Supporting Premature Infants’ Oral Feeding in the NICU—A Qualitative Study of Nurses’ Perspectives

One major task in the neonatal intensive care unit (NICU) involves ensuring adequate nutrition and supporting the provision of human milk. The aim of this study was to explore nurses’ experiences of the oral feeding process in the NICU when the infant is born extremely or very preterm. We used a qualitative inductive approach. Nine nurses from three family-centered NICUs were interviewed face-to-face. The interviews were transcribed verbatim and analyzed using content analysis. Five sub-categories and two generic categories formed the main category: ‘A complex and long-lasting collaboration.’ The nurses wished to contribute to the parents’ understanding of the feeding process and their own role as parents in this process. The nurses’ intention was to guide and support parents to be autonomous in this process. They saw the family as a team in which the preterm infant was the leader whose needs and development directed the feeding and the parents’ actions in this process. Written and verbal communication, seeing all family members as important members of a team and early identification of the most vulnerable families to direct the emotional and practical feeding support accordingly can strengthen the feeding process in the NICU.

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The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00097 ◽

2019 ◽

Vol 4 (6) ◽

pp. 1507-1515

Author(s):

Lauren L. Madhoun ◽

Robert Dempster

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Hospital Discharge ◽

Neonatal Intensive Care ◽

Oral Feeding ◽

Medical Attention ◽

Primary Role ◽

Speech Language Pathologists ◽

The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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Nurses' Perception of Family-Centered Care in Neonatal Intensive Care Units

Journal of Pediatric Intensive Care ◽

10.1055/s-0039-1695060 ◽

2019 ◽

Vol 09 (01) ◽

pp. 016-020

Author(s):

Haydeh Heidari ◽

Marjan Mardani-Hamooleh

Keyword(s):

Intensive Care ◽

Data Analysis ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Neonatal Intensive Care Units ◽

Family Centered Care ◽

Face To Face ◽

Centered Care ◽

Conventional Content Analysis ◽

Family Centered

AbstractFamily-centered care (FCC) is one of the important elements of care in neonatal intensive care units (NICUs). The aim of this study was to understand the nurses' perception of FCC in NICUs. This qualitative study was performed using conventional content analysis. Participants in this study included 18 nurses who were selected by a purposeful method. Semistructured, in-depth and face-to-face interviews were conducted with the participants. All interviews were written down, reviewed, and analyzed. Two categories were identified after the data analysis: (1) prerequisite for providing FCC and (2) parents' participation. Prerequisite for providing FCC consisted of two subcategories namely suitable facilities and adequate personnel. Parents' participation included subcategories of parents: neonate's attachment and parents' training. Nurses' perception of FCC in NICUs can facilitate an appropriate condition for the participation of family members in the care of neonates.

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Direct swallowing training and oral sensorimotor stimulation in preterm infants: a randomised controlled trial

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2021-321945 ◽

2021 ◽

pp. fetalneonatal-2021-321945

Author(s):

Ju Sun Heo ◽

Ee-Kyung Kim ◽

Sae Yun Kim ◽

In Gyu Song ◽

Young Mi Yoon ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Controlled Trial ◽

