Paper
Saturday, July 16, 2005
Questioning Current Practice: Using a Systematic Review to Identify Safe and Effective Assessment of the Preterm Infant's Readiness to Feed
Linda Marie Crowe, RN, EM, MMid, Anne M. Chang, RN, DipNEd, BEdSt, MEdSt, PhD, and Karen Louise Wallace, RN, EM, GradDipMid. Nursing Research Centre (inc. Queensland Centre for Evidence Based Nursing and Midwifery), Mater Health Services, Brisbane, Queensland, Australia
| Learning Objective #1: Identify the process involved in finding evidence through systematic reviews |
| Learning Objective #2: Identify an approach that is effective for practice based on the evidence presented |
Unlike most full-term infants who are able to safely feed soon after birth, preterm infants often take time to transition from gavage feeding to exclusive breast or bottle feeds. The time taken to transition is inconsistent and dependent on a variety of factors including the infant's developmental maturity. Gestational age has been commonly used in practice as an indicator of developmental maturity and therefore readiness to commence oral feeding. However, recent studies have found that although gestational age is a guide to expected maturity there are differences in the rates that infants mature. The impact of using gestational age as an indicator is not fully understood but it is thought that it may cause unnecessary delay in commencement of feeding in some infants while pushing others who are less developmentally mature. Both of these situations have the potential to cause undue stress on infant and mother and delayed discharge. As a result some nurses are questioning whether the “routine” practice of commencing feeds at a particular gestational age is appropriate. A more accurate and effective approach may be to assess individual infant's readiness to feed. Evidence to substantiate the effectiveness of methods to assess preterm infant's readiness to feed is unknown and a systematic review or clinical guideline is needed. Such a review is currently underway. An outcome of this review is to ensure that care provided is current, beneficial and relevant to nurses, infants and mothers. This paper will examine the different approaches to assessing readiness to feed in preterm infants including the benefits and limitations of these methods. The current gaps of knowledge and future direction of feeding assessment will be discussed. A brief overview of the process involved in conducting this systematic review will also be given.