NICU Feeding Policy

New Cue-Based Feeding Policy for NICU
Each year over half a million infants are born prematurely and admitted to NICU who are at increased risk for nutritional, growth, motor and sensory problems (Shaker, 2012). The risk of feeding difficulties increases as the gestational age decreases. Statistics show that 62% of infants born weighing less than 600 grams had continued feeding issues at two years corrected age and 29% had gastrostomy tubes (Shaker, 2012). Early feeding difficulties of premature infants and the resulting adverse outcomes dictate a critical need to examine “the culture of feeding” in NICU and establish an evidence-based feeding policy (Shaker, 2012).
The current feeding practice in NICU is a traditional volume-driven feeding
“Evidence suggests that doing so benefits the infant from a neuro-development point of view over the long-term” (White & Parnell, 2013). In this evidence-based approach to oral feeding development, the infant drives feeding initiation and progression based on emerging behavioral cues during the transition from tube to full oral feeding. Transition to full oral feeding is based on brain maturation, positive oral feeding experiences, medical stability, and maturing of oral-motor strength and coordination. “Infants may have better neuro-developmental outcomes if they are allowed to demonstrate their emerging feeding competence through their individual behavior, muscle tone, reflexes, and movements before, during, and after attempts to feed orally” (White & Parnell, 2013). Recognition of behavioral cues and the understanding of the developmental nature of acquiring feeding skills are essential for caregivers, both nurses and parents, in providing an infant a positive, nurturing experience. Caregivers act as a guide for the infant to strengthen and support the infant’s efforts while respecting and protecting their limits (Thoyre, Park, Pados, & Hubbard,
The primary goal of implementing this policy is to address the needs of infants by providing safe, successful feedings that are also individually and developmentally appropriate throughout the transition from tube to full oral feeding. The policy also aims to assist parents in the understanding of the dynamics of oral feeding development so that their expectations are realistic of their baby’s journey to feeding independence (White & Parnell, 2013). The policy describes characteristics of each stage, oral-motor skill development, and specific therapeutic goals and interventions to facilitate successful transition through the various stages. The policy also contains a list describing specific neurobehavioral cues, caregiver techniques, and charting guidelines for readiness scores, infant-driven feeding scale quality, and a breastfeeding