Getting to Full Feeds Faster in the Nicu Utilizing Cue-based Feeding

Kristen Carrierfenster; Christine Rue-Donlon; Rubia Khalak

doi:10.1542/peds.141.1_MeetingAbstract.522

Background: Evidence exists that provider directed feeding may contribute to oral aversion or longer term feeding disruptions. Studies have shown that infants display cues indicating their readiness to feed orally. A cue-based feeding guideline standardizes the assessment of cues for an infant directed oral feeding. Objective: To determine if implementation of cue-based feeding assessment will allow earlier achievement of full oral feedings. Methods: Infants < 35 weeks gestation admitted to our NICU from 1/1/2014- 12/31/2014 were included in the study if they survived to discharge, did not have surgical NEC, did not have gastric tube placement or were not transferred to another facility prior to reaching full oral feeds. The time period selected represents 4 months before and 8 after the implementation of the NICU cue-feeding readiness guideline. Along with demographic and NICU course findings, data was collected for type of feeding, timing, progression of oral feeds and discharge weights. Results: A total of 276 infants were included in this IRB approved study. Three infant groups were established, January-April 2014, the time period prior to cue-based feeding guideline usage (pre-cue), May-August 2014, period after guidelines were initiated but staff still on learning curve, (learning cue) and September-December 2014 when staff was felt to be well established in use of cue-based feeding guidelines, (established cue). Infants were assigned to a group depending upon when the infant reached post-menstrual age (PMA) of ≥32 weeks. There were 74 infants in the pre-cue group, 98 in the learning-cue group and 104 in the established cue group. We found that compared to the pre-cue group, the established-cue infants were younger in gestational age (GA) and smaller in birth weight (BW), see Table. Despite this obstacle, the infants in the established-cue group were able to establish first oral feed and reach full feeds at similar PMA as the pre-cue group. Infants in the established-cue group were also discharged at a similar weight percentile as the larger BW infants in the pre-cue group. Finally, the smaller infants in the established-cue group only took one day longer to achieve full feeds compared to the pre-cue group but this was not statistically significant. Conclusions: Although the infants in the established-cue group were younger and smaller than the infants in the pre-cue group, they were able to establish full feeds and discharge weight percentiles similar to the larger BW infants in the pre-cue group.