Timing Introduction and Transition to Oral Feeding in Preterm Infants: Current Trends and Practice

Introduction and management of oral feeding for preterm infants is a major challenge for clinicians in the neonatal intensive care unit (NICU). Feeding practices are often inconsistent and contradictory among clinicians and NICUs and based on custom rather than evidence. There is a need to establish a systematic approach, which is evidence based to facilitate decision making and clinical practice. Assisting the preterm infant to achieve the ability to fully orally feed takes time and is often a requirement for discharge. To be discharged from hospital, an infant must have a safe and efficient feeding method, ideally by breast or bottle. If sucking and oral feeding are developmentally programmed in infants, then maturation to a certain gestational age would be all that is needed. Early introduction of oral feeding and interventions to facilitate bottle or breast would be unnecessary. However, if practice or experience plays a significant role, then a systematic approach to timing of introduction and transition to oral feeding would be beneficial. Determining the optimal time to introduce oral feeds and strategies for progression would perhaps lead to earlier attainment and discharge from hospital especially in the “healthy” preterm population. The purpose of this article is to review the current research to (1) identify best practices related to (i) timing of introduction of oral feeds and (ii) transition to full oral and to (2) provide support for evidence-based practice and decision making for clinicians working with premature infants in the NICU.