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Schanz WR, Akhter A, Richardson G, Story WT, Samuelson R, Imdad A. Perceptions of families and healthcare providers about feeding preterm infants in the neonatal intensive care unit: protocol for a qualitative systematic review. BMJ Open 2024; 14:e084884. [PMID: 38908851 PMCID: PMC11328663 DOI: 10.1136/bmjopen-2024-084884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2024] Open
Abstract
INTRODUCTION The underdevelopment of preterm infants can lead to delayed progression through key early milestones. Demonstration of safe oral feeding skills, constituting proper suck-swallow reflex are requirements for discharge from the neonatal intensive care unit (NICU) to ensure adequate nutrition acquisition. Helping an infant develop these skills can be draining and emotional for both families and healthcare staff involved in the care of preterm infants with feeding difficulties. Currently, there are no systematic reviews evaluating both family and healthcare team perspectives on aspects of oral feeding. Thus, we first aim to evaluate the current knowledge surrounding the perceptions, experiences and needs of families with preterm babies in the context of oral feeding in the NICU. Second, we aim to evaluate the current knowledge surrounding the perceptions, experiences and needs of healthcare providers (physicians, advanced practice providers, nurses, dietitians, speech-language pathologists and occupational therapists) in the context of oral feeding in the NICU. METHODS AND ANALYSIS A literature search will be conducted in multiple electronic databases from their inception, including PubMed, CINHAL, Embase, the Cochrane Central Register for Controlled Trials and PsycINFO. No restrictions will be applied based on language or data of publication. Two authors will screen the titles and abstracts and then review the full text for the studies' inclusion in the review. The data will be extracted into a pilot-tested data collection sheet by three independent authors. To evaluate the quality, reliability and relevance of the included studies, the Critical Appraisal Skills Programme checklist will be used. The overall evidence will be assessed using the Grading of Recommendation Assessment, Development and Evaluation criteria. We will report the results of the systematic review by following the Enhancing Transparency in Reporting the synthesis of Qualitative research checklist. ETHICS AND DISSEMINATION Ethical approval of this project is not required as this is a systematic review using published and publicly available data and will not involve contact with human subjects. Findings will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023479288.
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Affiliation(s)
- Willow R Schanz
- The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Aunum Akhter
- Division of Neonatology, The University of Iowa Health Care, Stead Family Department of Pediatrics, Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Georgette Richardson
- Division of Pediatric Psychology, The University of Iowa Health Care, Stead Family Department of Pediatrics, Iowa City, Iowa, USA
| | - William T Story
- Department of Community and Behavioral Health, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Riley Samuelson
- University of Iowa Hardin Library for the Health Sciences, Iowa City, Iowa, USA
| | - Aamer Imdad
- Division of Gastroenterology, Hepatology, Pancreatology and Nutrition, University of Iowa Health Care, Stead Family Department of Pediatrics, Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
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Boctor DL, Fenton TR, Goulet O, Lambe C. Pediatric Intestinal Failure Associated Eating Disorder: An Overview of the Importance of Oral Feeding in a Population at Risk for Feeding Difficulties. Gastroenterol Clin North Am 2024; 53:309-327. [PMID: 38719381 DOI: 10.1016/j.gtc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Achieving feeding skills and food acceptance is a multi-layered process. In pediatric intestinal failure (PIF), oral feeding is important for feeding skills development, physiologic adaptation, quality of life and the prevention of eating disorders. In PIF, risk factors for feeding difficulties are common and early data suggests that feeding difficulties are prevalent. There is a unique paradigm for the feeding challenges in PIF. Conventional definitions of eating disorders have limited application in this context. A pediatric intestinal failure associated eating disorder (IFAED) definition that includes feeding/eating skills dysfunction, psychosocial dysfunction, and the influence on weaning nutrition support is proposed.
