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Oral-feeding guidelines for preterm neonates in the NICU: a scoping review

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Abstract

Objective

This scoping review describes the nature and evidence base of internationally available guidelines for the introduction of oral feeding for preterm infants in neonatal units.

Study design

Thirty-nine current infant oral feeding introduction guidelines were obtained, and their recommendations contrasted with available scientific literature.

Result

Documents were primarily from the USA, UK, Canada, and Australia, from hospitals, regional health authorities, and journal articles. Specifics of nonnutritive sucking, gestational age at first feed, exclusions to oral feeding, suggested interventions, and the definition of full oral feeding varied between documents. There was variable use of scientific evidence to back up recommendations.

Conclusion

Guidelines for oral feeding, whether written by clinicians or researchers, vary greatly in their recommendations and details of interventions. Areas more widely researched were more commonly discussed. Recommendations varied more when evidence was not available or weak. Guideline developers need to synthesize evidence and local variability to create appropriate guidelines.

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Fig. 1: Inclusion/Exclusion Numbers.
Fig. 2: Results of AGREE-II Evaluation By Question.

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References

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

    Google Scholar 

  2. 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.

    Google Scholar 

  3. Holloway EM. The dynamic process of assessing infant feeding readiness. Newborn Infant Nurs Rev. 2014;14:119–23.

    Google Scholar 

  4. Ross K, Heiny E, Conner S, Spener P, Pineda R. Occupational therapy, physical therapy and speech-language pathology in the neonatal intensive care unit: Patterns of therapy usage in a level IV NICU. Res Dev Disabil. 2017;64:108–17.

    PubMed  PubMed Central  Google Scholar 

  5. Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Potential benefits, limitations, and harms of clinical guidelines. Br Med J. 1999;318:527–30.

    CAS  Google Scholar 

  6. Willis CD, Saul J, Bevan H, Scheirer MA, Best A, Greenhalgh T, et al. Sustaining organizational culture change in health systems. J Health Organ Manag. 2016;30:2–30.

    PubMed  Google Scholar 

  7. Chantry CJ, Howard CR. Clinical protocols for management of breastfeeding. Pediatr Clin North Am. 2013;60:75–113.

    PubMed  Google Scholar 

  8. Crouse-Hood JL. Implementing a cue based feeding protocol and staff education program in the neonatal intensive care unit. University of Delaware; 2019.

  9. Briere CE, McGrath J, Cong X, Cusson R. State of the science: a contemporary review of feeding readiness in the preterm infant. J Perinat Neonatal Nurs. 2014;28:51–8.

    PubMed  Google Scholar 

  10. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. Can Med Assoc J. 2010;182:E839–42.

    Google Scholar 

  11. Aromataris E, Munn Z, editors. JBI manual for evidence synthesis. JBI; 2020. https://doi.org/10.46658/JBIMES-20-01.

  12. Arvedson J, Clark H, Lazarus C, Schooling T, Frymark T. Evidence-based systematic review: effects of oral motor interventions on feeding and swallowing in preterm infants. Am J Speech Lang Pathol. 2010;19:321–40.

    PubMed  Google Scholar 

  13. Asadollahpour F, Yadegari F, Soleimani F, Khalesi N. The effects of non-nutritive sucking and pre-feeding oral stimulation on time to achieve independent oral feeding for preterm infants. Iran J Pediatr. 2015;25:5.

    Google Scholar 

  14. Ziadi M, Heon M, Aita M. A critical review of interventions supporting transition from gavage to direct breastfeeding in hospitalized preterm infants. Newborn Infant Nurs Rev. 2016;16:78–91.

    Google Scholar 

  15. Lubbe W. Clinician’s guide for cue-based transition to oral feeding in preterm infants: an easy-to-use clinical guide. J Eval Clin Pr. 2018;24:80–8.

    Google Scholar 

  16. Rhooms L, Dow K, Brandon C, Zhao G, Fucile S. Effect of unimodal and multimodal sensorimotor interventions on oral feeding outcomes in preterm infants: an evidence-based systematic review. Adv Neonatal Care. 2019;19:E3–20.

