Tube to oral transition pathway to guide feeding advancement in moderate to late preterm infants: a systematic review

Abstract

Background: Oral feeding for preterm infants are a complex process and a delay in attaining full oral feedings can detain hospital discharge, considerably increase the cost of care and lead to unnecessary hospital readmissions. Moderate-to-late preterm neonates are often regarded as ‘small newborns’, and their clinical needs and conditions receive little individualised attention. Research aim/objectives: This study attempted to explore the best evidence to determine the factors to be considered when facilitating the transition process of tube-to-oral feeding in the moderate-to-late preterm neonate admitted to the neonatal ward. Method: A six-step systematic review of literature was conducted to answer the review question. ScienceDirect, EBSCOhost, Elsevier, Scopus, AePublications electronic databases were scoped for relevant articles and then evaluated by using the PRISMA. Final articles were appraised using the John Hopkins and CASP tools. Results: Factors that influence tube-to-oral transition include NNS (Non-nutritive Sucking), Provider education and caregiver skills, Cue-based-feeding, Kangaroo Mother Care (KMC), Neurological maturity and State of behavioural organisation. Conclusion: Results lean towards cue-based feeding as the most effective approach for a successful transition from tube-to-oral feeding; however, there seems to be scarcity in the supporting evidence to design a pathway for the moderate-to-late preterm neonate.