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Affiliation(s)
- Dana Liza Boctor
- Alberta Children's Hospital, Section of Gastroenterology, Hepatology and Nutrition, University of Calgary, Calgary, 28 Oki Drive NW, Calgary, Alberta T3B-6A8, Canada.
| | - Tanis R Fenton
- Department of Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 3rd Floor, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Olivier Goulet
- Department of Pediatric Gastroenterology-Hepatology-Nutrition, National Reference Center for Rare Digestive Diseases, Pediatric Intestinal Failure Rehabilitation Center, Hôpital Necker-Enfants Malades, Université Paris Cité, 149 Rue de Sèvres, Paris 75015, France
| | - Cecile Lambe
- Department of Pediatric Gastroenterology-Hepatology-Nutrition, National Reference Center for Rare Digestive Diseases, Pediatric Intestinal Failure Rehabilitation Center, Hôpital Necker-Enfants Malades, Université Paris Cité, 149 Rue de Sèvres, Paris 75015, France
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3
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Genç C, Gözen D, Narter F. Elastic sac to support oral feeding performance of preterm infants: Crossover randomized controlled study. Nutr Clin Pract 2024. [PMID: 38824273 DOI: 10.1002/ncp.11161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/26/2024] [Accepted: 05/10/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Swaddling is recommended for preterm infants during feeding. Swaddling preterm infants with elastic cotton materials allows infants to easily stretch and move their extremities. This study aimed to assess the effect of bottlefeeding in a novel "elastic sac" on physiological parameters and feeding performance of preterm infants. METHODS A randomized controlled, crossover trial was conducted with total of 26 preterm infants at 26-36+6 weeks of gestation. Infants randomly assigned to group 1 (n = 13) were bottlefed in an elastic sac (researcher-designed single-piece pouch made of soft, elastic cotton) for the first feeding and in normal clothes for the next feeding. Infants randomly assigned to group 2 (n = 13) were fed first in normal clothes and then in the elastic sac. The physiological parameters and feeding performance of the infants were assessed during each feeding. RESULTS Preterm infants fed in the elastic sac had lower heart rate and higher oxygen saturation during and after feeding than infants fed in normal clothes (P < 0.05). Although all values were within clinically normal ranges, the findings suggest that feeding preterm infants in the elastic sac had a favorable effect on physiological parameters compared with feeding in normal clothes. There was no significant difference in the infants' feeding performance (P > 0.05). CONCLUSION A semielevated right lateral position and flexed body posture are recommended while feeding preterm infants, which can be easily maintained using the elastic sac. Feeding preterm infants in an elastic sac may support physiologic stability during oral feeding.
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Affiliation(s)
- Canan Genç
- Nursing Department, Faculty of Health Sciences, Fenerbahce University, Istanbul, Turkey
- Institute of Graduate Studies, Doctorate Program of Pediatric Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Duygu Gözen
- School of Nursing, Koç University, Istanbul, Turkey
| | - Fatma Narter
- Department of Pediatrics, Division of Neonatology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
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Neu J, Ashley P, Chowdhary V, Lampland A, Porcelli P, Rothstein R, Slancheva B, Kronström A, Rastad J, Strömberg S, Thuresson M. Progression of Enteral Feeding Volumes in Extremely Low Birth Weight Infants in the "Connection Trial". Am J Perinatol 2024; 41:e2717-e2726. [PMID: 37683670 DOI: 10.1055/s-0043-1774314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
OBJECTIVE Investigate daily feeding volumes and their association with clinical variables in the early postnatal care of premature infants of the "Connection Trial." STUDY DESIGN A total of 641 infants of 510 to 1,000-g birth weight (BW, mean: 847 g) and mean 27 weeks' gestational age at birth (GA) were analyzed for total daily enteral (TDE) feeding volumes of 10, 20, 40, 80, and 120 mL/kg/d and their association with 24 clinical variables. Uni- and multivariable Cox regression models were used to calculate hazard ratios (HR) with 95% confidence intervals as a measure of the chance of reaching each of the TDE volumes. RESULTS Daily feeding volumes were highly variable and the median advancement from 10 to 120 mL/kg/d was 11 mL/kg/d. Univariable analyses showed the lowest chance (HR, 0.22-0.81) of reaching the TDE volumes for gastrointestinal (GI) serious adverse events (SAEs), GI perforation, GI obstruction, and necrotizing enterocolitis, as well as respiratory SAEs, persistent ductus arteriosus, and hypotension. Each GA week, 100-g BW, and point in 5-minute Apgar score at birth associated with 8 to 20% increased chance of reaching the TDE volumes. Multivariable analyses showed independent effects for BW, GA, Apgar score, GI SAEs, abdominal symptoms/signs, respiratory SAEs, days on antibiotics, and hypotension. CONCLUSION This observational analysis demonstrates the variable and cautious progression of enteral feedings in contemporary extremely low BW infants and the extent to which clinical variables associate with this progression. KEY POINTS · Total feedings of 10 and 120 mL/kg/d were reached at median 4 and 14 day of age, respectively, and at a daily increase of 11 mL/kg.. · Each incremental GA week, 100-g BW, and point in 5-minute Apgar score associated with 8 to 20% increased chance of reaching enteral feedings of 10 to 120 mL/kg/d.. · Progression of enteral feeding associated with several clinical events and was slower than advocated in common feeding protocols..
