Feeding Difficulties in Late Preterm Infants and Their Impact on Maternal Mental Health and the Mother-Infant Relationship: A Literature Review.

Late preterm infants constitute the largest subset of premature infants and are more likely to experience feeding issues leading to delayed oral feeding independence and low breastfeeding rates. Considering the increased parental concern about their infants' nutrition and growth, we performed a literature review to provide an update on the feeding challenges faced by late preterm infants and the impact of these issues on maternal mental health and the mother-infant relationship. Based on our findings, late preterm infants have a high prevalence of feeding difficulties which need to be addressed by targeted support interventions to promote breastfeeding success and the establishment of a harmonious dyadic interaction between the mother and her infant, all of which contribute to the prevention of altered feeding behavior later in life. There is still a need for additional research to develop a standardized and shared strategy that can be proven to be effective. Should this be accomplished, it will be possible to offer appropriate support for mothers, encourage the oral skills and maturation of late preterm infants, and improve the relationship quality within the dyad.

Approach to fever in children among final-year nursing students: a multicenter survey.

BACKGROUND: Unfounded concerns regarding fever are increasingly observed among nurses worldwide. However, no study has so far explored the preferred approach towards pediatric fever among nursing students. Therefore, we aimed to investigate the attitude towards pediatric fever among final-year nursing students. METHODS: Between February and June 2022, final-year nursing students of 5 Italian university hospitals were asked to answer an online survey on their approach to fever in children. Both quantitative and qualitative methods were utilized. Multiple regression models were employed to explore the existence of moderators on fever conceptions. RESULTS: The survey was filled in by 121 nursing students (response rate 50%). Although most students (98%) do not consider discomfort to treat fever in children, only a minority would administer a second dose of the same antipyretic in nonresponsive cases (5.8%) or would alternate antipyretic drugs (13%). Most students would use physical methods to decrease fever (84%) and do not think that fever has mainly beneficial effects in children (72%). The own know-how adequacy on fever was inversely associated (OR 0.33, 95% CI 0.13-0.81) with the beliefs that high fever might lead to brain damage. No further predictive variable was significantly associated with the concern that fever might be associated with brain damage, the advice of physical methods use, and the assumption that fever has mostly positive effects. DISCUSSION: This study shows for the first time that misconceptions and inappropriate attitudes towards fever in children are common among final-year nursing students. Nursing students could potentially be ideal candidates for improving fever management within clinical practice and amongst caregivers.

Parent's Health Locus of Control and Its Association with Parents and Infants Characteristics: An Observational Study.

The Parent Health Locus of Control (PHLOC) investigates the individual's beliefs about the factors that govern their state of health and that of their children. The direct association between PHLOC and preventive health behaviours compliance has already been demonstrated in the literature. However, it is still unclear how socio-demographic variables affect the PHLOC. We investigated the Parent Health Locus of Control of parents of full-term and preterm infants and evaluated whether there were any correlations between PHLOC and socio-demographic characteristics of both parents and infants. A single-centre transverse observational study was conducted in the Neonatology Operating Unit IRCCS Ca 'Granda Foundation Ospedale Maggiore Policlinico of Milan. A self-administered questionnaire of the PHLOC scale was distributed to a sample of 370 parents of 320 full-term and 52 preterm infants attending the follow-up service. Parents under the age of 36 and with a higher level of education (bachelor's degree or above) believe less in the influence of the media on their child's health. Parents of preterm and first-child infants recognize the greater influence of health care workers, while parents of newborns that have experience complications in their clinical course, believe more in the influence of fate (Chance Health Locus of Control) and God. Younger parents with a higher level of education may be more prone to healthy preventative behaviours. Preterm birth is positively associated with an increased trust in health care professionals. The experience of disease can increase a "Chance Health Locus of Control" and risky behaviours. Assessment of PHLOC helps identify categories of parents prone to risky health behaviours and offer targeted health education interventions.

Pilot Feasibility Study of a Hospital-Based Post-Natal Educational Intervention on New Mothers in a BFHI-Compliant Tertiary Referral Center for Neonatal Care.

