THE EFFECT OF CUE-BASED ORAL FEEDING GUIDELINES ON AGE AT FULL ORAL FEEDING IN PREMATURE INFANTS WITH AN OXYGEN NEED.

Abstract

Previous studies have shown that advancing oral feedings using infant behavioral readiness signs and feeding cues can lead to earlier achievement of full oral feeding in select populations of healthy preterm infants. We subsequently used these principles to design a guideline to facilitate oral feeding advancement in a broader population of nonsurgical premature infants. In a pilot study, we found that full oral feeding could be achieved at an earlier postmenstrual age (PMA) by using this guideline without compromising weight gain. We know that infants with chronic lung disease (CLD) are at a higher risk of oral feeding problems. Although infants with CLD were included in our pilot study, the study was not designed to analyze feeding progression in this specific population. We hypothesized that our oral feeding guideline, which bases advancement on infant behavioral readiness signs and feeding cues, would facilitate achievement of full oral feeding at an earlier PMA in premature infants with an oxygen need compared with historical controls. A prospective cohort of premature infants whose oral feedings were advanced by the guidelines beginning July 1, 2004, was compared with historical controls randomly selected from infants discharged between July 1, 2002, and June 30, 2003. We initially screened 222 infants (111 in each group). Infants with a syndrome, grade 3 or 4 intraventricular hemorrhage, periventricular leukomalacia, or necrotizing enterocolitis or who had not completed their oral feeding advancement at our institution were excluded. A total of 182 infants were analyzed (n = 88 control, n = 94 study). The infants were grouped according to oxygen need at the start of oral feeding and further stratified by prior ventilator days (≤ 7 days or > 7 days). General linear modeling was used to perform analysis of covariance, adjusting for gestational age and gender. Achievement of full oral feedings was significantly earlier in study infants that began oral feeding with an oxygen need and had > 7 days of prior ventilator support versus controls (p = .001; see Table). These results suggest that a cue-based guideline can facilitate earlier achievement of full oral feeding for infants with an oxygen need at the start of oral feeding and a history of ventilator support for more than 7 days.