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Affiliation(s)
- Josef Neu
- Department of Pediatrics, University of Florida Health Shands Children's Hospital, Gainesville, Florida
| | - Patricia Ashley
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Vikas Chowdhary
- Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Andrea Lampland
- Department of Neonatology, Children's Minnesota St. Paul Clinic, Saint Paul, Minnesota
| | - Peter Porcelli
- Department of Pediatrics, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Robert Rothstein
- Department of Pediatrics, Baystate Children's Hospital, Springfield, Massachusetts
| | - Boriana Slancheva
- Department of Neonatology, Medical University of Sofia, Sofia, Bulgaria
| | | | - Jonas Rastad
- Infant Bacterial Therapeutics Inc., Stockholm, Sweden
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Kelich F, Qalehsari MQ, Zabihi A, Jafarian Amiri SR, Danaee N. The effect of oropharyngeal mother's milk on nutritional outcomes in preterm infants: a randomized controlled trial. BMC Pediatr 2024; 24:155. [PMID: 38439006 PMCID: PMC10910779 DOI: 10.1186/s12887-024-04621-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/06/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Oropharyngeal interventions are an accepted method to improve the nutritional performance of premature infants. Considering the countless benefits of breast milk and the few studies on the use of breast milk as an oral-pharyngeal intervention, this study was conducted with the aim of determining the effect of oral-pharyngeal administration of breast milk on nutritional outcomes in premature infants. MATERIALS AND METHODS In this clinical trial, 80 premature infants hospitalized in the neonatal intensive care unit of Amir al-Mu'minin Hospital in Semnan (a city in Iran) were randomly assigned to intervention (n = 40) and control groups (n = 40). Infants in the intervention group were given breast milk, and infants in the control group were given sterile water as a placebo. The data collection tool included demographic and clinical questions checklist, including sex, gestational age, weight, milk administration time, lavage and its amount, vomiting, abdominal distension, and so on. Data analysis was performed using SPSS23. RESULTS The mean volume of total milk received by infants (p = 0.047) and the mean volume of milk received by mouth (p < 0.000) at the time of discharge were higher in the intervention group. Moreover, the time to start enteral nutrition in the intervention group was lower than in the control group (P = 0.012). Administering mother's milk through the oropharyngeal method led to a reduction in infants' length of stay in the hospital (P = 0.022). CONCLUSION Based on the results of the present study, the oropharyngeal administration of breast milk in the first days after the birth of premature infants admitted to the hospital improves the outcomes related to their nutritional status. Therefore, it is suggested that this convenient, safe, and feasible method be used in hospitalized premature infants as soon as possible so that premature infants can benefit from the important advantages of breast milk.
