Evidence-based practice is essential for optimizing outcomes in medicine and therapy. SOFFI® is grounded in evidence, and has been studied in several settings.
SOFFI® is the ONLY evidence-based intervention to date that assessed feeding skills both within the NICU setting AND after discharge, when parents were the primary feeders. Additionally, it is the FIRST intervention that is designed for both premature infants, and infants with medical comorbidities.
Horner, S., Simonelli, A. M., Schmidt, H., Cichowski, K., Hancko, M., Zhang, G., & Ross, E. S. (2014). Setting the Stage for Successful Oral Feeding: The Impact of Implementing the SOFFI Feeding Program With Medically Fragile NICU Infants. J Perinat Neonatal Nurs, 28(1), 59-68.
In 2013, Horner, et al, published data from a tertiary-level NICU, with approximately 600 admissions per year. Data related to feeding, growth and length of stay from a convenience sample of 81 infants pre-SOFFI® training, compared to 75 infants recruited post-SOFFI® training. 65 infants were preterm; 91 were term infants with medical comorbidities. Nearly 2/3 of each cohort had Neonatal Morbidity Index scores of 4 or 5 and were not significantly different (p=0.65). At 3-5 months post-term, semi-structured parent phone interviews related to feeding and growth at home were conducted (n=128).
At the time of discharge, length of stay and growth (g/kg/day) were not significantly different for either the preterm or term infants prior to or after SOFFI® implementation. Preterm infants did reach full oral feedings on average 8.5 days sooner (p=.01) in the cohort cared for after SOFFI®implementation. Shifting the focus from volume-driven to infant-led feedings may have improved feeding experiences without negatively impacting length of stay or growth outcomes. Additionally, to date there is no evidence-based intervention that we know of that reliably shortens length of stay.
Parents were interviewed by telephone when their infant was 3-5 months post-term. At that time, several outcomes were significantly improved in the cohort of infants who were cared for after SOFFI® implementation. Specifically improvements were noted with fewer feeding problems (53% vs. 75%, p=.01), less arching with meals (10% vs 30%, p=.003), less spitting/vomiting with meals (35% vs. 59%, p=.006), and fewer infants were seeing a feeding therapist (25% vs 44%, p=.03). Additionally, two additional questions trended towards significance (p=.06), “gagging with meals”(10% vs 21%) and “discomfort with meals” (10% vs. 21%).
Horner, S., Ross, E., Hancko, M., Simonelli, A. M., Cichowski, K., & Schmidt, H. (2014). The Impact of the SOFFI on Feeding Outcomes of Medically Fragile NICU Infants. Paper presented at the The Physical and Developmental Environment of the High Risk Newborn, St. Petersburg, FL.
A presentation at the Physical and Developmental Environment of the High Risk Newborn, this was a subanalysis of the original cohort. When looking at the outcomes of infants with a Neonatal Morbidity Index score of 4, there were no differences in the number of infants discharging from the hospital either orally feeding exclusively, NG or G-Tube fed exclusively, or a combination of these methods. However, during the parental interviews at 3-5 months post-term, significantly more infants were fully orally fed (p<.03) in the group that were cared for in the hospital after implementation of SOFFI®. Additionally, more of these infants were demonstrating fewer feeding problems, less arching with meals, less spitting/vomiting with meals, less gagging during meals, and fewer infants seeing a feeding therapist (p<.05).
Hanin, M., Nuthakki, S., Malkar, M. B., & Jadcherla, S. R. (2015). Safety and Efficacy of Oral Feeding in Infants with BPD on Nasal CPAP. Dysphagia, 30(2), 121-127.
In 2015, a group of researchers implemented the SOFFI® framework and tested the feasibility of feeding trials while on nasal continuous positive airway pressure with a cohort of term infants with bronchopulmonary dysplasia (BPD). The SOFFI® algorithm guided decisions regarding baseline physiological and behavioral stability, and the need to stop a feeding trial. Data from infants with BPD (37-42 weeks post menstrual age) that were orally fed while on NCPAP (n=26) were compared with those that were exclusively gavage fed on NCPAP (n=27). The cohorts were similar in demographic characteristics such as gender, gestational age, and birth weight, and clinical characteristics such as frequency of intraventricular hemorrhage and surgically corrected patent ductus arteriosus were similar (p>0.05), as were characteristics of respiratory and airway function (p>0.05). However, infants in NCPAP-oral fed group acquired full oral feedings 17 days earlier (median) versus infants who were not orally fed during NCPAP (p<0.05).