The immediate post-partum period offers a valuable opportunity for parental education on various health topics. The aim of this study was to pilot test the feasibility in a tertiary referral center for neonatal care of a post-natal educational intervention (the Diary) designed to provide mothers with basic information concerning newborn care and breastfeeding. Furthermore, we aimed to evaluate its effect on exclusive breastfeeding rates at discharge and at 48 h post-discharge, and on maternal perceived support during hospital stay, compared to standard care. A single-center two-phase interventional study was carried out from 1 December 2018 to 2 June 2019. The Diary was given to mothers enrolled in Phase 2, together with the Nurse-Parent Support Tool (NPST). The Diary-NPST couples analyzed were 269. The Diaries filled out and returned were 62.2%. Overall, mothers rated the information received through the Diary as "clear and comprehensive". Exclusive breastfeeding rates at discharge resulted in being higher in Phase 1 than in Phase 2 (80.6% vs. 72.5%, p = 0.04), whereas no difference emerged in terms of exclusive breastfeeding rates at 48 h. In both phases, the median NPST total score (4.05) was high. In conclusion, we propose a new instrument of in-hospital post-natal maternal education and, in line with the current literature, we support well-designed written educational materials to promote mothers' knowledge and satisfaction with post-partum hospital assistance. Further studies that are multicentric and with a longer follow-up period are needed to evaluate the potential impact of the Diary on exclusive breastfeeding duration.

Post-partum Hospital Stay and Mothers' Choices on Breastfeeding and Vaccines: A Chance We Should Not Miss.

Parents' education and knowledge regarding major topics of children's health, such as nutrition and vaccines, have a paramount role. However, breastfeeding rates in first year of life are lower than recommended, and vaccine hesitancy is progressively spreading. To reverse this harmful trend, healthcare professionals are challenged to promote correct health information. This study aimed to assess newly mothers' knowledge of breastfeeding and vaccinations, and education received on both topics during hospital stay. We performed a cross-sectional survey in the Postnatal Unit of our Center. Mothers of full-term babies with a birthweight >2,500 g were enrolled. Two different questionnaires, one about breastfeeding and one about vaccines, were proposed to the 140 enrolled mothers. Ninety-nine percent of mothers enrolled were aware of breastfeeding benefits, and 92% felt adequately supported by maternity staff. Less than 25% stated to have received sufficient information regarding breastfeeding. Only 20% of mothers received information about vaccines during hospital stay. Healthcare providers were identified as primary, secondary, and tertiary source of information on vaccines by 55, 15, and 30% of mothers, respectively. Healthcare professionals are crucial in informing and educating mothers on breastfeeding and vaccinations. Post-partum hospital stay could be the right time for this critical responsibility.

From dyad to triad: a survey on fathers' knowledge and attitudes toward breastfeeding.

Fathers are known to impact breastfeeding outcomes. We aimed to explore paternal knowledge and attitude toward breastfeeding, and possible association with breastfeeding rates at discharge. In this cross-sectional study, we enrolled 200 fathers of healthy term neonates. At discharge, fathers were asked to rate their degree of agreement to 12 items on a 5-point Likert scale. A total score was obtained from their answers. Univariate binary logistic regression analysis was used to verify if the total score was predictive of exclusive breastfeeding at discharge. A multivariable logistic regression model was then used to adjust for possible confounders. ROC analysis was performed, and a Youden's total score cut-off value was determined to define total score's performance in predicting exclusive breastfeeding at discharge. Fathers showed a solid knowledge of maternal (87%) and neonatal (98%) benefits of breastfeeding, skin-to-skin (99.5%), rooming-in (79%), and responsive feeding (67.5%); conversely, only 51% knew about the recommended use of pacifiers. Fathers felt personally involved in babies' feeding in 79% of cases. An association was found between total score and exclusive breastfeeding at discharge at univariate (OR: 1.07, p = 0.04) but not at multivariable analysis (OR: 1.07, p = 0.067). ROC analysis was not statistically significant (AUC 0.58, p = 0.083).Conclusion: By using a novel instrument aimed at quantifying fathers' knowledge and overall attitude toward breastfeeding, this study underlines the importance of including fathers in the promotion of breastfeeding. Expanding the classic mother-baby dyad to a more modern mother-father-baby triad may impact breastfeeding outcomes at discharge. What is known: • Social support plays a major role in improving breastfeeding outcomes. • Fathers may greatly influence initiation and duration of breastfeeding; the more they know, the more helpful they can be. What is new: • A multidisciplinary team created a structured questionnaire aimed at quantifying fathers' knowledge and attitude toward breastfeeding. • The association between a higher questionnaire total score and exclusive breastfeeding rates at discharge highlights the importance of including fathers in the promotion of breastfeeding, as part of the breastfeeding team.

Heart-rate agreement between ECG and a new, wireless device during early skin-to-skin contact.