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Affiliation(s)
- Fatemeh Kelich
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Mojtaba Qanbari Qalehsari
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Zabihi
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Navid Danaee
- Pediatric Research Center, School of Medicine, Associate Professor of Neonatal-Perinatal Medicine, Semnan University of Medical Sciences, Semnan, Iran
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Cresi F, Maggiora E, Capitanio M, Bovio C, Borla F, Cosimi S, Enrietti D, Faggiano F, Loro S, Rovei SM, Runfola F, Scrufari M, Taglianti MV, Vignali F, Peila C, Coscia A. Effects of a valved infant-bottle with ergonomic teat on the coordination of sucking, swallowing, and respiration in late-preterm infants. The Safe Oral Feeding randomized Trial. Front Pediatr 2024; 12:1309923. [PMID: 38283629 PMCID: PMC10808751 DOI: 10.3389/fped.2024.1309923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Introduction Breastfeeding naturally enables the coordination of sucking, swallowing, and respiration patterns for safe feeding. When breastfeeding is not possible a feeding device that releases milk in response to intra-oral vacuum could potentially offer improved coordination of sucking, swallowing, and breathing patterns compared to conventional devices. The aim of the study is to evaluate the effect of a valved infant-bottle with an ergonomic teat compared to a standard infant-bottle. Methods This unblinded randomized controlled trial focused on late preterm infants fed by bottle for at least three meals over the day, admitted to the Neonatal Unit of Sant'Anna Hospital (Turin, Italy). Infants were randomized to be fed with a valved infant-bottle with an ergonomic teat (B-EXP arm) or with a standard infant-bottle (B-STD arm). Monitoring included a simultaneous synchronized recording of sucking, swallowing and respiration. The main outcome was the swallowing/breathing ratio. Results Forty infants (20 B-EXP arm; 20 B-STD arm) with a median gestational age of 35.0 weeks (IQR 35.0-36.0 weeks) completed the study. Four infants were censored for the presence of artifacts in the polygraphic traces. The median swallowing/breathing ratio was 1.11 (1.03-1.23) in the B-EXP arm and 1.75 (1.21-2.06) in the B-STD (p = .003). A lower frequency of swallowing events during the inspiratory phase of breathing was observed in B-EXP arm compared with B-STD arm (p = 0.013). Discussion The valved infant-bottle with an ergonomic teat improves the coordination of sucking-swallowing-respiration and limits the risk of inhalation reducing the frequency of swallowing during the inspiratory phase.
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Affiliation(s)
- Francesco Cresi
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Elena Maggiora
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Martina Capitanio
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Cecilia Bovio
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Federica Borla
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Sara Cosimi
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Desirèe Enrietti
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Francesca Faggiano
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Sara Loro
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Serena Maria Rovei
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Federica Runfola
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Mariangela Scrufari
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Michela Vigna Taglianti
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Federica Vignali
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Chiara Peila
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Alessandra Coscia
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Obsterics and Gynecology, Città Della Salute e Della Scienza di Torino, Turin, Italy
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Dekker DM, van Brakel M, van den Akker CH, Plötz FB. Enteral Feeding for Moderately Premature and Low Birth Weight Infants: A Single-Center Retrospective Observational Cohort Study. JPGN REPORTS 2023; 4:e288. [PMID: 37200721 PMCID: PMC10187862 DOI: 10.1097/pg9.0000000000000288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/13/2023] [Indexed: 05/20/2023]
Abstract
Controversy exists in clinical practice regarding optimal initial enteral feeding (EF) for moderately premature and low birth weight (BW) infants. We included 96 infants stratified into 3 groups (I: 1600-1799 g [n = 22]; II: 1800-1999 g [n = 42]; III: 2000-2200 g [n = 32]). The protocol recommended starting with minimal EF (MEF) in infants weighing <1800 g. On the first day of life, 5% of the infants in group I did not follow the protocol mandating MEF, but started with exclusive EF instead, compared to 36% and 44% of the infants in groups II and III, respectively. The median number of days until exclusive EF was achieved was 5 days longer for infants receiving MEF than for infants who had received normal portions of EF from birth onward. We observed no significant differences in feeding-related complications. We advocate omitting MEF in moderately premature infants with a BW of 1600 g or higher.