Tube Feeding ◽

Tertiary Hospital ◽

Oral Feeding ◽

Very Preterm Infants ◽

Very Preterm ◽

Randomised Controlled

ObjectiveTo evaluate the effects of direct swallowing training (DST) alone and combined with oral sensorimotor stimulation (OSMS) on oral feeding ability in very preterm infants.DesignBlinded, parallel group, randomised controlled trial (1:1:1).SettingNeonatal intensive care unit of a South Korean tertiary hospital.ParticipantsPreterm infants born at <32 weeks of gestation who achieved full tube feeding.InterventionsTwo sessions per day were provided according to the randomly assigned groups (control: two times per day sham intervention; DST: DST and sham interventions, each once a day; DST+OSMS: DST and OSMS interventions, each once a day).Primary outcomeTime from start to independent oral feeding (IOF).ResultsAnalyses were conducted in 186 participants based on modified intention-to-treat (63 control; 63 DST; 60 DST+OSMS). The mean time from start to IOF differed significantly between the control, DST and DST+OSMS groups (21.1, 17.2 and 14.8 days, respectively, p=0.02). Compared with non-intervention, DST+OSMS significantly shortened the time from start to IOF (effect size: −0.49; 95% CI: −0.86 to –0.14; p=0.02), whereas DST did not. The proportion of feeding volume taken during the initial 5 min, an index of infants’ actual feeding ability when fatigue is minimal, increased earlier in the DST+OSMS than in the DST.ConclusionsIn very preterm infants, DST+OSMS led to the accelerated attainment of IOF compared with non-intervention, whereas DST alone did not. The effect of DST+OSMS on oral feeding ability appeared earlier than that of DST alone.Trial registration numberClinicalTrials.gov Registry (NCT02508571).

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Severity of respiratory disease is correlated with time of first oral feeding and need for a gastrostomy tube at discharge in premature infants born at <30 weeks of gestation

10.22541/au.162455705.58095878/v1 ◽

2021 ◽

Author(s):

Emily Anderson ◽

Matthew Gregoski ◽

Daniel Gehle ◽

William Head ◽

Thomas Hardy ◽

...

Keyword(s):

Premature Infants ◽

Neonatal Intensive Care ◽

Retrospective Chart Review ◽

Oral Feeding ◽

Gastrostomy Tube ◽

Respiratory Support ◽

Respiratory Parameters ◽

Postmenstrual Age ◽

Highly Correlated ◽

Different Levels

Background: Premature infants who cannot achieve full oral feeds may need a gastrostomy tube (GT) to be discharged from the neonatal intensive care unit (NICU). We previously developed a model to predict which infants born <30 weeks (w) gestational age (GA) will require a GT before discharge. Here we report the detailed respiratory variable data to describe the general respiratory course for infants in the NICU <30w GA at birth and the association between different levels of respiratory support with postmenstrual age (PMA) at the time of first oral feeding attempt (PMAff), including later need for GT for discharge. Methods: Retrospective chart review of 391 NICU admissions comprising test (2015-2016) and validation (2017-2018) cohorts. Data, including respiratory support, were collected on 204 infants, 41 GT and 163 non-GT, in the test cohort, and 187 infants, 37 GT and 150 non-GT, in the validation cohort. Results: Respiratory data were significantly different between GT and non-GT infants. Infants who required GT for discharge were on significantly higher respiratory support at 30 days of age, 32w PMA, and 36w PMA. Respiratory parameters were highly correlated with PMAff. Conclusion: Respiratory status predicts PMAff, which was the variable in our previously described model that was most predictive of failure to achieve full oral feeing. These data provide a catalyst to develop strategies for improving oral feeding outcome for infants requiring prolonged respiratory support in the NICU.

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Developing a Family-Centered Care Model in the Neonatal Intensive Care Unit (NICU): A New Vision to Manage Healthcare

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17197197 ◽

2020 ◽

Vol 17 (19) ◽

pp. 7197 ◽

Cited By ~ 1

Author(s):

Sagrario Gómez-Cantarino ◽

Inmaculada García-Valdivieso ◽

Eva Moncunill-Martínez ◽

Benito Yáñez-Araque ◽

M. Idoia Ugarte Gurrutxaga

Keyword(s):

Health Care ◽

Intensive Care ◽

Neonatal Intensive Care ◽

Current Knowledge ◽

Neonatal Intensive Care Units ◽

Family Centered Care ◽

The Family ◽

Centered Care ◽

New Vision ◽

Family Centered

Family-centered care (FCC) currently takes a greater role in health care, due to the increasing empowerment parents experience. Within neonatal intensive care units (NICUs), family participation has an impact on the humanized care of the preterm newborn (PN). This integrative review conducted according to Whittemore and Knafl investigated current knowledge of the FCC model and its application in PN care in specific units. The data were collected from PubMed, Cochrane, CINHAL, Scopus, and Google Scholar. A total of 45 articles were used, of which 13 were selected which met inclusion criteria. Their methodological quality was evaluated using the mixed method appraisal tool (MMAT), and after they were analyzed and grouped into four thematic blocks: (1) parental participation; (2) health parental training; (3) benefits of family empowerment; and (4) humanized care. The results revealed that FCCs promote the integration of health equipment and family. In addition, parents become the primary caregivers. The benefits of the family–PN binomial enable an earlier hospital discharge. Humanized care involves an ethical approach, improving health care. Changes are still needed by health managers to adapt health services to the needs of the family and PNs.

