Feeding practices in the neonatal intensive care unit: The transition to full oral feeding

The final milestone the preterm infant must achieve prior to discharge home is the ability to grow and gain weight while taking all feedings orally, via bottle or breast. The transition to full oral feedings can be problematic for the preterm infant due to immature neurodevelopment and difficulty maintaining physiologic homeostasis. The purpose of this research was to examine common practices among NICU nurses regarding oral feeding of the premature infant. This included nurses' opinions, daily practice, and documentation of bottle-feeding.;A national randomized sample of 268 NICU nurses participated in this study via mailed-out questionnaires. Twenty-three of these nurses participated in telephone interviews. Descriptive analysis was used to summarize key variables within the sample. Interviews and open-ended questions on the questionnaire were transcribed and analyzed qualitatively using grounded theory.;All of the nurses in this study stated that preterm infant behavioral signs of stress should be considered when rating the success of bottle-feeding; slightly less than half of the nurses reported that they routinely document feeding-induced stress Most of the nurses in this study reported that they document feeding on the 24-hour flowsheet. Half of nursing flowsheets contained space to document how the feeding was "tolerated" using broad categories such as "poor," "fair," or "well." Only 16% of flowsheets contained space for documenting infant feeding behaviors.;Use of the term "tolerated" resulted in ambiguity in relation to bottle-feeding. Nurses' suggested that documentation of feeding should be: (a) more thorough, (b) easier, (c) readily accessible to other providers, and (d) in the form of a checklist to reinforce attention to infant feeding behaviors.;Using a checklist on the flowsheet to document nursing interventions as well as the infant's nippling performance is a potential improvement of the traditional feeding plan. Documentation that is an accurate reflection of preterm infant performance and the support that was provided by the feeder could promote the transition to full oral feedings. This potentially could result in earlier discharge from the hospital with a subsequent reduction in healthcare costs.