The focus of Step 8 is cue-based feeding. In many birthing facilities, preterm and late-preterm infants are the last to be "allowed” to follow cue-based feeds and are often put on scheduled feeds for the benefit of staff care and documentation. "Feeding regimes for the advancement from tube to oral feeds that are followed and described in the literature are often inconsistent and contradictory among clinicians and even NICUs and are based on custom rather than evidence,” (Lubbe, 2017).
"Poor feeding is a common reason for readmission to hospital within 2 weeks after neonatal intensive care unit (NICU) discharge, especially in infants born between 34 and 37 weeks postconceptual age. These late preterm infants are more prone to poor oral feeding because of medical issues, such as respiratory distress, jaundice, hypoglycaemia, and temperature instability... Therefore a [cue-based feeding] skilled and observant caregiver is essential to assist the infant in a pleasurable feeding experience that maximizes intake and minimizes stress,” (Lubbe, 2017).
"Cue-based feeding is a method that combines the use of non‐nutritive sucking (NNS) to promote awake behaviour for feeding, use of behavioural assessment to identify readiness for feeding, and systematic observation of and response to infant behaviour cues to regulate frequency, duration, and volume of oral feedings,” according to Lubbe's study.
This extensive and well-documented study is a must-read for any healthcare staff working with newborns, as well as preterm infants. Multiple tables are included in the study, focusing on the benefits of non-nutritive sucking, benefits of cue-based feeding, and signs of readiness to transition from tube to oral feeds. A colorful chart diagrams the protocol and would make an excellent poster for neonatal care units of any type. Pacifier shapes and sizes are discussed, emphasizing mimicking the fetal thumb at various developmental stages, as well as the maternal nipple shape and size when breastfeeding is initiated as a part of cue-based feeding. The link below will take you to the Wiley journal website where you can freely download a PDF of the study.
Share this among your colleagues for discussion, hopefully leading to a positive change for the infants under your care.
Kathy Parkes, MSN-Ed, RN, IBCLC, FILCA CHC
Professional Development Educator
Lubbe, W. (2017). Clinicians guide for cue-based transition to oral feeding in preterm infants: An easy-to-use clinical guide. J Eval Clin Pract; 24: 80-88. https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.12721
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