NICU feeding neonates

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CHILD HEALTH CLINICAL PRACTICE GUIDELINES Subject/Title:

ORAL FEEDING

Date Established: April 30, 2004

Date Reviewed: March 2009

Reference:

Page:

2-0-2

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PURPOSE 1. To provide guidelines for family, staff and physicians for the introduction and management of oral feeding for high-risk infants. 2. To create positive feeding experiences while assisting infants to achieve full oral feeding and to attempt to prevent the development of oral aversive behaviors.

UNDERLYING PRINCIPLES 1. 2. 3. 4.

Feeding is an active social interaction between caregiver and infant. Development of oral feeding follows stages that can be identified.166,172 Stages are used to plan physiologically appropriate feeding experiences.172 Movement within and between stages may be bi-directional.

PRINCIPLES OF FEEDING ASSESSMENT 1. Continuous assessment of infant state and responses before, during and after non nutritive sucking (NNS) as well as nutritive sucking (NS), is essential. 146, 152, 154,166 2. Providing interventions that are contingent on infant responses is needed to achieve specific goals within each stage. 76, 152, 156 3. Reassessment of oral feeding process and plans should occur when: 3.1. Engagement/readiness cues are present and if positive signs persist: • Identifiable hunger cues • Increased/enhanced quiet alert state • Stable physiologic responses 3.2. Disengagement/distress cues are present and if distress signs persist: • Significant changes in heart rate (bradycardia, tachycardia) • O2 saturation outside normal limits • Color changes (pallor, cyanosis, mottled) • Significant changes in respiratory status (rate, grunting, nasal flaring, retractions, apnea) • Loss of postural tone • Loss of state 3.3. Feeding skills improve: • Improved suck/swallow/breathe (SSB) coordination • Satiety cues

CHILD HEALTH


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NICU feeding neonates by Hemant Nandgaonkar - Issuu