Date of Award


Document Type


Degree Name

Doctor of Nursing Practice (DNP)

School Name

Donna and Allan Lansing School of Nursing and Health Sciences



Major Advisor

Kelly Ruppel

Second Advisor

Linda Mefford

Third Advisor

Bonnie Hibbs


In the United States, currently, 1 in 10 babies are born premature. Due to the immaturity of their neurological, gastrointestinal, and cardio-respiratory functions, preterm infants can experience the inability to coordinate sucking, swallowing, and breathing that is essential to oral feed. Cue-based oral feeding methods are designed to give the caregiver the ability to recognize signs of readiness and respond appropriately to the infant cues to adjust the manner in which feeding intervention is performed to match the infant’s current state of physiologic tolerance. The Infant Driven Feeding™ program incorporates scales to assess readiness and quality of the oral feeding, along with supportive caregiver techniques. The goal of this project was to implement IDF™ as a feeding practice change in a level II neonatal intensive care unit (NICU) while assessing staff knowledge and the effects on patients born < 37 weeks gestation. Infants in the IDF™ group did not show changes in length of stay. Improvement was seen in the time to full oral feeds in the IDF™ group 28-33.6 weeks gestation with a mean decrease of 2.24 days (p = .59). Nursing knowledge of preterm feeding techniques was also evaluated. Improvement was seen in average test score from 66% to 86% four months post implementation of IDF™. This article offers one level II NICUs methods, outcomes, implications for nursing practice, and administrative recommendations when implementing IDF™.