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Open Access 01-12-2022 | Care | Research

Cue-based feeding and short-term health outcomes of premature infants in newborn intensive care units: a non-randomized trial

Authors: Sefatbaqa Samane, Zahed Pasha Yadollah, Hasanpour Marzieh, Hajian - Tilaki Karimollah, Zarkesh Mohammad Reza, Arzani Afsaneh, Heidelise Als

Published in: BMC Pediatrics | Issue 1/2022

Abstract

Background

Feedings based on behavioral cues is a method relying on infants’ behavioral expressions of readiness to feed. The objective of this interventional study was to determine the effect of cue-based feeding on the short-term health outcomes of preterm infants.

Methods

This quasi-experimental study utilized a historical or phase lag design. It involved 60 preterm infants admitted to an Iranian referral hospital’s Level III-Newborn Intensive Care Unit (NICU) from April 2017 until January 2018. The experimental group (n = 30) received a three-step intervention of offering behavioral-cue-based oral (BCBO) feedings: Step 1 – One BCBO feeding every 12 hours for 3 days; Step 2 - Two BCBO feedings every 12 h for 3 days; and Step 3 – All feedings as BCBO feedings for 3 days. The control group received standard care feedings. Group difference data were analyzed with SPSS version 16 using descriptive and inferential statistics.

Results

The infants’ mean weight at time of discharge for the intervention and control groups were 1492.79 ± 21.65 g and 1395.71 ± 17.61 g (P = .003) respectively. The mean durations of achieving full oral feedings in the intervention and control groups were 17 ± 6 and 20 ± 11 days, respectively (P = .19). The mean frequencies of hypoxia were 1 ± 1.54 and 5 ± 9.31 respectively (P = .03) and of gavage feedings 725 ± 584 and 1846 ± 2097 respectively (P = .009). No apnea events were reported for the intervention group; the frequency of apnea in the control group was 1 ± 2.11 (P = .16).

Conclusion

The findings indicate that cue-based feeding is beneficial for preterm infants. Therefore, it is recommended that nurses employ cue-based feeding in the NICU.

Trial registration

IRCTID: IRCT20170828035962N2. Registered 27 may 2018 – Retrospectively registered, https://en.irct.ir/trial/27024.

World Health Organization, et al. Born too soon: the global action report on preterm birth. Geneva: World Health Organization; 2012.

Blencowe H, Cousens S, Oestergaard MZ, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379(9832):2162–72.CrossRef

Health Education News. Simple ways to reduce premature deaths. Hamshahri [Internet]. 2012 May 7 [cited 2012 May 10]. Available from: http://hamshahrionline.ir/details/169250. [In Persian].

Moser K. Gestational age-specific infant mortality by social and biological factors among babies born in England and Wales in 2006. Health Stat Q. 2009;42:78–87.CrossRef

Hoki R, Bonkowsky JL, Minich LL, Srivastava R, Pinto NM. Cardiac testing and outcomes in infants after an apparent life-threatening event. Arch Dis Child. 2012;97(12):1034–8.CrossRef

Valizadeh S, Hosseini MB, Karimijavan G. Effect of oral massage vs. non-nutritive sucking on attainment of independent oral feeding and duration of hospitalization in NICU: a randomized trial. J Hayat. 2014;20(1):38–47.

Browne JV, Ross ES. Eating as a neurodevelopmental process for high-risk newborns. Clin Perinatol. 2011;38(4):731–43.CrossRef

Shaker CS. ‘Mom, You Got This’ Feeding is communication. When we help NICU caregivers interpret what their preemie is telling them during feeding, we support the parent-infant relationship. ASHA Leader. 2018;23(10):54–60 Shaker C. Reading the feeding.CrossRef

Howson CP, Kinney MV, McDougall L, Lawn JE, the Born Too Soon Preterm Birth Action G. Born Too Soon: Preterm birth matters. Reproduct Health. 2013;10(1):S1.

10.

Als H, Lawhon G, Duffy FH, GB MA, Gibes-Grossman R, Blickman JG. Individualized developmental care for the very low birthweight infant: medical and neurofunctional effects. J Am Med Assoc. 1994;272:853–8.CrossRef

11.

American Academy of Pediatrics Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate. Pediatrics. 2008;122(5):1119–26. https://doi.org/10.1542/peds.2008-2174.

12.

