Preterm Infant Driven Feeding: Learning Through Experience
Preterm Infant Driven Feeding: Learning Through Experience
Facilitating a successful transition to oral feeding is a key factor in preparing an infant for discharge from the neonatal intensive care unit (NICU). Nipple feeding is a complex, highly coordinated sensorimotor task, and the preterm infant has to reach a certain level of developmental maturity to be successful in the oral feeding process. It also requires a skilled, observant caregiver to assist the infant in achieving a pleasurable experience as well as maximizing intake and minimizing stress.
Traditional practices involve the clinician ordering nipple feedings, which are primarily based on an infant's weight and gestational age. In this model of care, successful feeding is often defined as the volume taken by an infant and infant readiness is determined by the time on the clock, not by the overall state of the infant. This practice can lead to increased stress on the infant and slow the progression to successful oral feedings.
Feeding preterm infants in response to their developmental cues, cue based feeding, may help in the establishment of independent oral feeding. Infant-Driven Feeding Scales © (IDFS©) were developed by Ludwig & Waitzman (2007; 2014) to incorporate a cue-based approach into feeding practices of premature infants in the NICU. It includes scales on feeding readiness, quality of nipple feeding, and caregiver techniques. The scales are used together to capture the infant's readiness to nipple feed, the infant's feeding abilities, as well as techniques used by the caregiver feeding the infant. These scales, used in conjunction with standard documentation, provide the health care team with a picture of the infant's feeding skills, overall stability, and progress toward discharge. This practice requires the bedside nurse to identify the infant's feeding readiness signs to establish when an infant is ready to attempt nipple feedings and when he is ready to be advanced. The infant will be given nipple attempts only if he shows certain readiness cues; this may give an infant shorter, more frequent oral feeding opportunities and lead to an infant driven feeding approach as opposed to a physician driven approach. A successful feeding in the IDF model includes the achievement of the following major goals: the feeding is safe, functional, nurturing, and individually, as well as developmentally appropriate. This type of practice is considered to be more physiologically appropriate compared to the traditional practice and has been shown to accelerate feeding advancement and shorten the time of hospital stay. Infant-Driven Feeding Scales © work as a comprehensive communication plan and educational campaign for the neonatal nurses, clinicians, and caregivers that promotes a safe, positive, individualized feeding experience for our patients.
The goals of this project were: 1) incorporate the Infant-Driven Feeding Scales © into our NICU practice, 2) develop a process to identify which infants are ready to begin IDF, 3) develop a process to safely advance oral feedings, 4) assess the effect of the IDF method of feeding on post-conceptual (PCA) age at initiation of oral feedings, at ad libitum, and at discharge.
Background
Facilitating a successful transition to oral feeding is a key factor in preparing an infant for discharge from the neonatal intensive care unit (NICU). Nipple feeding is a complex, highly coordinated sensorimotor task, and the preterm infant has to reach a certain level of developmental maturity to be successful in the oral feeding process. It also requires a skilled, observant caregiver to assist the infant in achieving a pleasurable experience as well as maximizing intake and minimizing stress.
Traditional practices involve the clinician ordering nipple feedings, which are primarily based on an infant's weight and gestational age. In this model of care, successful feeding is often defined as the volume taken by an infant and infant readiness is determined by the time on the clock, not by the overall state of the infant. This practice can lead to increased stress on the infant and slow the progression to successful oral feedings.
Feeding preterm infants in response to their developmental cues, cue based feeding, may help in the establishment of independent oral feeding. Infant-Driven Feeding Scales © (IDFS©) were developed by Ludwig & Waitzman (2007; 2014) to incorporate a cue-based approach into feeding practices of premature infants in the NICU. It includes scales on feeding readiness, quality of nipple feeding, and caregiver techniques. The scales are used together to capture the infant's readiness to nipple feed, the infant's feeding abilities, as well as techniques used by the caregiver feeding the infant. These scales, used in conjunction with standard documentation, provide the health care team with a picture of the infant's feeding skills, overall stability, and progress toward discharge. This practice requires the bedside nurse to identify the infant's feeding readiness signs to establish when an infant is ready to attempt nipple feedings and when he is ready to be advanced. The infant will be given nipple attempts only if he shows certain readiness cues; this may give an infant shorter, more frequent oral feeding opportunities and lead to an infant driven feeding approach as opposed to a physician driven approach. A successful feeding in the IDF model includes the achievement of the following major goals: the feeding is safe, functional, nurturing, and individually, as well as developmentally appropriate. This type of practice is considered to be more physiologically appropriate compared to the traditional practice and has been shown to accelerate feeding advancement and shorten the time of hospital stay. Infant-Driven Feeding Scales © work as a comprehensive communication plan and educational campaign for the neonatal nurses, clinicians, and caregivers that promotes a safe, positive, individualized feeding experience for our patients.
The goals of this project were: 1) incorporate the Infant-Driven Feeding Scales © into our NICU practice, 2) develop a process to identify which infants are ready to begin IDF, 3) develop a process to safely advance oral feedings, 4) assess the effect of the IDF method of feeding on post-conceptual (PCA) age at initiation of oral feedings, at ad libitum, and at discharge.
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