Introduction of oral feeding in premature infants on high flow nasal cannula in a level IV neonatal intensive care unit: a quality improvement initiative

J Perinatol. 2024 Nov;44(11):1692-1699. doi: 10.1038/s41372-024-01917-3. Epub 2024 May 7.

Abstract

Background: Failure to reach full oral feeding remains a significant barrier for premature infants to discharge home. Postmenstrual age (PMA) at first oral feeding is significantly associated with the length of hospital stay (LOS).

Methods: Single-center QI to introduce oral feeding to infants on high-flow nasal cannula (HFNC) by reducing the flow to 2 L during feeds.

Global aim: To reduce PMA at first oral feeding and reduce the LOS.

Smart aim: To introduce oral feeds in 40% of infants who are on ≤4 L HFNC by the end of 12 months.

Results: Over 12 months, SMART aim reached with 100% enrollment. PMA at first oral feeding decreased from a median of 42.4w ((IQR) (40,46.6) to 37.8w (35.8,43.2), PMA at discharge decreased from 47w (44.6,50.7) to 42.6w (41.3,48.8).

Conclusion: Allowing oral feeding in infants while on HFNC is feasible. This approach can significantly reduce PMA at first and full oral feeding.

MeSH terms

  • Bottle Feeding
  • Cannula*
  • Enteral Nutrition* / methods
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Intensive Care Units, Neonatal*
  • Length of Stay*
  • Male
  • Oxygen Inhalation Therapy / methods
  • Patient Discharge
  • Quality Improvement*