Impact of an Infant-Driven Feeding Initiative on Feeding Outcomes in the Preterm Neonate : Advances in Neonatal Care

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Practice Improvements in Neonatal Care

Impact of an Infant-Driven Feeding Initiative on Feeding Outcomes in the Preterm Neonate

Ilahi, Zara MD; Capolongo, Theresa RN, NM; DiMeglio, Angela MS, CCS, SLP; Demissie, Saleshi DrPH; Rahman, Amanda DO

Editor(s): Harris-Haman, Pamela A. DNP, CRNP, NNP-BC, Section Editor

Author Information
Advances in Neonatal Care 23(3):p 205-211, June 2023. | DOI: 10.1097/ANC.0000000000001033



Poor feeding techniques result in adverse outcomes for preterm infants. Infant-driven feeding (IDF) is a structured feeding method that standardizes neonatal cue-based feedings, and matches the neurodevelopmental stage of the preterm infant. The purpose of this quality improvement project is to assess whether initiation of an IDF initiative impacts time from first nipple feed (NF) to full NF and to discharge in infants born before 35 weeks' gestational age. Secondary aims include assessment of the impact of IDF on neonatal growth and feasibility of following an IDF protocol in a level III neonatal intensive care unit (NICU).


This quality improvement project assesses differences in time to first NF, length of hospital stay, and neonatal growth before and after usage of an IDF protocol. Eighty infants were included, 40 prior to and 40 after IDF intervention. Nurses were trained on IDF philosophy and methods prior to initiation.


IDF was associated with discharge at a younger corrected gestational age (CGA), attainment of ad lib feeds at a younger CGA, and shorter amount of days between first NF and discharge. Infants utilizing IDF had slower weight gain, demonstrated by a larger drop in z score in the IDF group. The medical team and bedside nurses were able to follow the IDF protocol with few exceptions.

Implications for Practice/Research: 

IDF allows for optimization of a preterm infant's NICU stay and prepares infants for a safe discharge sooner. This could lead to increased parental satisfaction and decreased hospital cost. Further studies are indicated to ensure these benefits remain and focus on impact direct breastfeeding plays in the IDF model.

© 2022 by The National Association of Neonatal Nurses.

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