Infant-Driven Feeding™ Clinical Support

∙Brar G et al. A Quality improvement project to decrease time to full po feeds and to decrease length of stay in premature infants by implementing Infant Driven Feeding guidelines in the NICU. Poster presented by Mercy Children’s at Vermont Oxford Network Quality Meeting; September 20-23, 2018; Chicago IL.

The setting for this QI project was a 30-bed level 3 unit. The project involved premature infants ≤ 32 weeks GA over a 7-month period. A comprehensive QI initiative was implemented to initiate Infant- Driven Feeding™ guidelines using the IDF™ Scale. A retrospective chart review was done to establish the outcome data using the traditional Practitioner Driven plan. Four PDSA cycles were conducted to implement and test changes after implementing IDF guidelines. Results indicated initiation of a comprehensive IDF bundle resulted in a significant reduction (29.6%)  in the time from initiation of oral feeds to full PO feeds; 53.5% reduction in length of stay days; Breastfeeding rates at discharge increased from 20% to 62%; Kangaroo care increased to 40% to 90%; Reduction in length of stay resulted in cost savings of $45,750 per patient.

∙Carlson C, Frazer J. (2020). Introducing Infant Driven Feeding Guidelines in a Level III NICU.(Unpublished manuscript). College of Nursing, Creighton University.

The purpose of this pilot project was to establish the Infant-Driven Feeding™ (IDF™) program for preterm and late preterm infants to facilitate the time to full oral feeds and reduce length of stay. Included were preterm infants who were 32-36 weeks gestation. The design of the project was a retrospective chart review and Vermont Oxford Network (VON) data review, as well as, a prospective chart review and VON data review. Time to initiation of oral feedings was improved post-implementation in 34 and 35-week infants. Time to full oral feedings were decreased by 4.25 days in 32-week infants, 5.44 days in 33 weeks infants, 5.38 days in 34-week infants, 3.64 days in 35-week infants, and 0.16 days in 36-week infants. Time to discharge was improved in 36-week infants by 0.83 days, 35 weeks decreased by 2.86 days, 34 weeks decreased by 4.5 days, 33 weeks decreased by 8.89 days, and 32 weeks decreased by 0.75 days. The IDF™ approach was associated with a significant reduction in time to achieve full oral feeds, and time to discharge in all gestational ages.

∙Fill K, Klasmier N. 3-Years Post implementation: IDF at UPMC Children’s Hospital of Pittsburgh. Poster presented by UPMC Children’s at NANT 2020, Virtual Conference, May.

Quality improvement project in a 55 bed Level IV NICU of 71 retrospective and 80 prospective infants. Implementation of IDF™ resulted in reduced length of stay by mean of 10 days; Decreased time to full oral feedings median of 4 days; Improved nurse knowledge and satisfaction.

∙Frisco, S. & Mohr, L. (2022). Implementing Infant Driven Feeding in the Level IV NICU: A Doctor of Nursing Practice Pilot Project. Association of Women’s Health, Obstetric, and Neonatal Nurses Annual Convention.

PDSA design used to guide the evidence-based practice pilot in a Level IV NICU. Project was a 3-month pilot of 40 infants that demonstrated increased human milk use, maternal lactation support, and decreased length of stay by 1.3 days for infants 33 weeks and above, with potential cost savings of $306,475.00.

∙Gelfer P, McCarthy A, Turange Spruill C. Infant driven feeding for preterm infants: learning through experience. Newborn and Infant Nursing Reviews. 2015;15(2):64-67.

The goal of the project was to incorporate an IDF model of care into large, referral neonatal intensive care unit and to assess its effects on infants born at ≥ 30 weeks gestation. An algorithm detailing an IDF practice, educational programs for the nurses and parents, a chart audit tool, and practice guidelines were developed as quality improvement intervention strategies. Infants in the IDF group attained ad libitum feedings earlier (35.0 ± 1.1 vs. 35.6 ± 1.1 weeks’ PCA, p = 0.008) without compromising weight gain. There was propensity to the earlier hospital discharge and fewer feeding therapist consults in the IDF group, but the results did not reach statistically significant difference.

∙Ilahi Z, et al. Impact of an infant-driven feeding initiative on feeding outcomes in the preterm neonate. Advances in Neonatal Care. 2022;00(0):1-7. DOI: 10.1097/ANC.0000000000001033

This quality improvement project assessed differences in time to first nipple feed (NF), length of hospital stay, and neonatal growth before and after usage of an IDF protocol. Eighty infants were included, 40 prior to and 40 after IDF intervention. Nurses were trained on IDF philosophy and methods prior to initiation. IDF was associated with discharge at a younger corrected gestational age (CGA), attainment of ad lib feeds at a younger CGA, and shorter amount of days between first NF and discharge. Infants utilizing IDF had slower weight gain, demonstrated by a larger drop in z score in the IDF group. The medical team and bedside nurses were able to follow the IDF protocol with few exceptions.

