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Texas Health Dallas Offers New Approach to Feeding Newborns
10/25/2013

DALLAS — Born prematurely at 29 weeks, Daphne Miller could fit in the palm of her mother’s hand.

Daphne Miller, born at 29 weeks, is now healthy and home with her parents.
Daphne Miller, born at 29 weeks, is now healthy and home with her parents.

Daphne spent two months in the NICU before she was transferred to the Special Care Nursery.
Daphne spent two months in the NICU before she was transferred to the Special Care Nursery.

Today, Daphne has doubled her weight and is home with her parents, thanks to a new baby-driven feeding program at Texas Health Presbyterian Hospital Dallas that puts control in the tiny hands of babies.

The program, called Infant-Driven Feeding Protocols, lets premature babies in the hospital’s Special Care Nursery signal when they’re ready to eat. Traditionally, neonatal and special care units have used scheduled and volume-based systems to feed newborns. Scheduled feedings even called for sleeping babies to be woken up to eat, causing the infant to burn precious calories and expend needed energy.

The goal of the new infant-driven program at Texas Health Dallas is to help tiny newborns get the hang of eating on their own quicker and achieve stable growth — necessary steps before they can go home.

“What’s nice is we don’t have to wait until Daphne cries to know she’s hungry,” said mom Misty Jackson-Miller, 30. “Once she reached 33 weeks, the nurses started guiding us to watch for signs that she wanted to eat — and not solely depend on the chart. She was then fed only for as long as she was showing interest in feeding.

“I’m very attuned to her body language.”

The new program was implemented after pediatricians and neonatologists on the medical staff at Texas Health Dallas completed a year-long assessment to compare the effectiveness of chart-based, scheduled feedings against infant-driven methods that use infant cues to guide feedings. Their findings show babies between 33 to 36 weeks gestational age learn to nourish themselves faster and gain stable growth sooner with the infant-driven program — helping babies go home generally four days sooner than those who used the traditional feeding methods.

“The schedule-based feeding system has worked well for years, but we’re always looking for ways to improve care,” said Dr. Terri L. Major-Kincade, medical director of the Special Care Nursery at Texas Health Dallas. “What’s most interesting and rewarding about what we’ve found with the new program is that babies are learning to nourish themselves, meeting their goals faster and getting to go home sooner. This program isn’t an expensive, new technology or procedure. It’s just a better way to provide care.”

Upon admission to the hospital’s 44-private bed Special Care Nursery, Misty was trained to look for signals that Daphne was hungry and ready to eat: stirring before or during care time, staying awake, exhibiting rooting (sucking reflex) or hand-to-mouth motions.

While eating comes naturally to many newborns, premature babies have a much more difficult time with nourishing themselves, whether it’s drinking from a bottle or breast feeding, the doctors on the medical staff at Texas Health Dallas say.

“Feeding can be a difficult task for premature or high-risk infants like Daphne, due to trouble maintaining body temperature, less overall strength and endurance, and the need to maintain safe coordination of sucking, swallowing and breathing,” Major-Kincade said. “Fortunately, careful monitoring and early intervention often lessens some of the dangers posed to this extremely fragile population. In some cases, babies can catch-up after birth, but these patients usually remain smaller than expected.”

Born April 15 at 2 pounds, 4 ounces, Daphne suffered from low birth weight caused by intrauterine growth restriction, a condition that prevents normal infant growth during pregnancy. Unlike full-term babies born between 37-42 weeks, babies like Daphne often have underdeveloped muscles needed for swallowing, sucking and breathing — making the feeding process one of the biggest challenges in nurseries across the country. Those who spent time in the NICU on ventilators – before graduating to the Special Care Nursery — often have further weakened muscles needed for eating.

“Parents of preterm infants often feel overwhelmed because these small and premature babies can be more challenging to feed,” said Dr. Gerald Nystrom, medical director of the NICU at Texas Health Dallas and a neonatologist on the hospital’s medical staff. “Our infant-driven feeding program gives babies and families more opportunities to practice and succeed, which in turn supports the infant's developmental growth and long-term well-being.”

Upon reaching 33 weeks gestational age, preterm infants are introduced to the new feeding program. A one-year assessment found that using the infant-driven feeding protocols decreased the time it took infants to get the hang of eating on their own, improved parent’s confidence during feeding and helped babies shorten average hospital stay by four days.

“What’s impressive about our findings is how bigger preemies are getting to go home earlier than previously thought possible with traditional scheduled and volume-based methods,” Major-Kincade said.

Furthermore, findings from the year-long review also support increased collaborations between infants and caregivers, encouraged nursing and parent autonomy at the bedside, and enhanced parents’ confidence to care for their preemies.

“I like how this lets babies tell us when they’re ready to eat,” said Dede Scholl, R.N., nurse manager for the Special Care Nursery at Texas Health Dallas. “It improves the quality of nipple feeding because the baby is actually awake and interested at the feeding time. As a result, each feeding becomes a victory for the infant as he or she continues to gain competency and pleasure in eating.”

Each year, approximately 6,000 babies are born in the Margot Perot Center for Women and Infants at Texas Heath Dallas. More than 700 of these infants are born premature or have special needs and are admitted to the hospital’s level III NICU.

Baby Daphne spent two months in the NICU before she was transferred to the Special Care Nursery, where she thrived using the new feeding program. Today, Daphne is home with her parents and pet dog, Gracyee.

“We’re excited to see how much Daphne is growing,” Misty said, “and how big she’s getting.”

The program has also been implemented in nurseries at Texas Health Harris Methodist Hospital Fort Worth and Texas Health Arlington Memorial Hospital.

About Texas Health Presbyterian Hospital Dallas
Texas Health Presbyterian Hospital Dallas is an 898-bed acute care hospital and recognized clinical program leader, having provided compassionate care to the residents of Dallas and surrounding communities since 1966. U.S. News and World Report has ranked Texas Health Dallas among the nation’s best hospitals in digestive disorders, orthopedics, and neurology and neurosurgery. An affiliate of the faith-based, nonprofit Texas Health Resources system, Texas Health Dallas has approximately 4,000 employees and an active medical staff of more than 1,000 physicians. For more information, call 1-877-THR-WELL, or visit TexasHealth.org/Dallas.

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