Subscribe to RSS
Incidence of Nasogastric and Gastrostomy Tube at Discharge Is Reduced after Implementing an Oral Feeding Protocol in Premature (< 30 weeks) Infants
05 August 2016
03 March 2017
04 April 2017 (online)
Objective Reduce the number of infants requiring home tube feeds by initiating an oral feeding protocol (OFP).
Study Design All infants < 30 weeks' gestation were eligible. The OFP involved four steps: encourage non-nutritive suck before 30 weeks, oral motor exercises starting as early as 30 weeks, swallowing exercises as early as 31 weeks, and an infant-driven oral feeding pathway as early as 32 weeks.
Results The study included 129 infants before the protocol (January 2010 to December 2011) and 141 infants after the protocol (March 2013 to May 2015). Between the study periods, a multidisciplinary committee took 8 months to create the OFP, followed by a 3-month orientation of the protocol to the nursing and medical staff. The incidence of home tube feeds for 23 to 29 weeks was 26% before and 15% after the protocol (p = 0.03). Oral feeds were started sooner (p < 0.001), and full oral feedings were achieved earlier after the protocol was initiated (p < 0.001).
Conclusion After introducing an OFP, oral feedings were started earlier, full oral feedings were achieved sooner, and the incidence of home tube feeds at discharge was reduced.
- 1 American Academy of Pediatrics Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate. Pediatrics 2008; 122 (5) 1119-1126
- 2 Crapnell TL, Rogers CE, Neil JJ, Inder TE, Woodward LJ, Pineda RG. Factors associated with feeding difficulties in the very preterm infant. Acta Paediatr 2013; 102 (12) e539-e545
- 3 Bu'Lock F, Woolridge MW, Baum JD. Development of co-ordination of sucking, swallowing and breathing: ultrasound study of term and preterm infants. Dev Med Child Neurol 1990; 32 (8) 669-678
- 4 Lau C, Alagugurusamy R, Schanler RJ, Smith EO, Shulman RJ. Characterization of the developmental stages of sucking in preterm infants during bottle feeding. Acta Paediatr 2000; 89 (7) 846-852
- 5 Bazyk S. Factors associated with the transition to oral feeding in infants fed by nasogastric tubes. Am J Occup Ther 1990; 44 (12) 1070-1078
- 6 Bier JA, Ferguson A, Cho C, Oh W, Vohr BR. The oral motor development of low-birth-weight infants who underwent orotracheal intubation during the neonatal period. Am J Dis Child 1993; 147 (8) 858-862
- 7 Burklow KA, McGrath AM, Valerius KS, Rudolph C. Relationship between feeding difficulties, medical complexity, and gestational age. Nutr Clin Pract 2002; 17 (6) 373-378
- 8 Bakewell-Sachs S, Medoff-Cooper B, Escobar GJ, Silber JH, Lorch SA. Infant functional status: the timing of physiologic maturation of premature infants. Pediatrics 2009; 123 (5) e878-e886
- 9 Illingworth RS, Lister J. The critical or sensitive period, with special reference to certain feeding problems in infants and children. J Pediatr 1964; 65 (6) 839-848
- 10 Blackman JA, Nelson CL. Rapid introduction of oral feedings to tube-fed patients. J Dev Behav Pediatr 1987; 8 (2) 63-67
- 11 Dodrill P, McMahon S, Ward E, Weir K, Donovan T, Riddle B. Long-term oral sensitivity and feeding skills of low-risk pre-term infants. Early Hum Dev 2004; 76 (1) 23-37
- 12 Barfield WD ; American Academy of Pediatrics Committee on Fetus And Newborn. Levels of neonatal care. Pediatrics 2012; 130 (3) 587-597
- 13 Bingham PM, Abassi S, Sivieri E. A pilot study of milk odor effect on nonnutritive sucking by premature newborns. Arch Pediatr Adolesc Med 2003; 157 (1) 72-75
- 14 Schaal B, Hummel T, Soussignan R. Olfaction in the fetal and premature infant: functional status and clinical implications. Clin Perinatol 2004; 31 (2) 261-285 , vi–vii
- 15 Lessen BS. Effect of the premature infant oral motor intervention on feeding progression and length of stay in preterm infants. Adv Neonatal Care 2011; 11 (2) 129-139
- 16 Taha DK, Kornhauser M, Greenspan JS, Dysart KC, Aghai ZH. High flow nasal cannula use is associated with increased morbidity and length of hospitalization in extremely low birth weight infants. J Pediatr 2016; 173: 50-55.e1
- 17 Glackin SJ, O'Sullivan A, George S, Semberova J, Miletin J. High flow nasal cannula versus NCPAP, duration to full oral feeds in preterm infants: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2016; F1-F4
- 18 Kirk AT, Alder SC, King JD. Cue-based oral feeding clinical pathway results in earlier attainment of full oral feeding in premature infants. J Perinatol 2007; 27 (9) 572-578
- 19 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (4) 529-534
- 20 Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986; 33 (1) 179-201
- 21 Bell MJ, Ternberg JL, Feigin RD , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (1) 1-7
- 22 Wolff PH. The serial organization of sucking in the young infant. Pediatrics 1968; 42 (6) 943-956
- 23 Hack M, Estabrook MM, Robertson SS. Development of sucking rhythm in preterm infants. Early Hum Dev 1985; 11 (2) 133-140
- 24 Pinelli J, Symington AJ. Non-nutritive sucking for promoting physiologic stability and nutrition in preterm infants. Cochrane Database Syst Rev 2005; 4 DOI: 10.1002/14651858.CD001071.pub2.
- 25 Fucile S, Gisel E, Lau C. Oral stimulation accelerates the transition from tube to oral feeding in preterm infants. J Pediatr 2002; 141 (2) 230-236
- 26 Simpson C, Schanler RJ, Lau C. Early introduction of oral feeding in preterm infants. Pediatrics 2002; 110 (3) 517-522
- 27 Lau C, Sheena HR, Shulman RJ, Schanler RJ. Oral feeding in low birth weight infants. J Pediatr 1997; 130 (4) 561-569
- 28 Lau C, Smith EO. Interventions to improve the oral feeding performance of preterm infants. Acta Paediatr 2012; 101 (7) e269-e274
- 29 Hensch TK. Critical period regulation. Annu Rev Neurosci 2004; 27: 549-579