Premature and medically complex infants have delayed development of oral feeding skills, leading to prolonged hospitalization, costs, and family stress. There is no "gold standard" infant feeding skill assessment tool for bedside clinicians. The research team developed a novel feeding skill assessment, the SMART Tool, to monitor infant feeding skill development in the neonatal intensive care unit. This study aims to determine whether this tool improves clinical outcomes, including reduced hospital days and enhanced safety and quality of infant feedings.
Infants born between August 1, 2025, and July 31, 2026, AND admitted to NICU
No oral feeding started by July 15, 2026
Single group
SMART Tool
BehavioralThe intervention in this implementation study involves (1) integrating the SMART Tool into electronic health records (EPIC), (2) educating all NICU staff (about 850 nurses, lactation consultants, speech-language pathologists, and physicians), and (3) Quality improvement to reinforce learning.
Length of hospital stay
Days from birth to discharge
Number of days to full oral feeds
Days from birth to full oral feeds
Percent of Nasogastric tube days
Proportion of days with NG
Home Tube Feeding
Proportion of infants discharged home with nasogastric tube or gastrosotomy tubes
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