Question:  I work in a Level 2 special care nursery; it is staffed with PRN OTs and PTs who specialize here. A nurse on the unit has asked me for a guide to knowing when to refer for therapy services, based on evidence based research. She would like us to present this to the RN practice council at our hospital. I am wondering, do you use any guide, or know of research supporting when to refer, other than state requirements (i.e. LBW or drug exposed)?  I am very appreciative of your response in advance!  I really enjoy your Q and A series!!!

Answer: See the guidelines in my 2007 article “An Evidence-based Approach to Nipple Feeding” available on my website. Recent papers by Jadcherla et al (2010), Kirk et al (2007) also profile what I like to call the “high-risk fragile feeder” that would benefit from support by therapy. You also should consider adding those infants who continue to require ventilation or HFNC when approaching 34 weeks PMA, as their respiratory co-morbidities are readily supported by both Kirk and Jadcherla’s findings.

Shaker, C.S. & Woida, A.M. (2007) An evidence-based approach to nipple feeding in a level III NICU: Nurse autonomy, developmental support and teamwork. Neonatal Network, 26:2, 77-83.

Jadcherla, S. R., Wang, M., Vijayapal, A. S., & Leuthner, S. R. (2010). Impact of prematurity and co-morbidities on feeding milestones in neonates: a retrospective study. Journal of Perinatology, 30(3), 201-208.

Kirk, A.T., Alder, S.C. and King, J.D. (2007) Cue-based oral feeding clinical pathway results in earlier attainment of full oral feeding in premature infants. Journal of Perinatology 27(9): 572-8.

I hope this is helpful.

Catherine