Thoyre SM, Holditch-Davis D, Schwartz TA, Roman CR, Nix W. Co-regulated approach to feeding preterm infants with lung disease: effects during feeding. Nurs Res. 2012;61(4):242.CrossRef

13.

Als H. Program guide: newborn individualized developmental care and assessment program (NIDCAP®), rev. ed. South Attleboro (Mass): NIDCAP Federation International; 2008.

14.

Ludwig SM, Waitzman KA. Changing feeding documentation to reflect infant-driven feeding practice. Newborn Infant Nurs Rev. 2007;7(3):155–60.CrossRef

15.

Shaker CS. Cue-based feeding in the NICU: using the infant's communication as a guide. Neonatal Network. 2013;32(6):404.CrossRef

16.

Thoyre SM. Feeding outcomes of extremely premature infants after neonatal care. J Obstet Gynecol Neonatal Nurs. 2007;36(4):366–76.CrossRef

17.

Kirk AT, Alder SC, King JD. Cue-based oral feeding clinical pathway results in earlier attainment of full oral feeding in premature infants. J Perinatol. 2007;27:572–8.CrossRef

18.

Kish MZ. Oral feeding readiness in preterm infants: a concept analysis. Adv Neonatal Care. 2013;13:230–7.CrossRef

19.

Wellington A, Perlman JM. Infant-driven feeding in premature infants: a quality improvement project. Arch Dis Child Fetal Neonatal Ed. 2015;100(6):F495–500.CrossRef

20.

Shamsi A. The effect of olfactory stimulation with breast milk smell on the duration of feeding transitional time from gavage to oral feeding and hospital stay in premature infants hospitalized in neonatal intensive-care unit. Med Surg Nurs J. 2014;3(1):e87729.

21.

El Aziz R, Abd El Aziz S. Effect of Implementation of Cue Based Feeding Technique on Premature Infant Feeding Outcomes and Parent Satisfaction. IOSR J Nurs Health Sci (IOSR-JNHS). 2017;6(6):55–67.

22.

Als H, Manual for the Naturalistic Observation of Newborn Behavior. Newborn Individualized Developmental Care and Assessment Program (NIDCAP). 1981, 1984, 1995, 2006. ©NIDCAP Federation International, 2015.

23.

Verklan MT, Walden M, Forest S. Core curriculum for neonatal intensive care nursing e-book: Elsevier Health Sciences; 2020. p. 417–8.

24.

Keshavarz M, Rajaee Z, Sadeghi H, Razavi M, Montazeri A. Effect of non-nutritive sucking on weight gaining of preterm infants hospitalized in neonatal intensive care unit. Health Monit J Iran Instit Health Sci Res (Payesh). 2013;12(2):151–7.

25.

Asadollahpour F, Yadegari F, Soleimani F, Younesian S. The effect of Beckman prefeeding oral stimulation program on feeding performance of preterm infants. J Res Rehabil Sci. 2013;9(4):683–92.

26.

Newland L, L'huillier MW, Petrey B. Implementation of cue-based feeding in a level III NICU. Neonatal Netw. 2013;32(2):132–7. https://doi.org/10.1891/0730-0832.32.2.132 PMID: 23477983.CrossRefPubMed

27.

Pados BF, Thoyre SM, Knafl GJ, Nix WB. Heart rate variability as a feeding intervention outcome measure in the preterm infant. Adv Neonatal Care. 2017;17(5):E10–20. https://doi.org/10.1097/ANC.0000000000000430 PMID: 28891821; PMCID: PMC5679008.CrossRefPubMedPubMedCentral

28.

Lessen BS. Effect of the premature infant oral motor intervention on feeding progression and length of stay in preterm infants. Adv Neonatal Care. 2011;11(2):129–39.CrossRef

29.

NIDCAP Nursery Program, NIDCAP Nursery Assessment Manual, K. Smith, D. Buehler, H. Als, NIDCAP Federation International (NFI), 2001. See also www.nidcap.org.

Title: Cue-based feeding and short-term health outcomes of premature infants in newborn intensive care units: a non-randomized trial
Authors: Sefatbaqa Samane
Zahed Pasha Yadollah
Hasanpour Marzieh
Hajian - Tilaki Karimollah
Zarkesh Mohammad Reza
Arzani Afsaneh
Heidelise Als
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Care
Published in: BMC Pediatrics / Issue 1/2022
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-021-03077-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cue-based feeding and short-term health outcomes of premature infants in newborn intensive care units: a non-randomized trial

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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