introduction and transition to oral feeding in preterm infants: current trends and practice. Newborn Infant Nurs Rev. 2008;8:153–9.

    Article  Google Scholar 

  16. Shaker CS. Cue-based feeding in the NICU: using the infant’s communication as a guide. Neonatal Netw. 2013;32:404–8.

    Article  Google Scholar 

  17. Newland L, L’huillier MW, Petrey B. Implementation of cue-based feeding in a level III NICU. Neonatal Netw. 2013;32:132–7.

    Article  Google Scholar 

  18. Brown A, Arnott B. Breastfeeding duration and early parenting behaviour: the importance of an infant-led, responsive style. PLoS ONE. 2014;9:e83893. https://doi.org/10.1371/journal.pone.0083893.

  19. Ventura AK, Thompson K. Predictors of resilience among infants at risk for rapid weight gain. Obesity. 2019;27:130–6.

    Article  Google Scholar 

  20. McCain GC, Gartside PS, Greenberg JM, Lott JW. A feeding protocol for healthy preterm infants that shortens time to oral feeding. J Pediatr. 2001;139:374–9.

    Article  CAS  Google Scholar 

  21. McCain GC, Moral TD, Duncan RC, Fontaine JL, Pino LD. Transition from gavage to nipple feeding for preterm infants with bronchopulmonary dysplasia. Nurs Res. 2012;61:380.

    Article  Google Scholar 

  22. Kish MZ. Improving preterm infant outcomes: implementing an evidence-based oral feeding advancement protocol in the neonatal intensive care unit. Adv Neonatal Care. 2014;14:346–53.

    Article  Google Scholar 

  23. Watson J, McGuire W. Responsive versus scheduled feeding for preterm infants. Cochrane Database Syst Rev. 2016:CD005255. https://doi.org/10.1002/14651858.

  24. Wellington A, Perlman JM. Infant-driven feeding in premature infants: a quality improvement project. Arch Dis Child Fetal Neonatal Ed. 2015;100:F495–500.

    Article  Google Scholar 

  25. Davidson E, Hinton D, Ryan-Wenger N, Jadcherla S. Quality improvement study of effectiveness of cue-based feeding in infants with bronchopulmonary dysplasia in the neonatal intensive care unit. J Obstet Gynecol Neonatal Nurs. 2013;42:629–40.

    Article  Google Scholar 

  26. Puckett B, Grover VK, Holt T, Sankaran K. Cue-based feeding for preterm infants: a prospective trial. Am J Perinatol. 2008;25:623–8.

    Article  Google Scholar 

  27. Giannì ML, Sannino P, Bezze E, Plevani L, Esposito C, Muscolo S, et al. Usefulness of the infant driven scale in the early identification of preterm infants at risk for delayed oral feeding independency. Early Hum Dev. 2017;115:18–22.

    Article  Google Scholar 

  28. Ludwig S, Waitzman R. Changing feeding documentation to reflect infant-driven feeding practice. Newborn Infant Nurs Rev. 2007;7:155–60.

    Article  Google Scholar 

  29. Fry T, Marfurt S, Wengier S. Systematic review of quality improvement initiatives related to cue-based feeding in preterm infants. Nurs Women’s Health. 2018;22:401–10.

    Article  Google Scholar 

  30. Kirk A, Alder S, King J. Cue-based oral feeding clinical pathway results in earlier attainment of full oral feeding in premature infants. J Perinatol. 2007;27:572–8.

    Article  CAS  Google Scholar 

  31. Dalgleish SR, Kostecky LL, Blachly N. Eating in “SINC”: safe individualized nipple-feeding competence, a quality improvement project to explore infant-driven oral feeding for very premature infants requiring noninvasive respiratory support. Neonatal Netw. 2016;35:217–27.

    Article  Google Scholar 

  32. Kong SK, Lee DT. Factors influencing decision to breastfeed. J Adv Nurs. 2004;46:369–379. https://doi.org/10.1111/j.1365-2648.2004.03003.

    Article  PubMed  Google Scholar 

  33. Arora S, McJunkin C, Wehrer J, Kuhn P. Major factors influencing breastfeeding rates: mother’s perception of father’s attitude and milk supply. Pediatrics. 2000;106:e67. https://doi.org/10.1542/peds.106.5.e67.

