Htun, Z.T., Ferrara-Gonzalez, L et al (2025)  Oral Feeding of NICU Infants: A Global Survey of Current Practices and the Potential of Cold Milk Feeding Intervention. Nutrients                         -> available open access on Google Scholar

Summary of key takeaways:

A cross-sectional global electronic survey of 32 institutions across the US was distributed via professional society listservs and closed online professional group forums targeting neonatal providers and feeding therapists from June 2023 to June 2024. A total of 210 complete responses were received from level IV (51%), level III (42%), and level II (5%) NICUs.

The objectives of this study were to (1) Evaluate the prevalence of cold milk feeding as a therapeutic strategy for managing dysphagia in hospitalized infants. (2) Identify the PMA at which oral feeding is typically initiated for those born preterm. (3) Investigate the types of noninvasive respiratory support, such as CPAP and HFNC, that are permitted during oral feeding in hospitalized infants.

Results:

(1) While 30% of the respondents were aware of cold milk feeding as a dysphagia intervention, only 15% of the total respondents reported using it in practice. Among the 32 institutions implementing cold milk practices, only one had an established protocol.

(2) PMA at start of PO:

— data suggests 33-34 weeks PMA remains common (36% reported initiating oral feeds at or before 33 weeks’ , 43% at 34 weeks, and 9% at 35 weeks)

— data showed 70% indicated that feeding readiness cues were used alongside PMA

(2) Feeding protocols for their NICUs: 72% reported having a feeding protocol in place, often incorporating cue-based tools.

(3) Feeding on respiratory support: Most respondents (87.5%) did not allow oral feeding on CPAP, whereas 78% permitted PO on HFNC support (majority required ≤2L)

Conclusions: Although the awareness of cold milk feeding in neonates is increasing, its implementation remains limited and lacks standardization. Significant variability exists in oral feeding practices, particularly regarding feeding during respiratory support. This underscores the need for further research and evidence-based guidelines to ensure safe and consistent care for preterm infants.

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