NICU Graduates: On Track for Ongoing Feeding Success!

Published by Allyson Goodwyn-Craine on May 28, 2019

This article is reposted with permission from ASHA’s Leader Live blog and shares Sunnyside Medical Center’s three tracks to support feeding skills progression following the NICU.

As each little feeder prepares to transition from our 20-bed, level III neonatal intensive care unit (NICU) to home, the interprofessional team assigns them one of three tracks to support their feeding skills progression. We do this as part of the rounds our team participates in together each day.

This approach helps monitor feeding as babies mature, provides prompt intervention when needed, and supports our ongoing goal of reduced hospital readmissions associated with feeding.

Here’s how each track works to support our smallest patients:

Third track infants receive the guidance of our nurses and lactation nurses to advance their feeding skills. These babies are monitored through our general outpatient pediatrics services after discharge. The pediatrician, dietitian, and lactation registered nurse (RN) monitor the infant’s feeding progress. A neonatologist also calls to check in with the family shortly after discharge. If feeding concerns arise, any of these providers can initiate a referral for an outpatient feeding evaluation with a speech-language pathologist skilled in pediatric feeding and swallowing evaluation and treatment.

Second track infants require a feeding plan generated by our NICU SLPs, occupational and physical therapists (OT/PT) to support their feeding skills. Prior to discharge, they also recommend an outpatient referral to an SLP for continued feeding evaluation. The outpatient SLP works in collaboration with the pediatrician, lactation RNs, and pediatric dietitians as the infant continues to mature.

These infants benefit from specific and evolving interventions after discharge such as special positioning, pacing, or use of a special bottle/nipple they may soon outgrow. We might also make this type of referral for ongoing outpatient services to families who need added support to learn how to provide ongoing feeding intervention and support.

First (or fast) track infants require advanced clinical feeding evaluation by the NICU SLP. These evaluations can include videofluoroscopic or modified barium swallow studies. We also make a plan for treatment to address highly complex medical or feeding concerns often associated with swallowing, craniofacial, cardiac, ongoing endurance, and respiratory conditions.

Keeping the same NICU SLP—who follows the infant throughout their NICU course and develops first-hand knowledge of their feeding progress—creates seamless continuity of care during the transition to an outpatient with this same clinician. The SLP makes an initial outpatient feeding appointment for the infant “on the fast track” prior to discharge.

Some infants receive this follow-up care as soon as three days post-discharge, while others can wait up to two weeks depending upon their needs. The NICU SLP continues to follow the infant for feeding as an outpatient as clinically indicated.

Additional means of monitoring feeding progress

Pediatricians, pediatric dietitians, lactation nurses, and outpatient SLPs are on the front line in working with our NICU graduates.

All disciplines, including the outpatient SLPs, can provide phone, video, or in-office appointments based on the infant’s ongoing needs. Our hospital provides two types of NICU follow-up clinics: One has a neonatologist who monitors progress in collaboration with the infant’s pediatrician. Our multidisciplinary NICU follow-up clinic provides a neonatologist, physical and occupational therapists, pediatric dietitian, social worker and NICU/outpatient SLP. This team monitors overall development and continues to educate and support the family.

Our low-birth-weight infants automatically quality for early intervention services. Anyone on the team can also generate early-intervention referrals when sensory, motor, or other developmental concerns are observed at any time along the way.

Our outpatient pediatric feeding SLPs also receive feeding evaluation referrals from a variety of sources outside the NICU. We work closely with inpatient speech-language pathology colleagues at our local children’s hospitals when infants transfer to our care. In addition, area pediatricians, family practice physicians, lactation RNs, dietitians, head/neck surgeons, and motor therapists do a great job of monitoring feeding progression and weight trajectory in order to direct infants our way anytime they require additional clinical feeding support.

It truly is a collaborative team effort to keep our smallest patients on track for feeding success!

Allyson Goodwyn-Craine, M.S., CCC-SLP, BCS-S, works in the neonatal intensive care unit and outpatient rehabilitation services at Sunnyside Medical Center in Portland, Oregon. She is also an adjunct professor at Portland State University and a guest lecturer at Pacific University.