Missed Oral Feeding Opportunities and Preterm Infants' Time to Achieve Full Oral Feedings and Neonatal Intensive Care Unit Discharge

Abstract

Objective To examine the association of missed oral feeding opportunities among preterm infants with achievement of full oral feedings and length of hospitalization.

Study Design A secondary analysis of clinical trial data was conducted. Study infants included in the analysis (N = 89) were randomized to one of four standardized feeding progression approaches; detailed records on all feedings were maintained. The proportion of oral feeding opportunities reported as missed due to factors unrelated to the infant's clinical condition was calculated for each infant.

Results The proportion of missed oral feeding opportunities per infant ranged from 0 to 0.12; 30 infants experienced one or more missed oral feeding opportunity. Each 1% increase in the proportion of missed oral feeding opportunities extended the time to achieve full oral feeding by 1.45 days (p = 0.007) and time to discharge by 1.36 days (p = 0.047).

Conclusion Preterm infants' missed oral feeding opportunities may adversely affect feeding outcomes and extend hospitalization.

Keywords

standardized feeding protocol - prematurity - neonatal nursing care - NICU quality - missed care - gavage feedings

• References

• 1 American Academy of Pediatrics Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate. Pediatrics 2008; 122 (5) 1119-1126
• 2 Eichenwald EC, Blackwell M, Lloyd JS, Tran T, Wilker RE, Richardson DK. Inter-neonatal intensive care unit variation in discharge timing: influence of apnea and feeding management. Pediatrics 2001; 108 (4) 928-933
• 3 Simpson C, Schanler RJ, Lau C. Early introduction of oral feeding in preterm infants. Pediatrics 2002; 110 (3) 517-522
• 4 McCain GC. An evidence-based guideline for introducing oral feeding to healthy preterm infants. Neonatal Netw 2003; 22 (5) 45-50
• 5 Pickler RH. A model of feeding readiness for preterm infants. Neonatal Intensive Care 2004; 17 (4) 31-36
• 6 Pickler RH, Reyna BA. A descriptive study of bottle-feeding opportunities in preterm infants. Adv Neonatal Care 2003; 3 (3) 139-146
• 7 Howe TH, Sheu CF, Hinojosa J, Lin J, Holzman IR. Multiple factors related to bottle-feeding performance in preterm infants. Nurs Res 2007; 56 (5) 307-311
• 8 Pickler RH, Best A, Crosson D. The effect of feeding experience on clinical outcomes in preterm infants. J Perinatol 2009; 29 (2) 124-129
• 9 Blackwell MT, Eichenwald EC, McAlmon K , et al. Interneonatal intensive care unit variation in growth rates and feeding practices in healthy moderately premature infants. J Perinatol 2005; 25 (7) 478-485
• 10 Kuzma-O'Reilly B, Duenas ML, Greecher C , et al. Evaluation, development, and implementation of potentially better practices in neonatal intensive care nutrition. Pediatrics 2003; 111 (4 Pt 2) e461-e470
• 11 Korner AF, Stevenson DK, Kraemer HC , et al. Prediction of the development of low birth weight preterm infants by a new neonatal medical index. J Dev Behav Pediatr 1993; 14 (2) 106-111
• 12 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
• 13 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 (3) 374-379
• 14 Als H, Duffy FH, McAnulty GB , et al. Early experience alters brain function and structure. Pediatrics 2004; 113 (4) 846-857
• 15 Medoff-Cooper B, Shults J, Kaplan J. Sucking behavior of preterm neonates as a predictor of developmental outcomes. J Dev Behav Pediatr 2009; 30 (1) 16-22
• 16 Markham JA, Greenough WT. Experience-driven brain plasticity: beyond the synapse. Neuron Glia Biol 2004; 1 (4) 351-363
• 17 Kinneer MD, Beachy P. Nipple feeding premature infants in the neonatal intensive-care unit: factors and decisions. J Obstet Gynecol Neonatal Nurs 1994; 23 (2) 105-112
• 18 Hall EOC, Kronborg H, Aagaard H, Ammentorp J. Walking the line between the possible and the ideal: lived experiences of neonatal nurses. Intensive Crit Care Nurs 2010; 26 (6) 307-313
• 19 Rochefort CM, Clarke SP. Nurses' work environments, care rationing, job outcomes, and quality of care on neonatal units. J Adv Nurs 2010; 66 (10) 2213-2224
• 20 Pillay T, Nightingale P, Owen S, Kirby D, Spencer A. Neonatal nurse staffing and delivery of clinical care in the SSBC Newborn Network. Arch Dis Child Fetal Neonatal Ed 2012; 97 (3) F174-F178
• 21 Kalisch BJ. Missed nursing care: a qualitative study. J Nurs Care Qual 2006; 21 (4) 306-313 , quiz 314–315
• 22 National Research Council. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press; 2007