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Fathers’ experiences of feeding their extremely preterm infants in family-centred neonatal intensive care: a qualitative study

International Breastfeeding Journal ◽

10.1186/s13006-021-00394-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Evalotte Mӧrelius ◽

Sofia Brogren ◽

Sandra Andersson ◽

Siw Alehagen

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Shared Responsibility ◽

Oral Feeding ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Feeding Process

Abstract Background Extremely preterm infants need advanced intensive care for survival and are usually not discharged before they reach the time of expected birth. In a family-centred neonatal intensive care unit both parents are involved at all levels of care including the feeding process. However, studies focusing on fathers in this situation are scarce. The purpose of this study was to explore the experiences of feeding extremely preterm infants in a neonatal intensive care unit from fathers’ perspectives. Methods The study adopts a qualitative inductive method, reported according to the COREQ checklist. Seven fathers of extremely preterm infants (gestational age 24–27 weeks) in neonatal intensive care in Sweden were interviewed by telephone after discharge in 2013–2014. The interviews were analysed using a qualitative content analysis and confirmed by triangulation in 2021. Results Six sub-categories and two generic categories formed the main category: “a team striving towards the same goal”. The fathers were equally involved and engaged members of the feeding team all hours of the day. The fathers shared responsibility and practical duties with the mothers, and they provided as much support to the mothers as they could. However, the fathers found it difficult to support and encourage the mothers to breastfeed and express breastmilk when the breastmilk production was low. The fathers experienced a loss when breastfeeding was not successful. Conclusions The findings indicate that fathers want to be involved with infant care, including night-time feeds, and long and demanding feeding processes. Fathers and staff need to collaborate to provide the best support to mothers during the feeding process. This study may inspire hospital staff to acknowledge and support fathers to become more involved in the oral feeding process when an infant is born extremely preterm.

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Errors in Clinician–Parent Communication during Neonatal Hospitalization

Children ◽

10.3390/children6060080 ◽

2019 ◽

Vol 6 (6) ◽

pp. 80

Author(s):

John M. Idso ◽

Mir A. Basir

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Communication Technology ◽

Neonatal Intensive Care ◽

High Fidelity ◽

Parent Communication ◽

National Initiatives ◽

The Family ◽

Communication Methods ◽

Family Centered

Error in clinician–parent communication is not a new issue in pediatrics. It has been the impetus behind national initiatives, namely, family-centered rounds. While family-centered rounds have proven effective, their success is dependent on the family being present during rounds. This does not always occur during prolonged hospitalizations, particularly in the Neonatal Intensive Care Unit (NICU). Current communication methods with parents not present during rounds rely heavily on the provider’s prerogative and ability to multitask. Thus, errors in communication are commonplace and are largely accepted as inevitable. For the sake of the parents of a patient in the NICU, a high-fidelity communication system is urgently needed. NICUs must move beyond the telephone and use modern innovations in communication technology.

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Heart for Bonding: A New Protocol of Care for Hypoplastic Left Heart Syndrome

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.31.5.305 ◽

2012 ◽

Vol 31 (5) ◽

pp. 305-310

Author(s):

Mary E. Parker ◽

Wanda T. Bradshaw ◽

Hope R. Smith

Keyword(s):

Hypoplastic Left Heart Syndrome ◽

Postnatal Care ◽

Neonatal Intensive Care ◽

Left Heart ◽

Hypoplastic Left Heart ◽

The Family ◽

Centered Care ◽

Left Heart Syndrome ◽

Family Centered

There are significant challenges involved in the perinatal and postnatal care of an infant with hypoplastic left heart syndrome (HLHS) and the infant’s family. In the blink of an eye, the perfect child is lost, and a fragile infant is about to join the family. This case study and discussion is an overview of HLHS, a family’s desire to make the birth of their infant normal, and how that desire initiated a change in philosophy and practice in our neonatal intensive care unit. Keywords: hypoplastic left heart syndrome, HLHS, family centered care, parent-infant bonding, breastfeeding.