∙Jeanson E, Schumacher BK. Applying the four disciplines of execution to promote culture change in the NICU. Pediatric Nursing. 2021;47(5):240-243.

In this large regional level 4 NICU, a culture change project using a unique change model The Four Disciplines of Execution (4DX) was utilized while implementing IDF™. The project goal was to reduce cost of care by 5% in 12 months’ time. Lead and lag measures, including education completion, breastfeeding rates, cost of supplies, and length of stay, were used to demonstrate change over time. Between 2018 and 2019. All premature infants admitted to the NICU were enrolled in the IDF™ program. Following this project, the NICU reduced cost of feeding supplies by $78,000 and length of stay by about 14 days. A full 100% of staff completed education, and breastfeeding experiences increased by 92%.

∙Macho, P. Implementation of Infant Driven Feeding protocol in a level IV Neonatal intensive care unit. Presentation, Cohen Children’s Medical Center of New York, Northwell Health, Gravens conference 2018, Fl.

In a level 4 65-bed NICU, after the completion of online education module and implementation of the Infant-Driven Feeding protocol, infants reached full oral feedings 10 days earlier than pre IDF; length of stay decreased by 4.1 days with subsequent decreased hospital costs. Parents expressed less frustration and stress related to feedings and increased knowledge of readiness to feed and disengagement cues, along with increased knowledge of need for gavage vs po feeding.

∙McKenna LL, Bellini S, Whalen M, Magri E, Akerman M. Implementing an Evidence-Based Feeding Protocol: Impact on Nurses’ Knowledge, Perceptions, and Feeding Culture in the NICU. Adv Neonatal Care. 2022 Dec 1;22(6):493-502. doi: 10.1097/ANC.0000000000000923.

A pre-/post prospective comparative design was used to survey 120 registered nurses employed in a level 3 NICU about feeding practices, knowledge, and culture prior to IDF education and 1 to 2 months after IDF implementation. Postimplementation responses were significant for fewer nurses making decisions to begin oral feedings ( P = .035), greater use of gestational age to increase frequency of oral feeding attempts ( P = .03), less reliance on weight loss to decrease oral feeding attempts ( P = .018), an increase in use of combination interventions to prepare infants for oral feeding ( P = .001), and greater willingness to allow a rest period or stop the feeding if an infant falls asleep after completing 70% of the feeding ( P = .03). Although not statistically significant, results with clinical significance was noted trends for a heightened awareness of, and responsiveness to, infants states and behavioral cues.

∙Perry L, Allen R. Timing is everything! Reduced length of stay with Infant Driven Feeding protocol. Poster presented by McLane Children’s at NANT 2020, Virtual Conference, May.

A quality improvement initiative was completed at Baylor Scott & White McLane Children’s Medical Center for infants 30-34.6 weeks gestation that were admitted and assessed for fiscal year 2018 and 2019. Four cycles of PDSA interventions were implemented to improve the utilization of Infant-Driven Feeding. Results: At the end of PDSA cycle 4–Infants that followed protocol had a reduced LOS by 2.37 days compared to infants that did not follow protocol; $217,900 cost savings from infants following the protocol; Infants fed according to protocol had a shorter time to full feeds with median of 12 days vs 15 days; Missed revenue of $141,840 from infants that did not follow protocol; The NICU’s FY 2019 Observed/Expected ratio was 0.74 compared to FY 2018 0.84

∙Thomas T, Goodman R, Jacob A, Grabher D. Implementation of cue-based feeding to improve preterm infant feeding outcomes and promote parents’ involvement. JOGNN. 2021;50(3):328-339. DOI:

A level III NICU in the US Northeast implemented the Infant-Driven Feeding program through staff education and training. A retrospective review of medical records of 82 preterm infants before implementation and 167 preterm infants after implementation for the outcomes of time to achieve full oral feedings, length of stay, and parents’ involvement in the process. Results indicated for infants 23 0/7 weeks to 27 6/7 weeks gestation, time to achieve full oral feedings decreased by 7 days, length of stay decreased by 4.4 days, and parents’ involvement in the feeding process increased by 80% from before to after implementation. For infants 28 0/7 weeks to 31 6/7 weeks, time to achieve full oral feedings decreased by 6.6 days, length of stay decreased by 2.7 days, and parents’ involvement in the feeding process increased by 49% from before to after implementation. The organization saved $103,950 per year by decreasing length of stay.