Marc Belcastro

I have practiced neonatology for 27 years and have seen trends come and go and come back again. I have seen mishaps and great new therapies and technologies. One thing is for certain, the more we learn about our preterm infant cues and behaviors, the better we do at managing certain aspects of care. This probably falls under the umbrella of “patient centered care”.

For years I watched as we struggled with deciding when, how often, and how fast we should progress a preterm infant’s PO feeding as we knew this was dependent on neurologic pathways (barring any underlying disease states). We have learned that the development of these pathways can be observed in the growing preterm infant as specific behaviors and alert states. That is, the infant can be the driver of when to begin PO feeding. Thus, the “Infant Driven Feeding” system.

While this is physiologically sound, it is also elegant and simple. We write one order, “Infant Driven Feedings”, and when that magical time arrives, we write, “ad lib”. We find that infants are often ready to PO sooner than we realized, thus shortening their length of stay. A bonus is that the transition to breast feeding with this system is also quite simple and seamless. We just put the infant to breast when the order is written for ‘Infant Driven Feedings” and gavage based on time at the breast. This can continue as long as the mother “drives” the process. So now we have mother and infant driven feedings. It doesn’t get much better than that.