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Affiliation(s)
- Dorita M.Z. Dekker
- From the Tergooi MC, Department of Pediatrics, Blaricum, The Netherlands
| | - Monique van Brakel
- From the Tergooi MC, Department of Pediatrics, Blaricum, The Netherlands
| | - Chris H.P. van den Akker
- Amsterdam UMC, location University of Amsterdam, Emma Children’s Hospital, Department of Pediatrics—Neonatology, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Frans B. Plötz
- From the Tergooi MC, Department of Pediatrics, Blaricum, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC, location University of Amsterdam, Emma Children’s Hospital, Department of Pediatrics, Amsterdam, The Netherlands
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Barnes C, Herbert TL, Bonilha HS. Parameters for Orally Feeding Neonates Who Require Noninvasive Ventilation: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-20. [PMID: 37098117 DOI: 10.1044/2023_ajslp-22-00259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE Infants hospitalized in the neonatal intensive care unit (NICU) may be orally fed while receiving noninvasive ventilation (NIV), but the practice is variable and decision criteria are not well understood. This systematic review examines the evidence regarding this practice, including type and level of NIV used during NICU oral feeding, protocols, and safety of this practice. METHOD The PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched to identify publications relevant to this review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to ensure the appropriate inclusion of articles. RESULTS Fourteen articles were included. Seven studies (50%) were retrospective. Two were quality improvement projects, and the remaining five (35.7%) were prospective. Continuous positive airway pressure and high-flow nasal cannula were commonly used. Levels of respiratory support were variable between studies, if reported at all. Three studies (21.4%) included feeding protocols. Six studies (42.9%) identified use of feeding experts. While many studies commented that orally feeding neonates on NIV is safe, the only study to instrumentally assess swallow safety found that a significant number of neonates silently aspirated during feeding on continuous positive airway pressure. CONCLUSIONS Strong data supporting practices related to orally feeding infants in the NICU who require NIV are scarce. The types and levels of NIV, and decision-making criteria, are variable across studies and preclude clinically useful conclusions. There is a pressing need for additional research pertaining to orally feeding this population so that an evidence-based standard of care can be established. Specifically, this research should elucidate the impact of different types and levels of NIV on the mechanistic properties of swallowing as defined via instrumental assessment.
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Affiliation(s)
- Carolyn Barnes
- Department of Health Sciences & Research, Medical University of South Carolina, Charleston
| | - Teri Lynn Herbert
- Academic Affairs Faculty, Medical University of South Carolina, Charleston
| | - Heather S Bonilha
- Department of Health Sciences & Research, Medical University of South Carolina, Charleston
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA
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Implementing an Evidence-Based Feeding Protocol: Impact on Nurses' Knowledge, Perceptions, and Feeding Culture in the NICU. Adv Neonatal Care 2022; 22:493-502. [PMID: 34596085 DOI: 10.1097/anc.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Evidence-based feeding practices are often variable among neonatal providers due to lack of knowledge and neonatal intensive care unit (NICU) feeding culture norms. PURPOSE To evaluate changes in NICU nurses' knowledge, perceptions, feeding practices and culture following education about, and implementation of, an evidence-based Infant-Driven Feeding (IDF) protocol. METHODS A pre-/postprospective comparative design was used to survey 120 registered nurses employed in a level 3 NICU about feeding practices, knowledge, and culture prior to IDF education and 1 to 2 months after IDF implementation. RESULTS The preeducation survey yielded 59 respondents; of these, 30 responded to the same survey after IDF implementation. Postimplementation responses were significant for fewer nurses making decisions to begin oral feedings ( P = .035), greater use of gestational age to increase frequency of oral feeding attempts ( P = .03), less reliance on weight loss to decrease oral feeding attempts ( P = .018), an increase in use of combination interventions to prepare infants for oral feeding ( P = .001), and greater willingness to allow a rest period or stop the feeding if an infant falls asleep after completing 70% of the feeding ( P = .03). IMPLICATIONS FOR PRACTICE AND RESEARCH Trends in several survey categories following the education program and implementation of IDF support the use of evidence-based practices (EBPs) such as IDF. Future research focused on nurses' perceptions of how education influences integration of specific EBPs into practice is needed. Evaluating EBP mentorship combined with education about EBPs can provide insights on how best to integrate EBPs into practice.