AIM: To assess the agreement of heart rate (HR) between the new device - a fabric jacket for neonates, with integrated sensors detecting ECG signals and a Bluetooth connection to a computer (ComfTech, HOWDY) - and the clinical reference, ECG, during the skin-to-skin contact (SSC) in the first 2 h after birth, for the potential use of early detection of Sudden and Unexpected Postnatal Collapse (SUPC). METHODS: We enrolled newborns ≥35+0  weeks of gestation, with Apgar score >8 at 5 min in a prospective, observational study in the delivery room, excluding infants with need for resuscitation, clinical instability or major malformations. We assessed HR within 20 min after birth by both devices simultaneously: the index test ComfTech HOWDY and the standard ECG (Vita Guard VG 3100, Getemed). We compared HR between the two methods at 0, 15, 30, 45, 60, 90 and 120 min by the Bland-Altman plot. RESULTS: We included 60 infants. The mean difference between the methods was -1.3 bpm, 95%LoA -12.4 to 9.7 bpm. Spearman rank correlation coefficient ρ = -0.06. CONCLUSION: ComfTech HOWDY presents reliable agreement with the ECG and might assist in identifying infants at risk for SUPC.

[The use of International Classification for Nursing Practice (ICNP) in pediatric and neonatal settings: literature review]. / L'utilizzo della Classificazione Internazionale per la Pratica Infermieristica (ICNP) in ambito pediatrico e neonatale: revisione della letteratura.

INTRODUCTION: Literature reports that the use of Standardized Nursing Terminology contributes to a better implementation of nursing care and patients' safety and to do research. ICNP is an international and combinatorial standard terminology proposal by ICN, adaptable to different settings, among which paediatric and neonatal. METHODS: A literature review on different databases (Medline/Pubmed, CINAHL, Embase, Web of Science and Scopus) was conducted to investigate the use of ICNP in professional practice in paediatric and neonatal settings. RESULTS: 44 papers were included in the review; 33 of which focused on the paediatric setting while 11 on the neonatal setting. It is evident ICNP is usable in both settings, permitting to describe nursing care to different age groups, in-hospital, out-of-hospital and in specific clinical situations. DISCUSSION: ICNP is up to the task of describing nursing care, implementing nursing care plans, analysing types of nursing care for management aims, studying concepts or specific pediatric or neonatal situations. ICNP is adaptable to different nursing frameworks and models. Few studies analyses ICNP implementation or effectiveness in clinical settings. Additional research is needed to verify ICNP effectiveness in paediatric and neonatal settings and to implement contextual catalogues.

Nurses in Family Pediatric Practices: A Survey of the Health Protection Agency of the Metropolitan City of Milan.

PURPOSE: Primary pediatric care in Italy is guaranteed by family pediatricians, who may have their own private offices or work in group clinics that also have nurses/pediatric nurses in order to enrich their offer of services. The aim of this study was to investigate the activities of nurses working in pediatric practices in order to identify and classify the nursing healthcare services offered by the practices themselves. DESIGN AND STUDY: An observational study was conducted including nurses working in the pediatricians' offices who voluntarily agreed to undergo a semi-structured interview. The investigated variables were individual, institutional and organizational. The study sample consisted of 22 nurses with a mean age of 39 ± 13.3 years, 16 of whom were pediatric nurses. RESULTS: All of the nurses stated that they had not received suitable training for working outside a hospital, and that they carried out educational, diagnostic/therapeutic, and bureaucratic administrative/support activities. Nine of the nurses working in group pediatric clinics carried out educational activities autonomously, something that the nurses working in individual or associated clinics did not perform. Twenty of the interviewees also provided telephone consultancy, and 11 of the clinics used algorithms as guides. CONCLUSIONS/PRACTICE IMPLICATIONS: The findings of this study underline the potential of developing the nursing profession at community level. Further studies are desirable in order to extend the investigation of the pediatric nurses' activities implemented at community level in other Italian provinces.

Knowledge and attitude of health staff towards breastfeeding in NICU setting: are we there yet? An Italian survey.

