title: Improving preterm infant outcomes: implementing an evidence-based oral feeding advancement protocol in the neonatal intensive care unit.
abstract: BACKGROUND
  The ability of a preterm infant to exclusively oral feed is a necessary standard for discharge readiness from the neonatal intensive care unit (NICU). Many of the interventions related to oral feeding advancement currently employed for preterm infants in the NICU are based on individual nursing observations and judgment. Studies involving standardized feeding protocols for oral feeding advancement have been shown to decrease variability in feeding practices, facilitate shortened transition times from gavage to oral feedings, improve bottle feeding performance, and significantly decrease the length of stay (LOS) in the NICU.
  
  
  OBJECTIVE
  This project critically evaluated the implementation of an oral feeding advancement protocol in a 74-bed level III NICU in an attempt to standardize the process of advancing oral feedings in medically stable preterm infants.
  
  
  METHODS
  A comprehensive review of the literature identified key features for successful oral feeding in preterm infants.
  
  
  RESULTS
  Strong levels of evidence suggested an association between both nonnutritive sucking (NNS) opportunities and standardized feeding advancement protocols with successful oral feeding in preterm infants. These findings prompted a pilot practice change using a feeding advancement protocol and consisted of NNS and standardized oral feeding advancement opportunities. Time to exclusive oral feedings and LOS were compared pre- and postprotocol implementation during more than a 2-month evaluation period.
  
  
  CONCLUSIONS
  Infants using NNS and the standardized oral feeding advancement protocol had an observed reduction in time to exclusive oral feedings and LOS, although statistical significance was not achieved.
authors: DNP Program, Chatham University (2010-2012) and Magee Womens Hospital of the University of Pittsburgh Medical Center, Pennsylvania.
authors: Mary Z
authors: MZ
authors: Kish
mesh_terms: D001903:Bottle Feeding / Q000379:methods*; D001942:Breast Feeding / Q000379:methods*; D002985:Clinical Protocols; D055317:Evidence-Based Practice; D005248:Feeding Methods / Q000592:standards; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D058996:Quality Improvement; D012189:Retrospective Studies; D013391:Sucking Behavior; D013997:Time Factors