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Sokou R, Parastatidou S, Ioakeimidis G, Tavoulari EF, Makrogianni A, Isaakidou E, Iacovidou N, Konstantinidi A. Breastfeeding in Neonates Admitted to an NICU: 18-Month Follow-Up. Nutrients 2022; 14:nu14183841. [PMID: 36145216 PMCID: PMC9500865 DOI: 10.3390/nu14183841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The admission of neonates to Neonatal Intensive Care Units (NICUs) has been identified as a primary inhibiting factor in the establishment of breastfeeding. The aims of this study were to (1) estimate the prevalence and duration of breastfeeding in infants/toddlers who had been admitted to an NICU in Greece and (2) to investigate factors, associated with the NICU stay, which affected the establishment and maintenance of breastfeeding in infants/toddlers previously admitted to the NICU. Materials and methods: Data for this cohort study were retrieved from interviews with mothers of infants/toddlers who had been admitted to our NICU as neonates during the period of 2017−2019. Interviews were conducted based on a questionnaire regarding the child’s nutrition from birth to the day of the interview, including previous maternal experience with breastfeeding. Information related to the prenatal period, gestation age, delivery mode, duration of NICU stay, and neonatal feeding strategies during their hospital stay were recorded. Results: The response rate to the telephone interviews was 57%, resulting in 279 mother−infant pairs being included in this study. The results showed that 78.1% of children received maternal milk during their first days of life. Of all infants, 58.1% were exclusively breastfed during their first month, with a gradual decrease to 36.9% and 19.4% by the end of the third and sixth months of life, respectively. The prevalence of breastfed children reached 14.7% and 7.5% at the ages of twelve and eighteen months, respectively. In the multivariate analysis, prematurity emerged as an independent prognostic factor for the duration of exclusive and any breastfeeding (aHR 1.64, 95% CI: 1.03−2.62; and 1.69, 95% CI: 1.05−2.72, respectively; p < 0.05). Additionally, the nationality of the mother, NICU breastfeeding experience, the administration of maternal milk during neonatal hospital stay, and previous breastfeeding experience of the mother were independent prognostic factors for the duration of breastfeeding. Conclusions: Although breastfeeding is a top priority in our NICU, the exclusive-breastfeeding rates at 6 months were quite low for the hospitalized neonates, not reaching World Health Organization (WHO) recommendations. Mothers/families of hospitalized neonates should receive integrated psychological and practical breastfeeding support and guidance.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Correspondence: ; Tel.: +30-2132077346 or +30-2132077000
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Evangelia-Filothei Tavoulari
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Athanasia Makrogianni
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Elina Isaakidou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Aikaterini Konstantinidi
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
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Jiang X, Jiang H. Factors associated with post NICU discharge exclusive breastfeeding rate and duration amongst first time mothers of preterm infants in Shanghai: a longitudinal cohort study. Int Breastfeed J 2022; 17:34. [PMID: 35501877 PMCID: PMC9063107 DOI: 10.1186/s13006-022-00472-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 04/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breastfeeding is crucial for the preterm infants. Breast milk is not only food but also medicine. Few studies have focused on the longitudinal effects of exclusive breastfeeding outcome of preterm infants separated from their mothers after discharge, especially in Shanghai. We aimed to examine the exclusive breastfeeding rate and duration amongst first time mothers of preterm infants after discharge and its determinants. METHODS Analyses were based on 500 preterm infants separated from their mothers in a tertiary maternity and infant-specialized hospital in Shanghai from September 2018 to September 2019.The Socio-demographic characteristics, breastfeeding knowledge questionnaire, breastfeeding self-efficacy short form scale, Edinburgh postpartum depression scale and breastfeeding family support scale were used for the investigation and the exclusive breastfeeding rate of premature infants was followed up on 1 month, 3 months and 6 months after discharge. The changing trend of breastfeeding knowledge, breastfeeding self-efficacy, postpartum depression and family support were measured by ANOVA at different stages. Using the chi-square test and multiple logistic regression, factors impacting the breastfeeding rate of preterm infants at three time intervals after discharge were investigated. The Kaplan Meier survival curve and cox regression model were used to analyze the determinants of exclusive breastfeeding duration of premature infants after discharge. RESULTS Exclusive breastfeeding rates were 19.0, 17.2 and 10.4% at 1 month, 3 months and 6 months after discharge of preterm infants, respectively. The average length of exclusive breastfeeding duration was(3.69 ± 1.80)months. Finally, type of delivery (adjusted odds ratio [AOR] 1.564; 95% confidence interval [CI] 0.513,3.116), gestational age(AOR 0.612, 95% CI 0.236, 3.418), maternal family support (AOR 6.125,95% CI 6.359, 98.452) were discovered to be independent predictors on the exclusive breastfeeding rate at 6 months after preterm infants were discharged. Through the cox regression model, we found that a maternal planned pregnancy (HR 0.681, 95%CI 0.531,0.873), delivering breast milk during hospitalization (HR 0.797, 95%CI 0.412,2.288), NICU feeding mode during hospitalization (HR 1.221, 95%CI 0.128,1.381) and family support (HR 0.561, 95%CI 0.004,2.428) were significantly associated with the exclusive breastfeeding duration after discharge. CONCLUSIONS The exclusive breastfeeding outcome of premature infants was affected by many factors, so we should focus on the three levels of individual, family, society and design targeted intervention measures to increase the exclusive breastfeeding rate and prolong exclusive breastfeeding duration.
