Parental-Guided Responsive Feeding for Neonatal Transfers to General Pediatrics

Alex King

Background: 37% of moderately preterm neonates remained hospitalized due to inadequate oral feeding in 2019, contributing to a neonate’s length and cost of stay (Edwards et al., 2019). In fact, the successful transition to full oral feedings is considered one of the most common barriers to discharge in neonates (Edwards et al., 2019). Transferring from neonatal intensive care units to inpatient pediatric units presents additional challenges and questions such as identifying the appropriate criteria for a neonate to transfer in terms of age, weight, and medical stability. A parent-guided, cue-based feeding model was implemented to decrease length of stay and increase family satisfaction. Purpose: The purpose of this project was to implement a parent-guided, cue-based responsive feeding protocol to assist in the transition of neonates to full oral feedings in the pediatric inpatient setting. Methods: Utilized a quality improvement design under the Plan-Do-Study-Act framework within a midwest children’s hospital’s inpatient pediatric unit for neonates >34 weeks post-menstrual age at the time of transfer. Objectives of the project included a 90% adherence to PGRF feeding protocols among general pediatric staff, an increase family involvement in PGRF feeding practices for neonatal transfers to 75%, and 90% of neonatal transfers achieve key developmental milestones, including full oral feedings, consistent weight gain, and discontinuation of NG tube feedings. Findings: Data was collected via the electronic health record and included oral and tube feeding volumes, daily weight measurements, whether the neonate was fed by staff or family, and point of NG tube removal. The project consisted of 2 twin participants. Data was analyzed with a timeline analysis, mean weight gain and mean oral feeding volumes, and a two-tailed Wilcoxon signed-rank test comparing periods of low versus high caregiver involvement. Results revealed a statistically significant increase in mean oral feeding volumes during periods of high caregiver involvement compared to low caregiver involvement, with higher gains during periods of consistent high caregiver involvement. Difficulty with adherence to feeding practices by staff highlights the need for caregiver involvement during a transition of care. The small sample size makes generalizability difficult to establish. Discussion: Consistent, caregiver-initiated cue-based feedings show meaningful potential in decreasing neonatal length of stay when the transition to full oral feedings remains the final barrier to discharge.

Parental-Guided Responsive Feeding for Neonatal Transfers to General Pediatrics

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