The benefits of human milk in preterm infants, a population at high risk for developing adverse outcomes for which breast milk is a protective factor, are widely acknowledged. However, preterms' admission in a neonatal intensive care unit (NICU) and newborn's clinical conditions have been described as significant barriers, leading to lower rates of breastfeeding initiation and duration. Healthcare workers play a crucial role in encouraging breastfeeding. We conducted a cross-sectional survey among nurses working in six Italian NICUs, exploring their knowledge and attitude towards breastfeeding. Although the majority of nurses had a specific breastfeeding education, our results show still some variations among answers regarding aspects of breastfeeding support in this setting. Specifically, family-centered care, transition feeding to the breast, and skin-to-skin practice, despite being extensively addressed by the Neo Baby-Friendly Hospital Initiative, are the items that highlighted a range of answers that could result in conflicting information to mothers.Conclusion: By underlining the gaps of knowledge and attitude towards breastfeeding of nurses working in NICUs, this study provides an insight into what needs to be improved, with the aim of promoting higher rates of breastfeeding in the preterm population. What is Known: • Breastfeeding is particularly challenging in the preterm population, despite its universally recognized health benefits. • Improving healthcare professionals' knowledge and attitude towards breastfeeding has been shown to be crucial for promoting breastfeeding in NICUs. What is New: • Our results provide useful insight into nurses' knowledge and attitude towards breastfeeding in NICU settings. • By acknowledging strengths and weaknesses highlighted by this study, tailored strategies could be developed to improve health staff breastfeeding education and support to parents in NICU settings.

Exploring the Emotional Breastfeeding Experience of First-Time Mothers: Implications for Healthcare Support.

Background: Among breastfeeding determinants, the unique emotional breastfeeding experience has been poorly explored. The present study aimed to investigate the emotional breastfeeding experience in a cohort of first-time mothers. Materials and methods: We conducted a prospective observational study that enrolled primiparas having delivered singleton healthy term newborns, and exclusively breastfeeding at hospital discharge. At 3 months post-delivery mothers accessed an online questionnaire investigating their emotional breastfeeding experience. The chi-squared test was used to assess the association between the feelings experienced during breastfeeding and feeding outcomes at 3 months. Results: Out of the 421 enrolled mothers, 273 (65%) completed the questionnaire. At 3 months post-delivery exclusive breastfeeding was reported by a 66% of mothers, a 19% reported complementary feeding, and a 15% of mothers reported exclusive formula feeding. Breastfeeding experience was described as positive by 62% of mothers although breastfeeding difficulties were reported by 80% of the mothers. The mothers that had experienced fear, sadness, anger or concern during breastfeeding showed a significant higher exclusive formula feeding rate at 3 months post-delivery than those who did not (25.5 vs. 12.8%, p = 0.021; 28.6 vs. 13.4%, p = 0.02; 40 vs. 13.4%, p = 0.005; 20.5 vs. 11.8%, p = 0.049, respectively). An 85% of mothers stated that their breastfeeding experience was different from what they would have expected, blaming for this discrepancy the occurrence of difficulties during breastfeeding and the complexity of breastfeeding itself (50%), pain experience (8%), being dependent from the baby (6%), and breastfeeding failure (11%). A total of 25% of mothers, however, reported they found breastfeeding to be a much more positive experience than what they had expected. Conclusion: Breastfeeding care should include a tailored emotional support of first time-mothers in addition to the implementation of their breastfeeding knowledge and skills.

Overcoming Rooming-In Barriers: A Survey on Mothers' Perspectives.

Background: The importance of rooming-in in promoting breastfeeding initiation and continuation within the 10 Steps for Successful Breastfeeding is widely acknowledged. However, adherence to this practice by healthcare facilities is lower than that of other Steps. A deeper knowledge of maternal rooming-in experience has been advocated to identify the most effective rooming-in policies, thus enabling mothers to have a positive experience when practicing it in the postpartum period. Aim: To investigate maternal knowledge of rooming-in and the most frequently encountered barriers and possible facilitators of adherence to the practice, according to their experience. Study Design and Methods: We enrolled mothers who delivered healthy term or late preterm infants during the month of January 2019 in a tertiary referral center for neonatal care in Milan, Italy. At discharge, a structured interview about mothers' rooming-in experience was administered by healthcare professionals. Basic subjects' characteristics and mode of feeding were recorded. Results: The enrolled population included 328 mothers and 333 neonates. The great majority of mothers knew of rooming-in and 48.2% practiced it continuously. The 86.3% of mothers was aware of the beneficial effects of rooming-in; promotion of mother-infant bonding, increased confidence in taking care of the baby and ability to recognize baby's feeding cues were the most frequently cited, whereas improving breastfeeding was reported by a limited number of mothers, unless they were asked a specific question about it. The main reported obstacles were fatigue (40.5%) and cesarean section related difficulties (15.5%); night was the most critical time of the day for rooming-in. Strategies suggested by mothers for improving rooming-in were increased assistance to the dyad, organizational and structural changes and the possibility to have a family member during the night. Additionally, mothers who adhered to rooming-in practice continuously during hospital stay had a higher exclusive breastfeeding rate at discharge compared to mothers who did not. Conclusions: Our study contributes to a deeper knowledge of maternal rooming-in experience in an Italian tertiary maternity. We underline the importance of providing a tailored support to the mother-infant dyad in order to overcome rooming-in barriers perceived by mothers and promote a positive rooming-in experience.

