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Improving Preterm Infant Outcomes: Implementing an Evidence-Based Oral Feeding Advancement Protocol in the Neonatal Intensive Care Unit

Kish, Mary Z. DNP, NNP-BC

Section Editor(s): Dowling, Donna

doi: 10.1097/ANC.0000000000000099
Original Research
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BACKGROUND: The ability of a preterm infant to exclusively oral feed is a necessary standard for discharge readiness from the neonatal intensive care unit (NICU). Many of the interventions related to oral feeding advancement currently employed for preterm infants in the NICU are based on individual nursing observations and judgment. Studies involving standardized feeding protocols for oral feeding advancement have been shown to decrease variability in feeding practices, facilitate shortened transition times from gavage to oral feedings, improve bottle feeding performance, and significantly decrease the length of stay (LOS) in the NICU.

PURPOSE: This project critically evaluated the implementation of an oral feeding advancement protocol in a 74-bed level III NICU in an attempt to standardize the process of advancing oral feedings in medically stable preterm infants.

METHODS: A comprehensive review of the literature identified key features for successful oral feeding in preterm infants.

RESULTS: Strong levels of evidence suggested an association between both nonnutritive sucking (NNS) opportunities and standardized feeding advancement protocols with successful oral feeding in preterm infants. These findings prompted a pilot practice change using a feeding advancement protocol and consisted of NNS and standardized oral feeding advancement opportunities. Time to exclusive oral feedings and LOS were compared pre- and postprotocol implementation during more than a 2-month evaluation period.

CONCLUSIONS: Infants using NNS and the standardized oral feeding advancement protocol had an observed reduction in time to exclusive oral feedings and LOS, although statistical significance was not achieved.

DNP Program, Chatham University (2010-2012) and Magee Womens Hospital of the University of Pittsburgh Medical Center, Pennsylvania.

Correspondence: Mary Z. Kish, DNP, NNP-BC, Magee Womens Hospital of the University of Pittsburgh Medical Center NICU, 300 Halket St, Pittsburgh, PA 15213 (mkish@magee.edu).

The author thanks the staff of the neonatal intensive care unit of Magee Womens Hospital of the University of Pittsburgh Medical System for their assistance in this project.

The author declares no conflict of interest.

© 2014 by The National Association of Neonatal Nurses