Advances in Neonatal Care • Vol. 11, No. 3 • pp. 149-154 149 Copyright © 2011 National Association of Neonatal Nurses. Unauthorized reproduction of this article is prohibited. LINDA IKUTA, RN, MN, CCNS, PHN • Section Editor Feeding Intolerance A Concept Analysis Tiffany A. Moore, PhD(c), BS, BSN, RN; Margaret E. Wilson, PhD, CPNP infant population. 2 Therefore, FI is a recognized phe- nomenon that draws the attention of the researcher and the clinician. However, a clear and universal def- inition of FI is lacking despite the term’s frequent use in literature. 3 Furthermore, a distinction between FI as a result of an immature digestive adaptation to enteral feeding and Bell’s Stage 1 of NEC 4 is needed for clini- cians to develop an appropriate plan of care. Thus far, the numerous studies of FI have aimed at reducing the incidence and/or improving symptoms. However, varying definitions of FI have prevented comparison analyses to formulate conclusive guidelines for clini- cians to use in practice. In a recent Cochrane review of the use of erythromycin in the improvement and/or prevention of FI, 5 the authors reported that a meta-analysis was not performed because the diverse definitions of FI made this type of analysis unfeasible. Although the term feeding intolerance is repeatedly used throughout the literature, a thorough examination of the fundamental elements of FI as a concept was not found. Furthermore, a difference between idiopathic FI and NEC for conceptual and operational defini- tions is lacking. The purpose of this concept analysis was to clarify the phenomenon of FI and to provide a universal conceptual and operational definition for researchers and clinicians to use in practice theory. IDENTIFY USES OF THE CONCEPT Dictionary Definitions The definition of feeding intolerance, as one word, was not found in any dictionary. Therefore, the terms feeding and intolerance will be defined separately. Author Affiliations: University of Nebraska Medical Center, Omaha. Correspondence: Tiffany A. Moore, PhD(c), BS, BSN, RN, 985330 Nebraska Medical Center, Omaha, NE 68198 (tamoore@ unmc.edu). Copyright © 2011 by The National Association of Neonatal Nurses DOI: 10.1097/ANC.0b013e31821ba28e ABSTRACT Feeding intolerance is a well-known phenomenon in the NICU and is linked to morbidity and mortality in the premature infant. However, a universal definition for this concept is lacking. Properly defining a concept is a key step in a successful research project. A concept analysis is an examination of the fundamental elements of a concept to bring clarification and definition to the topic of interest. The purpose of this concept analysis was to clarify the phenomenon of feeding intoler- ance in the premature infant and to provide a universal conceptual and operational definition for researchers and clinicians to use in practice theory. KEY WORDS: enteral nutrition, feeding intolerance, infant, intensive care, neonatal, premature A concept analysis is an approach used in all levels of theory development to bring clarifi- cation and definition to a topic of interest. This is a crucial exercise because it adds rigor to research. A concept analysis is an examination of the fundamental elements of a concept used to refine ambiguous concepts in theory, clarify vague phe- nomena in practice, and provide an operational def- inition to support a concept’s theoretical base. 1 Several methods are available to conduct a thorough concept analysis. The concept feeding intolerance was selected and evaluated using the analysis method described by Walker and Avant. 1 PURPOSE OF ANALYSIS Feeding intolerance (FI) in the premature infant is a common and well-known setback for patients in the NICU. Although the exact mechanism is unclear, FI is often associated with necrotizing enterocolitis (NEC), a gastrointestinal disease that is a leading cause of morbidity and mortality in the premature