I have received a few requests for further information re: semi-demand feeding for preterm neonates following my previous response re: the neonatologist's/NICU staff queries about the value of human milk for preterm/sick neonates. As such, I have listed some articles re: semi-demand feeding following my somewhat lengthy explanation of semi-demand feeding...
In short, a semi-demand feeding method is designed to provide the healthy preterm neonate with opportunities for oral feeding at each feed (vs. every second feed or a set number of times daily). However, unlike other methods of scheduled feeds this method accounts for the infant's state when deciding to initiate or continue with an oral feed. For instance, if an infant is in a quiet-alert state oral feeding would be offered. However, the oral feed would be stopped and the remainder of the volume administered by means of an indwelling gavage tube if the infant begins to display stress cues (i.e., loss of tone or posture, changes in colour or breathing pattern, return to a sleeping state, etc.). Another example...If the infant is in a light sleep non-nutritive sucking is offered and the infant is given a chance to wake up for the feed. If the infant remains sleeping the feed volume is given by indwelling gavage tube. However, if the infant wakes an oral feed is offered as abov
e.
Research indicates that a semi-demand method of feeding helps infants to achieve full oral feeds faster. It is also consistent with a developmentally-appropriate approach to care as it helps the infant to learn new skills. This method ensures adequate fluid/caloric intake without forced feeding based on rigidly scheduled oral feeds. Additionally, as you are all abundantly aware, a baby can be forced to bottle feed but breastfeeding requires the infant to actively participate in the feed. A semi-demand approach accounts for this reality and removes some of the pressure to force feed babies by bottle if they have not taken a sufficient volume during a breastfeed.
Please note that this feeding method is intended for healthy preterm neonates. These are the little ones who are ready to begin oral feeding, NOT the ones that are attached to a ventilator with lines and inotropes keeping them alive. Those neonates are an entirely different ballgame. That being said, human milk is a vital component of care with sick preterm neonates. While the mode of delivery may be different (i.e., continuous or intermittent gavage feeds with/without PPN) many of the benefits remain the same (i.e., better feed tolerance, decreased risk of sepsis, NEC, etc.).
Hope this information is helpful :O)
Dru Antoniuk MA, BScN, RN (in an NICU in snowy Edmonton, Canada)
McCain, G. C. (2003) An evidence-based guideline for introducing oral feeding to healthy preterm infants. Neonatal Network, 22, 45-50.
McCain, G. C., Gartside, P. S., Greenberg, J. M., & Lott, J. W. (2001). A feeding protocol for healthy preterm infants that shortens time to oral feeding. J Pediatr, 139, 374-379.
Stade, B., & Bishop, C. (2002). A semidemand feeding protocol reduced time to full oral feeding in healthy preterm infants. Evidence Based Nursing, 5, 74.
The Cochrane Collaboration is also currently working on a protocol, although I have not been able to access it on-line (please email me privately if any of you have been able to do so or if you have any other information).
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