Background:
Feeding practices in the neonatal intensive care unit (NICU) are critical in determining when a preterm infant is ready for discharge. Infants born <35 weeks gestational age (GA) are often unable to effectively nipple feed (NF) due to uncoordinated suck/swallow, autonomic instability and variations in sleep-wake characteristics.
National surveys indicate that there is wide variation amongst feeding techniques in NICUs, likely due to a lack of structured plan to guide nurses, physicians, and families. This can lead to delayed discharge, oral aversion, and post discharge feeding problems.
Infant driven feeding (IDF) is a structured, standardized feeding method that consists of 3 key behavioral assessments: feeding readiness, quality of feeding, and caregiver support. By using both standardized scales and documentation, the health care team gains a better understanding about an infant's feeding abilities. This has in the past been associated with more developmentally appropriate feeding care.
Objective:
The primary objective is to determine if IDF impacts time from initiation of NF to attainment of full NF and time to NICU discharge. Secondary aims are to measure the feasibility of incorporating IDF feeding into our level III NICU by measuring adherence to IDF protocol and determining impact of IDF on neonatal growth.
Methods:
This is a quality improvement project before and after usage of IDF plan with retrospective baseline data. The study included infants <35 weeks GA without significant congenital anomalies born between December 2019 and November 2020. Day of first orogastric feed, day of first NF, and day of first ad lib NF for 48 hours was obtained from nursing documentation in electronic medical record. Two tailed unpaired t-tests and Mann Whitney U tests were done as appropriate to compare infants before and after IDF initiative. Chi Square analysis was done to compare population demographics.
Results:
Demographics of the study population are detailed in Table 1. The study population included 50 subjects, 27 babies before IDF initiation and 23 after.
There was no statistically significant differences between cohorts regarding birth weight, race, gender or gestational age at birth.
Neonates that utilized IDF had an earlier start to NFs and achieved ad lib feeds sooner than infants not fed using IDF. As shown in table 2, neonates in the IDF cohort were also discharged earlier the non-IDF group.
Infants that underwent IDF had slower weight gain than those who did not utilize IDF, as demonstrated by a larger drop in z-score in the IDF group.
Conclusion:
In our cohorts, IDF led to earlier initiation of NF and earlier time to ad lib feeds. Infants who underwent IDF were discharged to home at a younger GA and had shorter length of stay. Likely as a result of earlier discharge, these infants had overall poorer weight gain in the NICU, demonstrating that close outpatient follow-up is indicated for these infants.
