Decreasing Time to Full Oral Feedings Among Infants on Non-Invasive Respiratory Support in the Neonatal Intensive Care Unit
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Background: Infants hospitalized in the neonatal intensive care unit (NICU) must demonstrate both physiologic stability and competency in oral feeding prior to discharge. However, the introduction of oral feedings may be deferred for infants requiring non-invasive respiratory support. Delayed initiation of oral feedings in physiologically stable newborns on non-invasive respiratory support results in a higher incidence of missed oral feeding opportunities, increased time to achieve full oral feedings (FOF), and prolonged hospitalization. As a result, these infants are at increased risk for feeding-related morbidities, adverse neurodevelopmental outcomes, and altered parent-child interactions. Variation in NICU feeding practices and the lack of consensus on the oral feeding of newborns on non-invasive respiratory support contributes to this problem. Purpose: Implement a protocol to allow neonatal patients to orally feed while on high-flow nasal cannula (HFNC) in an effort to decrease time to first oral feeding, time to FOF, and length of stay (LOS).|Methods: An oral feeding protocol was developed and implemented in a Midwest Level III NICU. Education was provided to nursing staff prior to and throughout implementation. Infants included were at least 34 weeks’ gestation, on 2 L HFNC, and requiring 30% FiO2 or less. Infants with major congenital anomalies and those who were readmitted from home were excluded. Data was collected through chart audits from the electronic medical record.|Results: The sample included 5 term and 6 extremely preterm infants. Compared to term infants in the two years prior to implementation of the new protocol, the average time to first oral feeding, time to FOF, and LOS for term infants decreased by 55%, 53%, and 41%, respectively. Compared to extremely preterm infants in the two years prior to implementation of the new protocol, the average time to first oral feeding, time to FOF and LOS for extremely preterm infants decreased by 5.5%, 24%, and 11.9%, respectively. There were no reports of feeding-related complications in either group.|Implications for Practice: Allowing infants on HFNC to orally feed can decrease time to first oral feeding, time to FOF, and LOS without increasing complications. Consideration should be given to assessing these infants for oral feeding readiness while on HFNC.|Implications for Research: Future studies could investigate if there is a difference in the safety and efficacy of oral feedings for infants on 2 L HFNC, 4 L HFNC, and other methods of non-invasive respiratory support. Researchers might also seek to determine if specific feeding techniques play a role in successful initiation and advancement of oral feedings and if outcomes differ between breast-fed and bottle-fed infants. Further studies are also needed to determine the psychosocial and neurodevelopmental effects of initiating oral feedings while on HFNC.
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