Exploring the Gap Between Needs and Practice in Facilitating Breastfeeding Within the Neonatal Intensive Care Setting: An Italian Survey on Organizational Factors.

Introduction: The system-level factors of the neonatal intensive care unit work environment contribute to breastfeeding promotion in the preterm population. The aim of this study was to investigate the operative policies related to breastfeeding support in a sample of Italian Neonatal Intensive Care Units. Materials and Methods: A multicenter cross-sectional survey was conducted, including a sample of 17 head nurses. The items of the questionnaire investigated the following areas: breastfeeding policies, staff education, family centered care, and breastfeeding promotion and support both in the neonatal intensive care units and after discharge. Results: Written breastfeeding policies were available for staff in all the neonatal intensive care units, most commonly addressing procedures related to skin-to-skin contact, human milk expression, and preterm infant breastfeeding. Most of the neonatal intensive care units correctly advised the mothers to initiate milk expression within 6 h from delivery and to pump milk at least 6 times/days. Breastfeeding training for the nursing staff was planned in the majority of the neonatal intensive care units although according to different schedules. With regard to the family centered care implementation, time restrictions were present in seven neonatal intensive care units, mostly occurring during the night shift, and the morning hours concomitantly with medical rounds. Moreover, in the majority of the investigated neonatal intensive care units, the parents were asked to leave the ward when their infant underwent a major invasive procedure or during the nurse/physician shift change report. With regard to breastfeeding promotion and support, eight neonatal care units had a multidisciplinary team with several health care professionals and 10 provided information about community-based support services. Most of the units assessed breastfeeding after discharge. Conclusion: Based on the present findings, enrolled Neonatal Intensive Care Units appear to provide breastfeeding-supportive environments with special regard to breastfeeding policies, milk expression practices, interprofessional collaboration, and continuity of care. Health care professionals should exert efforts to ensure continuous and updated breastfeeding staff education and promote parent-infant closeness and family centered care.

Moral Distress in the Pediatric Intensive Care Unit: An Italian Study.

Introduction: There is paucity of data within the Italian context regarding moral distress in intensive pediatric settings. The aim of the present study was to assess the frequency, intensity, and level of moral distress experienced by nurses working in a sample of pediatric intensive care units (PICUs). Materials and Methods: A cross-sectional questionnaire survey was conducted in eight PICUs from five northern Italian regions in a convenience sample of 136 nurses. Moral distress was evaluated using the modified Italian version of the Moral Distress Scale Neonatal-Pediatric Version (MDSNPV). Each item was scored in terms of frequency and intensity on a five-point Likert scale, ranging from 0 to 4. The total frequency and intensity scores for all the 21 clinical items were comprised between 0 and 84. For each item, the level of moral distress was derived by multiplying the frequency score by the intensity score and quantified with a score ranging from 0 to 16. The total score of the moral distress level for the 21 items ranged from 0 to 336. Results: The mean total scores for the frequency, intensity and level of moral distress were 24.1 ± 10.4, 36.2 ± 18.6, and 57.7 ± 37.1, respectively. The clinical situations identified as the major causes of moral distress among nurses in the present study involved end-of-life care and resuscitation. At multivariate logistic regression analysis, number of deaths occurring in PICUs, having children and intention to leave work due to moral distress resulted to be independently associated with a higher total moral distress level. Conclusions: The results of the present study contribute to the understanding of moral distress experience in acute pediatric care settings, including the clinical situations associated with a higher moral distress level, and highlight the importance of sharing thoughts, feelings and information within the multidisciplinary health care professional team for effective shared decision making, particularly in situations involving end-of-life care and resuscitation.

Do a Few Weeks Matter? Late Preterm Infants and Breastfeeding Issues.