    PubMed  Google Scholar 

  17. Thakkar PA, Rohit HR, Das RR, Thakkar UP, Singh A. Effect of oral stimulation on feeding performance and weight gain in preterm neonates: a randomised controlled trial. Paediatr Int Child Health. 2018;38:181–6.

    PubMed  Google Scholar 

  18. Tubbs-Cooley HL, Pickler R, Meinzen-Derr J. Missed oral feeding opportunities and preterm infants’ time to achieve full oral feedings and neonatal intensive care unit discharge. Am J Perinatol. 2015;32:1–8.

    PubMed  Google Scholar 

  19. Cormier DME. Impact of cue-based feeding protocol on premature infants’ outcomes and hospital length of stay. California State University; 2014.

  20. 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.

    PubMed  Google Scholar 

  21. Fry TJ, 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.

    Google Scholar 

  22. Settle M, Francis K. Does the infant-driven feeding method positively impact preterm infant feeding outcomes? Adv Neonatal Care. 2019;19:51–55.

    PubMed  Google Scholar 

  23. Watson J, McGuire W. Responsive versus scheduled feeding for preterm infants. Cochrane Database Syst Rev. 2016;1:CD005255.

    Google Scholar 

  24. Whetten CH. Cue-based feeding in the NICU. Nurs Women’s Health. 2016;20:507–10.

    Google Scholar 

  25. Pickler RH, Reyna BA, Wetzel PA, Lewis M. Effect of four approaches to oral feeding progression on clinical outcomes in preterm infants. Nurs Res Pract. 2015;2015:716828.

  26. Wang YW, Hung HY, Lin CH, Wang CJ, Lin YJ, Chang YJ. Effect of a delayed start to oral feeding on feeding performance and physiological responses in preterm infants: a randomized clinical trial. J Nurs Res. 2018;26:324–31.

    PubMed  Google Scholar 

  27. Jadcherla SR, Wang M, Vijayapal AS, Leuthner SR. Impact of prematurity and co-morbidities on feeding milestones in neonates: a retrospective study. Am J Perinatol. 2009;30:201.

    Google Scholar 

  28. Jackson BN, Kelly BN, McCann CM, Purdy SC. Predictors of the time to attain full oral feeding in late preterm infants. Acta Paediatr. 2016;105:e1–6.

    PubMed  Google Scholar 

  29. Khan Z, Sitter C, Dunitz-Scheer M, Posch K, Avian A, Breseste I, et al. Full oral feeding is possible before discharge even in extremely preterm infants. Acta Paediatr. 2019;108:239–44.

    PubMed  Google Scholar 

  30. Brumbaugh JE, Colaizy TT, Saha S, Van Meurs KP, Das A, Walsh MC, et al. Oral feeding practices and discharge timing for moderately preterm infants. Early Hum Dev. 2018;120:46–52.

    PubMed  PubMed Central  Google Scholar 

  31. Ferrara L, Bidiwala A, Sher I, Pirzada M, Barlev D, Islam S, et al. Effect of nasal continuous positive airway pressure on the pharyngeal swallow in neonates. Am J Perinatol. 2017;37:398.

    CAS  Google Scholar 

  32. Samson N, Michaud A, Othman R, Nadeau C, Nault S, Cantin D, et al. Nasal continuous positive airway pressure influences bottle-feeding in preterm lambs. Pediatr Res. 2017;82:926–33.

    PubMed  Google Scholar 

  33. Samson N, Nadeau CN, Vincent L, Cantin D, Praud J-P. Effects of nasal continuous positive airway pressure and high-flow nasal cannula on sucking, swallowing, and breathing during bottle-feeding in lambs. Front Pediatr. 2018;5:296.

    PubMed  PubMed Central  Google Scholar 

  34. 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. 2017;102:F329–32.

    PubMed  Google Scholar 

  35. 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.

