Preterm infant cues during breastfeeding and its measurement: A scoping review

Background: Preterm infants display certain behaviors to communicate their needs, known
as preterm infant cues. However, the existing research on preterm infant cues primarily draws
from studies conducted on bottle-fed infants rather than breastfed infants.
Objective: This study aimed to investigate the concept of preterm infant cues during
breastfeeding and its appropriate instruments.
Design: A scoping review.
Data Sources: The articles published up to January 2022 were searched from multiple
sources from EBSCOhost Web, namely CINAHL Plus with Full Text, MEDLINE, ERIC, and EJournals.
Review Methods: The articles retrieved for this review were screened using PICO
(Population, Intervention, Comparison, and Outcomes) format. Preferred Reporting Items for
Systematic Reviews (PRISMA) checklist was used in selecting the articles, and Joanna Briggs
Institute Critical Appraisal was utilized by two independent authors to assess the articles’
quality. A descriptive method was used to analyze the data.
Results: The initial review stage found 183 potential articles, but only four satisfied the criteria.
The notion of preterm infant cues during breastfeeding is centered on the actions of preterm
infants while positioned on their mother's chest. These feeding cues are identifiable before,
during, and after breastfeeding and include cues for hunger, self-regulation, stress, satiation,
approach, avoidance, and sucking quality. To effectively recognize these cues, tools such as
the Preterm Infants Cues Coding System (PFCCS), Infant Driven Scale (IDS), Newborn
Individualized Developmental Care and Assessment Program (NIDCAP), and Preterm
Breastfeeding Behavior Scale (PIBBS) can be utilized.
Conclusion: The study findings highlight the importance of recognizing preterm infant cues
during breastfeeding to facilitate proper feeding and developmental care. Observational
studies have proven to be an effective means of observing these cues during breastfeeding.
By leveraging the cues identified in this review alongside tools such as PFCCS, IDS, NIDCAP,
and PIBBS, nurses can accurately interpret preterm infants' breastfeeding cues in neonatal
care settings of all levels. This, in turn, can aid in developing care plans that promote better
feeding ability outcomes.