Cue-Based Feeding for Preterm Infants: A Prospective Trial

ABSTRACT

We set out to test whether premature infants were able to be fed orally on feeding cues and be discharged home earlier than infants fed by traditional feeding regimens. Attainment of adequate growth, adverse events, and nursing time to provide care were also assessed. After screening, the recruited premature infants (< 36 wks post-conceptual age [PCA]) were divided into two feeding regimens. A control group of 40 infants was fed using an initial combination of scheduled gavage and bottle feeding and then graduating to demand feeds. The intervention group comprised 39 neonates who had gavage feeds discontinued at study entrance and fed orally on cues. Outcomes measured were: weight gain in grams/kg/day, length of stay (in days) after enrollment, PCA on entrance and at discharge, adverse events during feeding, number of cues per feed in the intervention group, and resource utilization using nurse/patient ratios. Differences between groups were evaluated using Mann-Whitney U test, Fisher's exact test, and regression analysis. Two-tailed p values of < 0.05 were considered significant. There was no difference between groups in the mean weight gain; in the control group mean weight gain was 12.5 gm/kg/day and in the intervention group 12.1 gm/kg/day (p = 0.83). The average length of stay in the control group of 14.5 days was significantly longer than the 10.0 days in the intervention group (p = 0.009). This difference remained significant after adjusting for gestational age at birth in regression analysis. The average total number of adverse events in the control group (12.5 events) was significantly greater than in the intervention group (3.5 events; p = 0.007). The mean PCA on study entry was 34.4 wks in both groups and on exit 36.5 wks in the control group and 35.8 wks in the intervention group, a significant difference (p = 0.02), The intervention group elicited 2.8 cues/feed. The nurse to patient ratios was equal in both groups throughout the study period. Cue-based feeding was possible for premature infants with similar weight gain as traditional feeding without affecting workload. Hospitalization and adverse events were decreased.

Nonscheduled - nonprescribed - satiation - self-regulatory - feeding cues

REFERENCES

• 1 Als H, Lawhon G, Duffy F H et al.. Individualized developmental care for the very low-birth-weight preterm infant.  JAMA. 1994;  272 853-858
• 2 Symington A, Pinelli J. Developmental care for promoting development and preventing morbidity in preterm infants.  Cochrane Database Syst Rev. 2006;  (2) CD001814
• 3 Collinge J M, Bradley K, Perks C, Rezny A, Topping P. Demand vs. scheduled feedings for premature infants.  J Obstet Gynecol Neonatal Nurs. 1982;  11(6) 362-367
• 4 Anderson G C, Behnke M, Gill N E, Conlon M, Measel C P, McDonie T E. Self-regulatory gavage-to-bottle feeding for preterm infants: effects on behavioural state, energy expenditure, and weight gain. In: Funk SG, Tornquist Em, Champagne MT, Copp LA, Wiese Ra Key Aspects of Recovery. New York, NY; Springer 1990: 83-97
• 5 Saunders R B, Friedman C B, Stramoski P R. Feeding preterm infants schedule or demand?.  J Obstet Gynecol Neonatal Nurs. 1991;  20 212-218
• 6 Waber B W, Hubler E G, Padden M L. A comparison of outcomes in demand versus schedule formula-fed premature infants.  Nutr Clin Pract. 1998;  13 132-135
• 7 McCain G C, Gartside P S, Greenber J M, Wright Lott J. A feeding protocol for healthy preterm infants that shortens time to oral feeding.  J Pediatr. 2001;  139 374-9
• 8 Simpson C, Schanler R J, Lau C. Early introduction of oral feeding in preterm infants.  Pediatrics. 2002;  110(3) 517-523
• 9 Crosson D D, Pickler R H. An integrated review of the literature on demand feedings for preterm infants.  Adv Neonatal Care. 2004;  4 216-225
• 10 Canadian Neonatal Network^TM . University of Alberta, Edmonton, Alberta, Canada 2001
• 11 Pridham K, Kosorok M R, Greer F, Carey P, Kayata S, Sondel S. The effects of prescribed versus ad libitum feedings and formula caloric density of premature infant dietary intake and weight gain.  Nurs Res. 1999;  48 86-93
• 12 Papalia D E, Wendkos Olds S. Physical Development in Infancy and Toddlerhood in Human Development. 6th ed. New York; McGraw-Hill 1995