An Evidence-Based Approach to Nipple Feeding in a Level III NICU: Nurse Autonomy, Developmental Care, and Teamwork

Historically, nipple feeding in the NICU has been initiated and advanced by physician order based on nursing observation and suggestions. The growing evidence base regarding nipple feeding readiness and progression, contingent caregiving, and nurse autonomy in decision making prompted our Level III NICU to reconsider our process. A literature review and discussions resulted in new protocols for initiating and advancing nipple feedings for three distinct groups: healthy preterm infants, preterm infants with complicated medical courses, and sick term or postterm infants. Through incorporating contingent caregiving, greater autonomy for the bedside nurse, developmental support, and collaboration, we expect to improve outcomes, communication, and problem solving.