    PubMed  PubMed Central  Google Scholar 

  36. Hanin M, Nuthakki S, Malkar MB, Jadcherla SR. Safety and efficacy of oral feeding in infants with BPD on nasal CPAP. Dysphagia. 2015;30:121–7.

    PubMed  Google Scholar 

  37. Clark L, Kennedy G, Pring T, Hird M. Improving bottle feeding in preterm infants: investigating the elevated side-lying position. Infant. 2007;3:154–8.

    Google Scholar 

  38. Park J, Thoyre S, Knafl GJ, Hodges EA, Nix WB. Efficacy of semielevated side-lying positioning during bottle-feeding of very preterm infants: a pilot study. J Perinat Neonatal Nurs. 2014;28:69–79.

    PubMed  Google Scholar 

  39. Park J, Pados BF, Thoyre SM. Systematic review: what is the evidence for the side-lying position for feeding preterm infants? Adv Neonatal Care. 2018;18:285–94.

    PubMed  Google Scholar 

  40. McGrath JM, Braescu AV. State of the science: feeding readiness in the preterm infant. J Perinat Neonatal Nurs. 2004;18:353–68.

    PubMed  Google Scholar 

  41. Einarsson-Backes LM, Deitz J, Price R, Glass R, Hays R. The effect of oral support on sucking efficiency in preterm infants. Am J Occup Ther. 1994;48:490–8.

    CAS  PubMed  Google Scholar 

  42. Hill AS, Kurkowski TB, Garcia J. Oral support measures used in feeding the preterm infant. Nurs Res. 2000;49:2–10.

    CAS  PubMed  Google Scholar 

  43. Ross ES, Browne JV. Developmental progression of feeding skills: an approach to supporting feeding in preterm infants. Semin Neonatol. 2002;7:469–75.

    PubMed  Google Scholar 

  44. American Speech-Language-Hearing Association. Pediatric dysphagia. 2020. http://www.asha.org/Practice-Portal/Clinical-Topics/Pediatric-Dysphagia.

  45. Rustam LB, Masri S, Atallah N, Tamim H, Charafeddine L. Sensorimotor therapy and time to full oral feeding in <33 weeks infants. Early Hum Dev. 2016;99:1–5.

    PubMed  Google Scholar 

  46. 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;27:572–8.

    CAS  PubMed  Google Scholar 

  47. Viswanathan S, Jadcherla S. Transitioning from gavage to full oral feeds in premature infants: When should we discontinue the nasogastric tube? J Perinatol. 2019;39:1257–62.

    CAS  PubMed  Google Scholar 

  48. Hwang YS, Ma MC, Tseng YM, Tsai WH. Associations among perinatal factors and age of achievement of full oral feeding in very preterm infants. Pediatr Neonatol. 2013;54:309–14.

    PubMed  Google Scholar 

  49. Embleton ND. Nutrition and growth. In: Phillip M, Turck D, Shamir R, editors. World review of nutrition and dietetics. S. Karger: Basel; 2013.

  50. Andrews JC, Schünemann HJ, Oxman AD, Pottie K, Meerpohl JJ, Coello PA, et al. GRADE guidelines: 15. Going from evidence to recommendation—determinants of a recommendation’s direction and strength. J Clin Epidemiol. 2013;66:726–35.

    PubMed  Google Scholar 

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Acknowledgements

Dr Huub Bakker for support with manuscript preparation and proofreading.

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Authors and Affiliations

  1. The University of Auckland, Auckland, New Zealand

    Lise Bakker, Bianca Jackson & Anna Miles

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  1. Lise Bakker
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Contributions

LB conceived the study design, identified and analyzed the documents, and wrote the manuscript. BJ and AM conceived the study design, provided support for document identification and analysis, and edited and approved the manuscript.

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Correspondence to Lise Bakker.

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Bakker, L., Jackson, B. & Miles, A. Oral-feeding guidelines for preterm neonates in the NICU: a scoping review. J Perinatol 41, 140–149 (2021). https://doi.org/10.1038/s41372-020-00887-6

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