Test of a Feeding Protocol for Preterm Infants with Bronchopulmonary Dysplasia

Friday, July 15, 2011: 10:50 AM

Gail C. McCain, PhD, RN, FAAN1
Teresa Del Moral, MD, PhD2
Jessica Loucas, MSN, RN, CPNP1
Robert Duncan, PhD3
(1)Nursing, University of Miami, Coral Gables, FL
(2)School of Medicine, University of Miami, Miami, FL
(3)Department of Epidemiology and Public Health, University of Miami, Miami, FL

Learning Objective 1: identify signs of respiratory distress in preterm infants with bronchopulmonary dysplasia (BPD).

Learning Objective 2: describe the semi-demand feeding method for preterm infants with BPD.

Purpose: Preterm infants with bronchopulmonary dysplasia (BPD) have difficulty making the transition from gavage to nipple feeding because of respiratory distress including compensatory tachypnea and dyspnea. Achievement of nipple feeding is usually the last milestone that preterm infants must accomplish before hospital discharge into the full time care of their parents. The hypothesis was that preterm infants with BPD assigned to the experimental feeding protocol (semi-demand) would require fewer days to attain nipple feeding compared to control infants receiving standard care, and that the experimental protocol would be cost effective.

Methods: The setting was a 120 bed neonatal intensive care unit. A randomized, experimental design included 86 preterm infants with BPD who were assigned to the control condition (n = 42) (standard care) or the experimental protocol (n = 44). Nurses assigned to the experimental protocol used infant behavioral and cardio-respiratory responses to regulate frequency, length, and volume of feedings during the transition from gavage to nipple feeding in order to minimize feeding distress, fatigue, and hypoxemia. Mean gestational ages at birth and birth weights were 25 + 1.54 weeks and 784 gm for the control group, and 25 + 1.48 weeks and 787 gm in the experimental group.

Results: Experimental infants reached full, nipple feedings M = 5.93 (0.74) days, while control infants took M = 12.33 (0.82) days (F[1, 85] = 40.21, p < .0001). The nursing costs for time associated with provision of feedings for infants in the control group were on average $1,123 and $722 for experimental infants (F[1, 85] = 7.84, p < .01).

Conclusion: The use of the experimental feeding method holds promise for helping preterm infants with BPD transition from gavage to nipple feeding in a manner that uniquely considers the infant’s signs of chronic respiratory distress and is cost effective.