    Article  CAS  PubMed  Google Scholar 

  34. Li R, Magadia J, Fein SB, Grummer‐Strawn LM. Risk of bottle‐feeding for rapid weight gain during the first year of life. Arch Pediatr Adolesc Med. 2012;166:436.

    Google Scholar 

  35. Ventura AK. Developmental trajectories of bottle‐feeding during infancy and their association with weight gain. J Dev Behav Pediatr. 2017;38:119.

    Article  Google Scholar 

  36. Chrupcala KA, Edwards TM, Spatz DL. A continuous quality improvement project to implement infant-driven feeding as a standard of practice in the newborn/infant intensive care unit. J Obstet Gynecol Neonatal Nurs. 2015;44:654–64.

    Article  Google Scholar 

  37. American Academy of Pediatrics Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate. Pediatrics. 2008;122:1119–26.

    Article  Google Scholar 

  38. Smith V, Hwang S, Dukhovny D, Young S, Pursley DM. Neonatal intensive care unit discharge preparation, family readiness and infant outcomes: connecting the dots. J Perinatol. 2013;33:415–21.

    Article  CAS  Google Scholar 

  39. Brumbaugh J, Colaizy T, Saha S, Van Meurs K, Das A, Walsh M, et al. Oral feeding practices and discharge timing for moderately preterm infants. Early Hum Dev. 2018;120:46–52.

    Article  Google Scholar 

  40. Edwards L, Cotton CM, Smith PB, Goldberg R, Saha S, Das A. et al. Inadequate oral feeding as a barrier to discharge in moderately preterm infants. J Perinatol. 2019;39:1219–28. https://doi.org/10.1038/s41372-019-0422-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Crosson DD, Pickler RH. An integrated review of the literature on demand feedings for preterm infants. Adv Neonatal Care. 2004;4:216–25.

    Article  Google Scholar 

  42. Nangia S, Tiwari S. Failure to thrive. Indian J Pediatr. 2013;80:585–9.

    Article  Google Scholar 

  43. Browne JV, Ross ES. Eating as a neurodevelopmental process for high-risk newborns. Clin Perinatol. 2011;38:731–43.

    Article  Google Scholar 

  44. Jung JS, Chang HJ, Kwon JY. Overall profile of a pediatric multidisciplinary feeding clinic. Ann Rehabil Med. 2016;40:692–701. https://doi.org/10.5535/arm.2016.40.4.692.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank the healthcare team involved in selecting and implementing the IDF protocol and sharing electronic medical record information for the relevant patients. There were no sources of support or material to report.

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Author notes

  1. These authors contributed equally: Audrey Lane, Jonathan Pacella

Authors and Affiliations

  1. University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA

    Audrey Lane & Jonathan Pacella

  2. Department of Family Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA

    James R. Beal

  3. Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA

    Abe E. Sahmoun

  4. Neonatal Intensive Care Unit, Sanford Children’s Hospital Fargo, Fargo, ND, USA

    Susan Fedo-Rosvold & William M. Bellas

  5. Sanford Health Eating Disorders and Weight Management Center, Fargo, ND, USA

    Carrie Brower-Breitwieser

  6. Department of Psychiatry and Behavioral Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA

    Carrie Brower-Breitwieser

Authors
  1. Audrey Lane
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Contributions

CBB, WMB, AL, JP, AES, and JRB: involved in study conception and design. AL and JP: involved in data acquisition. JRB and AES: involved in data analysis. CBB, AL, and JP: involved in interpretation of data analysis and first draft of manuscript. CBB, WMB, SFR, AES, and JRB: critical revision of the manuscript. All authors: approved the final manuscript.

Corresponding authors

Correspondence to Jonathan Pacella or Carrie Brower-Breitwieser.

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The authors declare no competing interests.

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Lane, A., Pacella, J., Beal, J.R. et al. A cross-sectional analysis of infant-driven and traditional feeding outcomes for neonatal intensive care unit infants. J Perinatol 41, 1865–1872 (2021). https://doi.org/10.1038/s41372-021-01084-9

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  • DOI: https://doi.org/10.1038/s41372-021-01084-9

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