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Implementation of an Infant Oral Feeding Protocol within the Neonatal Intensive Care Unit

Background: In the neonatal intensive care unit (NICU) oral feeding practices vary amongst different institutions. Before a premature infant is discharged to home, they must attain full oral feeds. Feeding difficulties lead to an increased time to full oral feeds or nasogastric tube (NGT) removal and hospital length of stay (LOS). Infant-driven feeding (IDF) tactics with a guideline decrease the time from the first oral feed attempt to full oral feedings/NGT removal, decreases LOS, and improves parental/familial involvement and satisfaction.

Local Problem: There was no evidence-based feeding guideline at the local organization’s level IV NICU.

Methods: A quality improvement project using the Early Feeding Skills Assessment (EFSA) for premature infants less than 35 weeks gestation was completed by the bedside nurse.

Intervention: Over an eight-week period the EFSA was used to assess the readiness and quality of a feed, the first initial oral feed, and time to full oral feeds as documented by nurses. A pre- and post- implementation survey design was used to determine nurses’ compliance and perception of the use of the EFSA. Bedside nurse charting of the EFSA was used to measure nursing compliance with the protocol.

Results: There was 61% nursing compliance with the use of the EFSA, many nursing barriers were identified, and the time to full oral feeds decreased by 3.9 days.

Conclusion: Use of an infant oral feeding protocol (IOFP) is beneficial for practice within the NICU considering nursing barriers are addressed.

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Work Title Implementation of an Infant Oral Feeding Protocol within the Neonatal Intensive Care Unit
Access
Penn State
Creators
  1. Sommer Shay
Keyword
  1. Nursing
  2. DNP Project
  3. Neonatal intensive care unit
  4. Infant-driven feeding
  5. Cue-based feeding
  6. Feeding readiness
  7. Infant
  8. Neonate
License In Copyright (Rights Reserved)
Work Type Professional Doctoral Culminating Experience
Sub Work Type Doctor of Nursing Practice Project
Program Nursing
Degree Doctor of Nursing Practice
Acknowledgments
  1. Dr. Beth Ann White
Publication Date March 19, 2025
Language
  1. English
Deposited March 19, 2025

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Version 1
published

  • Created

    March 19, 2025 21:40 by slw348

  • Updated

    March 19, 2025 21:40 by [unknown user]

  • Updated Keyword, Language, Publisher, and 3 more Show Changes

    March 19, 2025 21:45 by slw348

    Keyword
    • Nursing, DNP Project
    Language
    • English
    Publisher
    • Sommer Shay
    Geographic Area
    • Pennsylvania
    Description
    • Background: In the neonatal intensive care unit (NICU) oral feeding practices vary amongst different institutions. Before a premature infant is discharged to home, they must attain full oral feeds. Feeding difficulties lead to an increased time to full oral feeds or nasogastric tube (NGT) removal and hospital length of stay (LOS). Infant-driven feeding (IDF) tactics with a guideline decrease the time from the first oral feed attempt to full oral feedings/NGT removal, decreases LOS, and improves parental/familial involvement and satisfaction.
    • Local Problem: There was no evidence-based feeding guideline at the local organization’s level IV NICU.
    • Methods: A quality improvement project using the Early Feeding Skills Assessment (EFSA) for premature infants less than 35 weeks gestation was completed by the bedside nurse.
    • Intervention: Over an eight-week period the EFSA was used to assess the readiness and quality of a feed, the first initial oral feed, and time to full oral feeds as documented by nurses. A pre- and post- implementation survey design was used to determine nurses’ compliance and perception of the use of the EFSA. Bedside nurse charting of the EFSA was used to measure nursing compliance with the protocol.
    • Results: There was 61% nursing compliance with the use of the EFSA, many nursing barriers were identified, and the time to full oral feeds decreased by 3.9 days.
    • Conclusion: Use of an infant oral feeding protocol (IOFP) is beneficial for practice within the NICU considering nursing barriers are addressed.
    • Keywords: neonatal intensive care unit, infant-driven feeding, cue-based feeding, feeding readiness, infant, neonate
    Publication Date
    • 2025-03-19
  • Added Creator Sommer Shay

    March 19, 2025 21:45 by slw348

  • Added S. Shay- Final DNP Paper.pdf

    March 19, 2025 21:45 by slw348

  • Updated Acknowledgments Show Changes

    March 19, 2025 21:47 by slw348

    Acknowledgments
    • Dr. Beth Ann White
  • Updated License Show Changes

    March 19, 2025 21:47 by slw348

    License
    • https://rightsstatements.org/page/InC/1.0/
  • Published

    March 19, 2025 21:47 by slw348

  • Updated

    March 19, 2025 22:04 by [unknown user]

  • Updated Publisher, Geographic Area Show Changes

    April 23, 2025 21:26 by avs5190

    Publisher
    • Sommer Shay
    Geographic Area
    • Pennsylvania
  • Updated Keyword, Description, Degree, and 2 more Show Changes

    April 23, 2025 21:27 by avs5190

    Keyword
    • Nursing, DNP Project
    • Nursing, DNP Project, Neonatal intensive care unit, Infant-driven feeding, Cue-based feeding, Feeding readiness, Infant, Neonate
    Description
    • Background: In the neonatal intensive care unit (NICU) oral feeding practices vary amongst different institutions. Before a premature infant is discharged to home, they must attain full oral feeds. Feeding difficulties lead to an increased time to full oral feeds or nasogastric tube (NGT) removal and hospital length of stay (LOS). Infant-driven feeding (IDF) tactics with a guideline decrease the time from the first oral feed attempt to full oral feedings/NGT removal, decreases LOS, and improves parental/familial involvement and satisfaction.
    • Local Problem: There was no evidence-based feeding guideline at the local organization’s level IV NICU.
    • Methods: A quality improvement project using the Early Feeding Skills Assessment (EFSA) for premature infants less than 35 weeks gestation was completed by the bedside nurse.
    • Intervention: Over an eight-week period the EFSA was used to assess the readiness and quality of a feed, the first initial oral feed, and time to full oral feeds as documented by nurses. A pre- and post- implementation survey design was used to determine nurses’ compliance and perception of the use of the EFSA. Bedside nurse charting of the EFSA was used to measure nursing compliance with the protocol.
    • Results: There was 61% nursing compliance with the use of the EFSA, many nursing barriers were identified, and the time to full oral feeds decreased by 3.9 days.
    • Conclusion: Use of an infant oral feeding protocol (IOFP) is beneficial for practice within the NICU considering nursing barriers are addressed.
    • Keywords: neonatal intensive care unit, infant-driven feeding, cue-based feeding, feeding readiness, infant, neonate
    Degree
    • Doctor of Nursing Practice
    Program
    • Nursing
    Sub Work Type
    • Doctor of Nursing Practice Project