Dear NANN Colleagues,
Welcome to 2019!
For issues 2019 (1) and 2019 (2), we have strategically grouped together a collection of articles related to strategies to support oral feeding of high-risk infants. These are not articles submitted to be included in a special series; however, we noted a trend in our submissions and thought publishing the articles together could be advantageous to our readers. Feeding infants is an activity encountered almost daily by every neonatal nurse in the neonatal intensive care unit (NICU). As the monetary pressure to discharge infants home to families continues to increase, feeding strategies are continually under refinement since oral feeding success is the infant milestone that often opens the door to NICU discharge.
How do we help infants be successful with oral feeding? What are the best strategies to support these infants as they and their families prepare for discharge to home? What evidence is there to consider new or different strategies for supporting infants during the transition to full oral feedings be that by tube-feedings, at the breast, or by bottle-feeding? These questions among others are addressed in the articles included in this special collection of articles.
Choice of feeding strategies is often dependent on infant maturation, parental choices, and availability of the mother (or parent) to participate. There is much debate about when it is best to begin offering oral feeding, with some suggesting as early as 28 to 30 weeks postmenstrual age (PMA) for nuzzling at the mother's breast. Yet, one must first establish what is the purpose of these offerings. At 28 to 30 weeks PMA, the purpose is usually quite different from that at later points in development. Early offerings are often about the experience for both the infant and the mother. Later feeding offerings are more about developing the skills to successfully attain full-oral feeding competence. We hope you noticed we used the word “offering.” This choice was purposeful because we believe oral feeding is a cooperative event, whereby both the infant and the caregiver participate equally. The caregiver strategically provides the right amount of support to allow the infant to be successful and acknowledges that success at 30 weeks PMA might be quite different from success at 38 weeks PMA. In this issue, Logomarsino and colleagues provide the evidence to consider safety in feeding high-risk infants. Making choices that increase success is often about how mature the infants are and whether they can safely protect their airway. Griffith builds on this concept by examining exactly what is feeding success. She and her colleagues provide a sound way to consider what is “success.” Conveying the level of success to all care providers and particularly parents is important in understanding the infant's feeding progression.
Most NICU infants will receive some of their oral feedings from a bottle even if the mother intends to provide oral feedings directly at the breast. More understanding about how to support mothers and infants in the NICU who intend to exclusively breastfeed is needed. The articles in this issue do not provide as much information about direct feeding at the breast but stay-tuned there are articles in 2019 (2) that address this matter.
For infants receiving bottle-feedings, understanding how to choose the best nipple to support the progression of oral feeding is important. Pados and colleagues provide us with increased understanding about how one might choose a nipple. The number of different nipples on the market is increasing and parents/caregivers need direction about how to make sound choices when purchasing different nipples to support the infant's success. Almost every nipple on the market claims to be exactly what is needed for success, yet there are little data to support those claims. The findings of this study highlight the need to consider the nipple choice as important to the process.
Infant-driven feeding is more often, than not, considered the best way to support high-risk infants transitioning to full-oral feedings but what does that really mean? Also in this issue, Settle and colleagues provide us with the evidence to make better choices about what infant-driven feeding is and how best to provide it when caring for these infants. Infant-driven feeding is not just about feeding - it is also about co-regulation of feeding between the infant and the caregiver. Lastly, Fucile and colleagues provide us with the evidence about how to make choices for sensorimotor interventions that might increase oral feeding success. Every infant is an individual and no matter the evidence we must collaboratively work together to consider the individual needs of the infant and the available strategies with the right definition for success to support both the infant and the family. We hope you find this a helpful special series of articles and please stay-tuned for the next collection of oral feeding articles in 2019 (2).
Thank you to our readership and for your submissions to Advances in Neonatal Care.
Jacqueline M. McGrath, PhD, RN, FNAP, FAAN
Co-Editor; Advances in Neonatal Care
Debra Brandon, PhD, RN, CCNS, FAAN
Co-Editor; Advances in Neonatal Care