1. Objectives

To evaluate a feeding readiness instrument compared to no instrument or another instrument on time to establish full oral feeding and duration of hospitalisation in preterm infants

2. How studies were identified

The following databases were searched in February 2016:

• CENTRAL (The Cochrane Library 2016, Issue 1)
• MEDLINE
• EMBASE
• CINAHL
• Clinical.trials.gov
• WHO International Trials Registry and Platform

Reference lists were also searched and the authors directly contacted researchers

3. Criteria for including studies in the review

3.1 Study type

Randomized controlled trials and quasi-randomized trials

3.2 Study participants

Preterm infants (<37 weeks’ gestation) deemed ready on clinical grounds to commence either breast or bottle feeds

(Ready to commence oral feeds on clinical grounds was defined as a clinical impression, which could include gestational age, medical stability, or infant cues, but excluded the use of a formal assessment instrument)

(Studies enrolling infants with congenital malformations, syndromes, or severe neurological problems were excluded)

3.3 Interventions

An instrument used to assess readiness to commence oral breast- or bottle-feeding prior to the initiation of such feeding compared with either no instrument or an alternative instrument

(Instruments must have assessed motor development, behaviour state, physiological parameters, or integrity of oral anatomy, and must have undergone psychometric evaluation including tests for criterion-related or construct validity)

3.4 Primary outcomes

• Time from randomization to full oral feeding
• Duration of hospitalization (from randomization until the end of the trial)

Secondary outcomes included time from randomization until introduction of the first oral feed, age at establishment of first oral feeding, daily weight gain, breastfeeding at hospital discharge, time from randomization to regaining birth weight, parental satisfaction (validated assessment tool), and number of apnoea or bradycardia episodes requiring intervention by the caregiver (stimulation, oronasal suction, increase in delivery of oxygen, assisted ventilation)

4. Main results

4.1 Included studies

No studies meeting the inclusion criteria were identified

• Although two randomized trials evaluating a feeding protocol instrument found were identified, no comparison was made between assessment of feeding readiness using this instrument with no formal assessment or another instrument

4.2 Study settings

How the data were analysed
Two comparisons were planned: a formal instrument to assess readiness to commence oral feeds versus no instrument, and formal instruments to assess readiness to commence oral feeds versus other formal instruments to assess readiness to commence oral feeds. If data had been identified, they were to be pooled to generate risk differences and risk ratios for dichotomous outcomes and mean differences for continuous outcomes, all with corresponding 95% confidence intervals. To explore potential sources of heterogeneity, the following subgroup analyses were planned:

• Gestational age at birth: extremely preterm <28 weeks, very preterm 28 to 31 weeks, mildly preterm 32 to 37 weeks
• Method of feeding: breast versus bottle

5. Additional author observations*

Currently there is no evidence to inform clinical practice on the utility of instruments to assess readiness to commence oral feeding in preterm infants. Most observational research has focused on readiness to bottle feed, and thus further research on readiness to breastfeed is also required.