Infant-driven feeding in premature infants: a quality improvement project

Many neonatal units are adopting developmentally appropriate feeding practices such as cue-based or infant-driven feeding (IDF). There have been limited studies examining the clinical benefit of this approach.

A quality improvement initiative was undertaken to introduce an IDF protocol for premature infants <34 weeks gestational age (GA). Data were abstracted to determine whether time to full feeds and time to discharge would be shortened when compared with traditional practitioner-driven feeding (PDF) approach. Baseline data on postmenstrual age (PMA) at first feed, full nipple feeds and at discharge prior to implementation were compared with data obtained after implementation of the IDF protocol. Infants were divided into three subgroups: <28, 28-31(6/7) and 32-33(6/7) weeks gestation. A questionnaire assessed provider's acceptance of the plan.

The PMA at full nipple feeds and at discharge was significantly lower in the IDF than PDF group. Infants <28 weeks GA in the IDF versus PDF group reached full nipple feeds 17 days sooner and were discharged 9 days earlier. Babies 28-31(6/7) weeks GA reached full nipple feeds 11 days sooner and were discharged 9 days earlier in the IDF versus PDF group. Babies 32-33(6/7) weeks GA reached full nipple feeds 3 days sooner and were discharged 3 days earlier in the IDF versus PDF group. Providers viewed the implementation of the plan favourably.

The IDF approach was associated with significant reduction in time to full feeds and discharge, an effect that was most pronounced in infants >28 weeks GA. The downstream benefits included provider and parent satisfaction.