The late preterm infant population is increasing globally. Many studies show that late preterm infants are at risk of experiencing challenges common to premature babies, with breastfeeding issues being one of the most common. In this study, we investigated factors and variables that could interfere with breastfeeding initiation and duration in this population. We conducted a prospective observational study, in which we administered questionnaires on breastfeeding variables and habits to mothers of late preterm infants who were delivered in the well-baby nursery of our hospital and followed up for three months after delivery. We enrolled 149 mothers and 189 neonates, including 40 pairs of twins. Our findings showed that late preterm infants had a low rate of breastfeeding initiation and early breastfeeding discontinuation at 15, 40 and 90 days of life. The mothers with higher educational levels and previous positive breastfeeding experience had a longer breastfeeding duration. The negative factors for breastfeeding were the following: Advanced maternal age, Italian ethnicity, the feeling of reduced milk supply and having twins. This study underlines the importance of considering these variables in the promotion and protection of breastfeeding in this vulnerable population, thus offering mothers tailored support.

Complementary Feeding Practices in a Cohort of Italian Late Preterm Infants.

Limited data are available on complementary feeding in preterm infants, who show increased nutritional needs and are at risk of altered postnatal growth. The aim of this study was to investigate the timing and content of complementary feeding in a cohort of late preterm infants. We conducted a prospective, observational study, including mothers who had given birth to infants admitted to level I or II of care with a gestational age between 34 and 36 weeks. Mothers were contacted at 3, 6 and 12 months after delivery by phone calls and were asked about their infant's mode of feeding and the timing and schedule of the introduction of different solid foods types. A total of 49 mothers and 57 infants completed the study. The mean postnatal age of the introduction of complementary foods was 5.7 ± 0.7 months. Low energy and/or low protein-dense foods were first introduced in most infants. Fruit as the first type of complementary food in the infant's diet was associated with a 1.6-month advance in initiating complementary feeding. The present findings provide further insight into complementary feeding practices in late preterm infants and underline the need for specific recommendations addressing this vulnerable population.

Maternal views on facilitators of and barriers to breastfeeding preterm infants.

BACKGROUND: The supply of breast milk to preterm infants tends to occur at a lower rate than that recorded among term infants. We aimed to investigate the facilitators of and barriers to breastfeeding during hospital stay according to the experiences of mothers that gave birth to premature infants requiring admission to neonatal intensive care unit. METHODS: A cross-sectional questionnaire survey was conducted. Mothers who had delivered a newborn with a gestational age ≤33 weeks requiring intensive care, entered the study. Basic subjects' characteristics and infant feeding practices were also recorded. RESULTS: A total of 64 mothers were enrolled, leading to a total of 81 infants. At discharge, any breastfeeding was recorded in 66% of infants, with 27% of those infants being exclusively breastfed. Any infant was exclusively fed directly at the breast. Most mothers experienced adequate support during their infant's hospitalization and reported satisfaction with breastfeeding. Almost all mothers felt that feeding their infant human milk was beneficial for the infant's health. Thirty percent of the mothers reported that they had experienced some obstacles to breastfeeding. Specifically, infants born to mothers who experienced difficulties in pumping breast milk (OR = 4.6; CI 1.5-13.9) or in providing an adequate amount of milk to the infant (OR = 3.57; CI 1.1-11.5) were at higher risk of being fed with formula at discharge. CONCLUSIONS: On the basis of the present results, health care professionals should target their efforts to optimize breastfeeding support for mothers of premature infants admitted to level III care, especially by improving breast milk production and endorsing direct breastfeeding.

Usefulness of the Infant Driven Scale in the early identification of preterm infants at risk for delayed oral feeding independency.

BACKGROUND: Very preterm infants frequently experience difficulties in achieving feeding independency. The availability of feeding assessment instruments has been recommended to evaluate an infant's readiness for oral feeding and enable preterm infants' caregivers to document each infant's feeding readiness and advancements. AIMS: To investigate the implementation of the Infant Driven Scale in neonatal intensive care units and to identify a cut off value associated with delayed feeding independency. STUDY DESIGN: Prospective, observational, single-centre study. SUBJECTS: A total of 47 infants born at a gestational age≤32weeks, consecutively admitted to a tertiary neonatal unit between July 2015 and March 2016. OUTCOMES MEASURES: The infant's feeding readiness and the postmenstrual age at achievement of feeding independency. RESULTS: Mean postmenstrual age at feeding independency was 35.6±1.34weeks. A linear regression analysis showed that a score≤8 at 32weeks of postmenstrual age was associated with a delay of 1.8weeks in achieving feeding independency. CONCLUSION: The Infant Driven Scale appears to be a useful additional instrument for the assessment of preterm infants' oral feeding readiness and the early identification of the infants at risk for delayed feeding independency.