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The transition from tube feeding to oral feeding algorithm in preterm infants: case-control study
Omnia El-Kassas1, Ayman Amer1, Hesham Abdel-Hady2
1Phoniatrics Unit, ORL Department, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt.
Insights
A new feeding assessment for preterm infants in the neonatal intensive care unit (NICU) enables earlier oral feeding and shorter tube feeding durations. This approach improves feeding independence and outcomes without increasing the NICU team workload.
Area of Science:
- Neonatal care
- Pediatric nutrition
- Clinical assessment tools
Background:
- Oral feeding is a complex process for preterm infants, often managed with inconsistent, traditional methods.
- Current practices may delay the development of crucial oral feeding skills.
Purpose of the Study:
- To implement and evaluate a novel feeding approach for assessing early oral feeding independence in neonatal intensive care unit (NICU) preterm infants.
- To compare the effectiveness of a new approach against the traditional method using clinical outcomes.
Main Methods:
- A quasi-experimental design with control and intervention groups (40 and 41 infants, respectively).
- The control group followed standard post-menstrual age and weight-based feeding progression.
- The intervention group utilized the Mansoura Early Feeding Skills Assessment (MEFSA) for early oral feeding assessment and supportive intervention.
Main Results:
- The new approach considered oral feeding readiness cues, feeding practice, maintenance, and techniques beyond just age and weight.
- Preterm infants in the intervention group achieved earlier start of oral feeding (SOF) and full oral feeding (FOF).
- Infants experienced shorter durations of tube feeding and gained weight without increased workload for the NICU team.
Conclusions:
- The Mansoura Early Feeding Skills Assessment (MEFSA) is a successful bedside tool for evaluating early oral feeding independence in NICU preterm infants.
- This individualized approach facilitates early oral feeding experiences, minimizing clinical complications.
Background:
Oral feeding is a complex sensorimotor process influenced by many variables, making it challenging for healthcare providers to introduce and manage it. Feeding practice guided by tradition or a trial-and-error approach may be inconsistent and potentially delay the progression of oral feeding skills.
Aim:
To apply a new feeding approach that assesses early oral feeding independence skills of preterm infants in the neonatal intensive care unit (NICU). To prove its effectiveness, compare two approaches of oral feeding progression based on clinical outcomes in preterm infants, the traditional approach used in the NICU of Mansoura University Children Hospital (MUCH) versus the newly applied approach.
Methods:
A quasi-experimental, exploratory, and analytical design was employed using two groups, control and intervention groups, with 40 infants for the first group and 41 infants for the second one. The first group (the control) was done first and included observation of the standard practice in the NICU of MUCH for preterm oral feeding, in which oral feeding was dependent on post-menstrual age (PMA) and weight for four months. The second group (the intervention) included early progression to oral feeding depending on early assessment of Oral Feeding Skills (OFS) and early supportive intervention and/or feeding therapy if needed using the newly developed scoring system, the Mansoura Early Feeding Skills Assessment "MEFSA" for the other four months. Infants in both groups were studied from the day of admission till discharge.
Results:
In addition to age and weight criteria, other indicators for oral feeding readiness and oral motor skills were respected, such as oral feeding readiness cues, feeding practice, feeding maintenance, and feeding techniques. By following this approach, preterm infants achieved earlier start oral feeding (SOF) and full oral feeding (FOF) and were discharged with shorter periods of tube feeding. Infants gained weight without increasing their workload to the NICU team.
Conclusion:
The newly applied approach proved to be a successful bedside scoring system scale for assessing preterm infants' early oral feeding independence skills in the NICU. It offers an early individualized experience of oral feeding without clinical complications.
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