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Cue-Based Feeding as Intervention to Achieve Full Oral Feeding in Preterm Infants Primarily Managed with Bubble CPAP

Mohamed A Mohamed1, Kirsten K Teumer2, Mariana Leone3

  • 1Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio.

American Journal of Perinatology
|June 15, 2021
PubMed

Insights

Cue-based feeding, which aligns oral feeding with infant readiness, does not appear to delay achieving full oral feeding in preterm infants. This feeding method also showed no association with increased hospital stay for infants on bubble continuous positive airway pressure (CPAP).

Area of Science:

  • Neonatal Medicine
  • Pediatric Gastroenterology
  • Infant Nutrition

Background:

  • Cue-based feeding (CBF) is designed to synchronize the introduction of per-oral (PO) feeding with a preterm infant's physiological readiness, aiming to enhance PO intake and prevent oral aversion.
  • Concerns exist that CBF, particularly when used with bubble nasal continuous positive airway pressure (CPAP), might delay the initiation or achievement of full PO feeding in clinical practice.

Purpose of the Study:

  • To investigate the association between cue-based feeding and the timing of oral feeding introduction and completion in preterm infants.
  • To evaluate if CBF impacts the time to achieve full PO feeding in infants managed with bubble CPAP.

Main Methods:

  • A retrospective analysis comparing outcomes of preterm infants (≤32 weeks' gestational age, ≤2,000g birth weight) before and after a practice change from volume-based to cue-based feeding advancement.
  • Statistical analysis included t-tests and multilinear regression to compare continuous variables and control for confounders.

Main Results:

  • No significant differences were observed in demographic or clinical variables between the 194 infants in the CBF group and the 117 infants in the historical volume-based feeding group.
  • While the initial assessment for PO feeding was earlier in the CBF group, the age of first PO feeding and achieving some PO at each feed was mildly delayed (34 vs. 33.7 weeks and 36.2 vs. 36.0 weeks, respectively).
  • Crucially, the age of achieving full PO feeding did not differ significantly between groups (36.8 vs. 36.4 weeks), and growth parameters at 36 weeks' postmenstrual age or discharge were similar. Subgroup analyses for infants ≤1,000g and 1,001-2,000g yielded comparable results.

Conclusions:

  • Cue-based feeding, when implemented in preterm infants managed with bubble CPAP, does not appear to be associated with a delay in achieving full oral feeding.
  • The findings suggest that CBF is not linked to a prolonged length of hospital stay in this population.
  • CBF effectively matches PO feeding initiation with infant readiness without compromising the timeline for full oral feeding attainment or growth outcomes.
Abstract

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