Cue-based versus scheduled feeding for preterm infants transitioning from tube to oral feeding: the Cubs mixed-methods feasibility study
HEALTH TECHNOLOGY ASSESSMENT(2021)
Abstract
Background: There is a lack of evidence of the effect of cue-based feeding compared with scheduled feeding on important outcomes for preterm infants. Objectives: The objectives were as follows: (1) to describe the characteristics, components, theoretical basis and outcomes of approaches to feeding preterm infants transitioning from tube to oral feeding; (2) to identify operational policies, barriers and facilitators, and staff and parents' educational needs in neonatal units implementing cue-based feeding; (3) to co-produce an intervention for feeding preterm infants in response to feeding cues; (4) to appraise the willingness of parents and staff to implement and sustain the intervention; (5) to assess associated costs of implementing cue-based feeding; (6) to determine the feasibility and acceptability of a future trial; (7) to scope existing data-recording systems and potential outcome measures; and (8) to determine stakeholders' views of whether or not a randomised controlled trial of this approach is feasible. Design: This was a mixed-methods intervention development and feasibility study comprising (1) a systematic review, case studies, qualitative research and stakeholder consensus; (2) the co-production of the intervention; (3) a mixed-methods feasibility study; and (4) an assessment of stakeholder preferences for a future evaluation. Setting: Three neonatal units in the UK (two level 3 units and one level 2 unit). Participants: Developmentally normal, clinically stable preterm infants receiving enteral feeds (n = 50), parents (n = 15 pre intervention development; n = 14 in the feasibility study) and health-care practitioners (n = 54 pre intervention development; n = 16 in the feasibility study). Intervention: An evidence-informed multicomponent intervention comprising training, a feeding protocol, feeding assessment tools, supplementary training materials [including posters, a film and a narrated PowerPoint (Microsoft Corporation, Redmond, WA, USA) presentation] and the 'Our Feeding Journey' document.
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Key words
CO-PRODUCTION,CONSENSUS,CUE-BASED FEEDING,CUES,ENTERAL NUTRITION, QUALITATIVE RESEARCH,FEASIBILITY STUDIES,INFANT NUTRITIONAL PHYSIOLOGICAL PHENOMENA,INFANT, PREMATURE,NEONATAL INTENSIVE CARE,NEONATAL UNITS,NEONATE,PARENTS,PRETERM INFANT,RESPONSIVE FEEDING,WEIGHT GAIN
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