Effect of Cue-based feeding on weight gain among preterm neonates born at 28 to 34 weeks of gestation at Kiwoko Hospital

Abstract

Background: In Uganda, preterm birth contributes significantly to neonatal morbidity and mortality, affecting an estimated 10–15% of all live births. Feeding difficulties due to immature sucking and swallowing mechanisms often hinder growth and recovery in these infants. Cue-based feeding, an individualized approach that relies on infant readiness cues rather than fixed feeding schedules, is increasingly recognized as a promising strategy for enhancing feeding efficiency, physiological stability, and growth outcomes in preterm infants. This study aimed to assess the effect of cue-based feeding on weight gain, measured by weight-for-age Z-scores (WAZ), among preterm neonates aged 28-34 weeks at Kiwoko Hospital. Methods: A facility-based retrospective cohort study was conducted at Kiwoko Hospital Special Care Unit, Uganda, using records of preterm neonates aged 28-34 weeks admitted between April 2017 and February 2022. Cohorts managed with volume-driven feeding (2017-2019) and those with cue-based feeding (2020-2022), separated by a nine-month washout period to prevent overlap were analyzed. Eligible neonates were admitted within 48 hours of birth and hospitalized for at least 21 days. Data were extracted from the hospital’s electronic neonatal database and verified against physical files. The primary outcome was weight-for-age z-score (WAZ) at day 21; secondary outcomes included weight velocity, change in WAZ, time to full oral feeds, and length of stay. Data were analyzed in Stata 19 using descriptive statistics, t-tests, chi-square tests, and multivariable linear regression adjusting for key maternal and neonatal covariates. Results: A total of 343 preterm infants were analyzed, 160 managed with volume-driven feeding and 183 with cue-based feeding. Infants in the cue-based group had significantly higher mean weight-for-age z-scores at day 21 (adjusted mean difference = 0.22; 95% CI: 0.07–0.38; p = 0.005) and greater weight velocity (adjusted mean difference = 2.06 g/kg/day; 95% CI: 1.12–3.00; p < 0.001). Although crude analyses showed a shorter hospital stay in the cue-based group (35.9 vs. 39.9 days; mean difference = –4.0; 95% CI: –7.1 to –1.0; p = 0.011), this difference was not significant after adjustment (adjusted p = 0.118). Time to full feeds did not differ between groups (mean difference = 0.3 days; 95% CI: –1.7 to 2.3; p = 0.777). Conclusion: Cue-based feeding significantly improved weight gain among preterm infants within the first three weeks of life. There was no significant difference in hospital stay and time to full feeds. Despite this, these findings suggest that, when implemented with trained staff and caregiver involvement, cue-based feeding promotes more effective weight gain and improved early growth outcomes among preterm infants, supporting its potential as a beneficial feeding approach in resource-limited neonatal care settings.