Purpose: Premature, compared to full-term, neonates are at risk for poorer development and other health problems, and these may persist throughout childhood. Key to neonatal development is the ability to take in nourishment. However, due to the delay in physical development, premature neonates have difficulties in controlling and coordinating breathing during the feeding process, and are at increased risk for dysphagia and apnea-related disorders. Premature neonates admitted to the Neonatal Intensive Care Unit (NICU) are traditionally fed according to rigid schedules. The first step to transition from the scheduled oral feedings to feeding on demand, is when the NICU staff, usually nurses, witness behavioral cues indicating that the premature neonates are hungry and physically able to take in oral nutrition. Several physical and clinical factors may delay the initiation of feeding on demand. However, if feeding on demand is successful, tube feedings end, and NICU release is possible. At approximately 33 week’s postmenstrual age (PMA), the suck reflex becomes more consistently coordinated with the pharyngeal swallow activity. The 34
th week in premature neonate development is a turning point, since at this age oral feeding may be attempted. Prior to 34 weeks of age (PMA), accordingly, NICUs schedule oral feedings for every three hours and nurses receive orders by physicians, to gradually replace scheduled feedings with feeding on demand. Feeding on demand means oral nutrition is provided based on hunger cues from the neonate. This feeding on demand model encourages individual, consistent, safe, functional, nurturing and developmentally appropriate feeding that reduces neonate and feeder stress as well as promoting positive oral feeding experiences and development. Besides the importance of feeding on demand for the neonate’s development, Infant feeding often serves as the focal point of parent holding and touching their baby, and early parent-infant interactions. Therefore, oral feeding offers a natural means of parent involvement. Early discharge supports the formation of parent-infant attachment.
Due to the limited information on when to begin feeding on demand, this thesis will examine whether the introduction of feeding on demand at the 34th week PMA (postmenstrual age), after adjusting for confounders, benefits premature neonates. The overarching research question is: “Does transitioning premature neonates as early as possible to feeding on demand result in better developmental progress?” Current criteria used to determine neonatal growth and development include assessments on: weight, head circumference (HC), and a collection of measurements on infant activities and general movements (GM) indicating developmental progress. GM follow a pattern that can be observed in neonates as young as nine weeks post term. In neonates without neurological dysfunction, GM continue in a similar pattern until about the end of the second month post term, which then is followed by a gradually emerging new GM pattern. GM records comprise the state-of-the art parameters used to conduct neonatal developmental assessments. Methods: This mixed methods study will include: a quantitative component using an historical cohort study design of premature neonates (n=200) admitted to the NICU who had at least one developmental pediatrics visit within four to eight weeks post discharge; and a qualitative component with semi-structured interviews of a purposive sample of premature neonates' parents (n=8). The qualitative component enables us to gain insights on the parents’ feeding experience in the NICU and at home. Contribution/Results: Results from this study will determine whether earlier feeding on demand leads to better infant developmental outcomes and identify the factors associated with successful feeding on demand in premature neonates. The goal of this study is to promote early NICU discharge and better outcomes for the premature neonate and parents.
Conclusion: the research is not yet complete, hence the conclusions are not yet available.
