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Implementing a three-hourly feeding schedule in stable preterm infants to decrease maternal fatigue

  • Aradhya, Abhishek S1
  • Kaur, Inderjot1
  • Gupta, Rima1
  • Kaur, Sonaljot1
  • Shrimanth, Yamasandi Siddegowda1
  • Masih, Parveen Darshan1
  • Kumar, Praveen1
  • 1 Post Graduate Institute of Medical Education and Research, Chandigarh, India , Chandigarh (India)
Published Article
BMJ Open Quality
BMJ Publishing Group
Publication Date
Aug 03, 2021
Suppl 1
DOI: 10.1136/bmjoq-2021-001439
PMID: 34344736
PMCID: PMC8336179
PubMed Central
  • 1506


Background A three-hourly feeding schedule has been shown to be as safe as a two-hourly schedule in preterm neonates. It saves nursing time and may be less tiring for the mothers. However, tradition and apprehensions have prevented its wider acceptance. We used a quality improvement approach to implement a three-hourly feeding schedule in stable preterm infants >32 weeks postmenstrual age (PMA) in our unit through a series of plan–do–study–act (PDSA) cycles. Methods All preterm neonates >32 weeks PMA, who were on full enteral feeds and without any respiratory support were eligible. The key quantitative outcome was maternal fatigue score. Safety was assessed in terms of episodes of hypoglycaemia and feed intolerance. Qualitative experiences from nursing staff were captured. The volume of expressed breastmilk and requirement of formula feeds were also recorded. After recording baseline data on a two-hourly feeding schedule, four PDSA cycles were sequentially completed over 21 weeks. The results of each PDSA cycle informed the change strategy for the next cycle. Results In the baseline phase, five neonates on a two-hourly schedule were studied. In PDSA cycles I, II, III and IV, a cumulative of 122 neonates were studied on a three-hourly schedule. There was a significant decrease in median maternal fatigue score (13 (IQR 8–23) to 3 (IQR 1–6); p=0.01)). Only one neonate had feed intolerance, while two had mild asymptomatic transient hypoglycaemia. Six (5%) neonates were shifted to two-hourly feeds temporarily due to transient reasons. Nursing staff felt mothers could devote more time to Kangaroo mother care. The volume of expressed breastmilk and requirement of formula feeds were not different from the three-hourly schedule. Conclusions It was possible to change the traditional two-hourly feeding schedule to three-hourly in stable preterm infants using a quality improvement approach, while objectively documenting its safety and benefits.

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