Evidence-based interventions for breast and bottle feeding in the neonatal intensive care unit

Breast and bottle-feeding are areas of concern in the neonatal intensive care unit (NICU). The clinical issues encompass the typically developing preterm infant, who requires special supports to develop the skills needed for successful oral feeding, and the preterm and term infants with dysphagia, who, when able, require specialized assessment and treatment strategies to facilitate the maturation of sucking behaviors and transition to oral feeding. Research is increasingly addressing the development from non-nutritive to nutritive sucking, maturation of typical and atypical nutritive sucking in young infants, as well as assessment strategies and treatment supports for emerging sucking and remediation of feeding or swallowing problems. There continue to be gaps in the available information. These gaps are filled by expert opinion and clinical experience. However, an increase of clinically relevant, databased information is promising. The primary goals of treatment in this population are to facilitate transition from tube to oral feeding and advance sucking skills sufficiently to support needs for nutrition and hydration as the infant grows. The purpose of this article is to review the recent research that has provided an evidence base for clinical practice. The discussion includes research and practice for the use of clinical and instrumental assessments, and for therapeutic interventions selected to prepare the infant for nipple feeding and to support the infant and improve sucking competencies during oral feeding.