Systematic Review of Quality Improvement Initiatives Related to Cue-Based Feeding in Preterm Infants

To examine and synthesize the outcomes of quality improvement (QI) initiatives related to cue-based feeding of preterm infants to facilitate implementation of findings to improve nursing practice.

Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete and PubMed were searched for full-text articles published from 2000 through 2017 included under the medical subject heading quality improvement and whose titles included any form of the term feeding combined with any of the following: bottle, breast, cue-based, demand, infant, neonate, newborn, oral, or responsive.

Articles were considered for inclusion if they were published in English-language journals and focused on QI initiatives concerning cue-based feeding of preterm infants in NICU settings.

After initial article review, we examined clinical outcomes and assessed study methodology using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS) framework.

Our review yielded seven studies related to cue-based feeding of preterm infants. Five studies included multidisciplinary stakeholder teams to assess their respective NICU environments and facilitate project completion. In two studies, feeding "champions" were designated as facilitators. In one study, researchers used a Plan-Do-Study-Act approach and emphasized process over outcome. In six studies, researchers measured hospital length of stay, which decreased in five intervention groups. In three studies, researchers measured infant weight gain, which increased in two intervention groups. In two studies, researchers monitored weight gain velocity, and in five studies, researchers reported earlier gestational attainment of full oral feedings.

Weight gain, time to full oral feedings, and hospital length of stay may be improved with the use of cue-based feeding. QI initiatives are a practical means to bring best evidence and multidisciplinary collaboration to the NICU.