A National Survey on Oral Feeding Management Practices Across Canadian Neonatal Intensive Care Units

To explore oral feeding management practices, specifically initiation and advancement of oral feeds, across level II and III neonatal intensive care units (NICUs) in Canada. A national online survey was conducted across 65 NICUs (34 level II, 31 level III), which included questions on hospital demographics and clinical approaches for initiating, advancing, and managing oral feeds. A descriptive analysis was performed on the responses. Of the 65 NICUs surveyed, 74% (n = 48) completed the survey. Many reported using custom-developed NICU guidelines for initiating and advancing oral feeds (n = 22, 46%), while few used evidence-based protocols (n = 16, 33%) or standardized assessments (n = 1, 2%). The most common clinical factors considered for initiating and advancing oral feeds include, behavioral cues (n = 47, 98%), stable vital signs (n = 47, 98%), gestational age (n = 43, 90%), and suck-swallow-breathe coordination (n = 26, 54%). Most units utilized a multidisciplinary approach (n = 38, 79%) with family involvement (n = 38, 79%). Feeding issues were typically addressed only during hospitalization, with no post-discharge follow-up (n = 31, 65%). This study revealed significant variation in oral feeding management practices across Canadian level II and III NICUs and highlights a shift toward evidence-based clinical factors for oral feeding initiation and advancement. These findings highlight the need for standardized, evidence-based guidelines to ensure consistent and optimal care in NICUs.