How to get your Team "on board" to Improve Neonatal Oral Feeding Practices

There has been a plethora of research done in the last 20 years on best practices for neonatal oral feedings, however many neonatal units continue to struggle with prioritizing a commitment to the Safety and Quality of oral feedings.

Whether it be a QI study or updating the unit’s oral feeding practices and policies, there are ways to get everyone “on board” with change. No need to “row the boat” on your own.

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?“Show them the research”

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Is your unit’s feeding practices supported in the literature? The literature supports cue-based feeding,1,2,3 even more specifically, Infant-Driven Feeding?.** In addition, the works of Britt Pados and Katlyn McGrattan have shed light on the importance of consistency of feeding tools and the science behind bottle feeding.4,5,6,7

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Refer to VON Principles

The Vermont Oxford Network (VON) is a nonprofit collaboration of healthcare professionals worldwide working to change the landscape of neonatal care. Their mission is “to improve the quality, safety, and value of care for newborn infants and their families through a coordinated program of data-driven quality improvement, education, and research.”8

From 2023 to 2026, a focus of VON is All Care is Brain Care. Neuroprotection is no longer only a neonatal therapist’s responsibility but is now the responsibility of all. VON states “Every interaction with an infant and their family in the neonatal intensive care setting is an opportunity to be brain-focused and have a direct impact on the developing brain.” The VON standards now include oral feeding-related items in their practice gap assessments such as:

-Promote positive olfactory and gustatory experiences

-Infant-driven/cue-based feeding protocol

-Ongoing skin-to-skin

If your hospital is a member of the VON network, speak with your VON representative. Even if your hospital is not a member, there are free resources/videos to learn more about All Care is Brain Care at https://public.vtoxford.org/quality-education/brain-care/.

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Apply Standards of Neonatal Practice

Infant Family-Centered Developmental Care (IFCDC) - In 2020, the Consensus Committee on Recommended Standards, Competencies, and Best Practices for Infant and Family-Centered Developmental Care in the Intensive Care Unit provided guidelines for NICU Developmental Care.9 This committee was comprised of a variety of NICU disciplines, including MDs.

The guidelines include a section on the management of feeding, eating, and nutrition delivery. Recommendations for best practices in this section include competencies such as 1) Consistency of feeding practices among staff who feed an infant shall be promoted, monitored, and verified; and 2) All oral experiences should be based upon the baby’s behaviors and focused on enjoyable non-stressful interactions. Find out more about these guidelines at:

https://nicudesign.nd.edu/nicu-care-standards/.

AAP Standards for Levels of Neonatal Care II, II, and IV – These standards, published in 2023 by the American Academy of Pediatrics, affirm the need for a nationally consistent standard of care to improve neonatal outcomes. Information includes identification of resources that are to be provided, including therapy, and a description of the Neonatal Patient Safety and Quality Improvement Program. This program assists units with selecting quality measures and reviews of guidelines and policies. Practically, this guideline can be used to demonstrate the need for measuring changes a unit makes related to feeding practices in their units, or to help a therapy team provide a case for adequate coverage in the NICU.10

Get everybody on the same page

The Infant-Driven Feeding? Program has been transforming oral feeding practices in neonatal units for over 10 years. Those who have completed the Program report increased safety of oral feedings. The online 4-hour Program improves oral feeding practices and outcomes through evidence-based information, best practices, and concepts that can be applied by all neonatal professionals. The proprietary, proven-effective Infant-Driven Feeding? Scales offer objective data for teams, providing a consistent way to communicate? an infant’s feeding progress.

Facilitate positive, neuroprotective feeding experiences that last a lifetime.

**For a full reference list to support Infant-Driven Feeding?, please reach out to Dr. Brown’s Medical at [email protected]

References:

1? Fry TJ, Marfurt S, Wengier S. Systematic Review of Quality Improvement Initiatives Related to Cue-Based Feeding in Preterm Infants. Nurs Womens Health. 2018 Oct;22(5):401-410. doi: 10.1016/j.nwh.2018.07.006.

2? Lubbe W. Clinicians guide for cue-based transition to oral feeding in preterm infants: An easy-to-use clinical guide. J Eval Clin Pract. 2018 Feb;24(1):80-88. doi: 10.1111/jep.12721.

3? Samane S, Yadollah ZP, Marzieh H, Karimollah HT, Reza ZM, Afsaneh A, Als H. Cue-based feeding and short-term health outcomes of premature infants in newborn intensive care units: a non-randomized trial. BMC Pediatr. 2022 Jan 6;22(1):23. doi: 10.1186/s12887-021-03077-1.

4? Pados B, Park J, Dodrill P. Know the Flow: Milk flow rates from bottle nipples used in the hospital and after discharge. Advances in Neonatal Care. 2019 Feb;19(1):32-41. doi:10.1097/ANC.0000000000000538.8;00(0):1-10.

5? Pados B. Milk flow rates from bottle nipples: What we know and why it matters. Nursing for Women’s Health. 2021;25(3):229-235. https://doi.org/10.1016/j.nwh.2021.03.006.

6? Lau C, Fucile S, Schanler RJ. A self-paced oral feeding system that enhances preterm infants' oral feeding skills. J Neonatal Nurs. 2015 Jun 1;21(3):121-126. doi: 10.1016/j.jnn.2014.08.004.

7? McGrattan KE, Jansen GP, Barrera JM, Beckstrand M. Exploring Alternative Methods to Reduce Milk Flow Rate From Infant Bottle Systems: Bottle Angle, Milk Volume, and Bottle Ventilation. Am J Speech Lang Pathol. 2023 Sep 11;32(5):2245-2253. doi: 10.1044/2023_AJSLP-23-00109.

8 Vermont Oxford Network website. https://public.vtoxford.org/quality-education/brain-care/. Accessed July 10, 2024.

9? Browne, J. V., Jaeger, C. B., Kenner, C., Gravens on behalf of the Consensus Committee on Infant & Family Centered Developmental Care. (2020). Executive summary: Standards, competencies, and recommended best practices for infant- and family-centered developmental care in the intensive care unit. Journal of Perinatology, 40(Suppl 1), 5–10. doi:10.1038/s41372-020-0767-1

10? Stark A et al. Standards for levels of Neonatal care II, III, and IV. Pediatrics. 2023;151(6);1-31. https://doi.org/10.1542/peds.2023-061957