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Premature: growth and its relation to oral skills

CoDAS ◽

10.1590/2317-1782/20152014179 ◽

2015 ◽

Vol 27 (4) ◽

pp. 378-383

Author(s):

Camila Lehnhart Vargas ◽

Luana Cristina Berwig ◽

Eduardo Matias dos Santos Steidl ◽

Leila Sauer Prade ◽

Geovana Bolzan ◽

...

Keyword(s):

Hospital Stay ◽

Premature Infant ◽

Premature Infants ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Tube Feeding ◽

Oral Feeding ◽

Feeding Performance ◽

Time Of Feeding ◽

Oral Skills

OBJECTIVE: To evaluate the influence of oral motor skills of premature infants on their oral feeding performance and growth, during neonatal hospitalization.METHODS: Fifty-one newborns hospitalized in the neonatal intensive care unit of a hospital in Southern Brazil, between July 2012 and March 2013, were evaluated. The evaluation of oral feeding skills, according to Lau and Smith, was applied after prescription for starting oral feeding. The oral feeding performance was analyzed using the following variables: days taken to start independent oral feeding and hospital discharge. Growth was measured by weight, length, and head circumference, using the curves of Fenton, at birth, first and independent oral feeding, and hospital discharge.RESULTS: At birth, 71% preterm infants were proper for gestational age, most of them were males (53%), with average of 33.6 (±1.5) weeks of gestational age. The gestational age in the assessment did not influence the oral feeding performance of the premature infant and did not differ between levels. Time of transition from tube feeding to oral feeding and hospital stay was shorter when the oral skills were higher. At birth, there was a tendency of low weight and low oral feeding performance. Level IV premature infants in the release of oral feeding presented higher weights.CONCLUSION: The level of oral skills of the premature infant interfered positively on time of feeding transition from tube to independent oral feeding and hospital stay. Growth, represented by weight gain, was not affected by the level of oral skill.

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Dark and Bright—Two Sides of Family-Centered Care in the NICU: A Qualitative Study

Clinical Nursing Research ◽

10.1177/1054773818758171 ◽

2018 ◽

Vol 28 (7) ◽

pp. 869-885 ◽

Cited By ~ 1

Author(s):

Jila Mirlashari ◽

Sousan Valizadeh ◽

Elham Navab ◽

Jenene W. Craig ◽

Fatemeh Ghorbani

Keyword(s):

Family Involvement ◽

Neonatal Intensive Care ◽

Phenomenological Study ◽

Multiple Roles ◽

Family Centered Care ◽

The Family ◽

Centered Care ◽

Nurses Perceptions ◽

Two Sides ◽

Family Centered

Nurses in the Neonatal Intensive Care Unit (NICU) have an important role in implementing family-centered care (FCC). The aim of the study was to explore the lived experiences of NICU nurses on implementing FCC. An interpretative phenomenological study was conducted and 11 employed nurses were interviewed from April 2015 to February 2016. The data were analyzed through the Diekelmann, Allen, and Tanner approach. Four main themes of “strain to achieve stability,” “bewildered by taking multiple roles,” “accepting the family,” and “reaching bright horizon” were extracted. This study provided deeper understanding about nurses’ perceptions of FCC implementation. In Muslim developing countries, FCC implementation is challenging and nurses are under extra pressure because of a shortage in nursing workforce; however, having positive experiences with family participation and valuing theism beliefs allowed them to support family involvement. Support of nurses to take FCC strategies in the NICU is needed by officials overseeing the health care system.

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