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Affiliation(s)
- Xin Jiang
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, No 2699, West Gaoke Road, Pudong New Area, Shanghai, 200092, China
| | - Hui Jiang
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, No 2699, West Gaoke Road, Pudong New Area, Shanghai, 200092, China.
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Gentle SJ, Meads C, Ganus S, Barnette E, Munkus K, Carlo WA, Salas AA. Improving Time to Independent Oral Feeding to Expedite Hospital Discharge in Preterm Infants. Pediatrics 2022; 149:184890. [PMID: 35229126 DOI: 10.1542/peds.2021-052023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Achievement of independent oral feedings remains the most common barrier to discharge in preterm infants. Early oral feeding initiation may be associated with a lower postmenstrual age (PMA) at independent oral feeding and discharge. In preterm infants born between 25 and 32 weeks' gestation, our aim was to decrease the PMA at independent oral feedings and discharge by 1 week between June 2019 and June 2020. METHODS Following formation of a multidisciplinary team, the following plan-do-study-act cycles were targeted: (1) oral feeding initiation at <33 weeks' PMA, (2) cue-based feeding, and (3) practitioner-driven feeding in infants who had not yet achieved independent oral feedings by 36 weeks' PMA. Outcome measures included the PMA at independent oral feeding and discharge. Process measures included adherence to cue-based feeding assessments and PMA at oral feeding initiation. RESULTS In total, 552 infants with a median gestational age of 30.3 weeks' (interquartile range 28.1-32.0) and birth weight of 1320 g (interquartile range 1019-1620) were included. The PMA at discharge decreased from 38.8 to 37.7 weeks during the first plan-do-study-act cycle, which coincided with an increase in the number of infants initiated on oral feeds at <33 weeks' PMA from 47% to 80%. The age at independent oral feeding decreased from 37.4 to 36.5 weeks' PMA. CONCLUSIONS In preterm infants born between 25 and 32 weeks' gestation, earlier oral feeding initiation was associated with a decreased PMA at independent oral feeding and discharge.
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Affiliation(s)
| | - Claire Meads
- Rehabilitation Services, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Shae Ganus
- Rehabilitation Services, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth Barnette
- Rehabilitation Services, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
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Osborn EK, Jadcherla SR. Developing a Quality Improvement Feeding Program for NICU Patients. Neoreviews 2022; 23:e23-e35. [PMID: 34970663 DOI: 10.1542/neo.23-1-e23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Practices in NICUs vary widely, particularly when clinical decisions involve complex tasks and multiple disciplines, which occurs with feeding preterm infants. Neonatal feeding difficulties in preterm infants often lead to prolonged tube feeding and therefore lengthened hospital stays. Education and compliance with evidence-based protocols and guidelines are needed on the initiation of feedings and feeding advancement to transform enteral and oral feeding practices and thus reduce practice variation and improve clinical outcomes.
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Affiliation(s)
- Erika K Osborn
- Innovative Neonatal and Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Sudarshan R Jadcherla
- Innovative Neonatal and Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.,Divisions of Neonatology and Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
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Cheng F, McMillan C, Morrison A, Berkwitt A, Grossman M. Neonatal Abstinence Syndrome: Management Advances and Therapeutic Approaches. CURRENT ADDICTION REPORTS 2021. [DOI: 10.1007/s40429-021-00387-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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