A semidemand feeding protocol reduced time to full oral feeding in healthy preterm infants.

Intervention 44 infants were allocated to a semidemand feeding protocol. 10 minutes of non-nutritive sucking (NNS) were provided every 3 hours, followed up by an assessment of behavioural state (modified Anderson Behavioral State scale). If the infant was judged to be in a state of restlessness or wakefulness (scores >3), an oral feeding was offered. If the infant was in a sleep state, he was allowed to sleep for another 30 minutes and then assessed again; if at the second assessment the infant was still in a sleep state, he was fed by gavage. 45 infants were allocated to the control protocol, which comprised prescribed volumes of oral and/or gavage feedings at 3 hour intervals, with feeding time restricted to <30 minutes per feeding. Infants were started at 1 oral feeding per 24 hours, and advanced daily according to the protocol depending on weight gain, residual volumes <10% before each feeding, and absence of apnoea or bradycardia during oral feeding. In both groups, infants who did not ingest the prescribed nutrient volume orally were given the remainder by gavage. When an infant attained full oral feeding (ie, ingested all nutrient volumes in a 24h period without any gavage), the nasogastric tube was removed and the infant continued his or her study protocol for an additional 48 hours with all feedings offered orally. Infants in the semidemand group continued with behavioural assessments every 3 hours, but the time between feedings increased from 3.5 hours to up to 5 hours if an infant was sleeping. Infants in the control group continued to be fed prescribed volumes on a 3 hour schedule to meet 105–130 kcal/kg/day.