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Kebede DA, Tafere Y, Eshete T, Abebaw E, Adimasu M, Endalew B. The time to initiate trophic feeding and its predictors among preterm neonate admitted to neonatal intensive care unit, Multicenter study, Northwest Ethiopia. PLoS One 2022; 17:e0272571. [PMID: 35951594 PMCID: PMC9371352 DOI: 10.1371/journal.pone.0272571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 07/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Trophic feeding is a small volume, hypo-caloric feeding, gut priming or minimal enteral feeding acclimate the immature gut of enteral fasting preterm neonates. Delayed starting of trophic feeding had resulted in short and long-term physical and neurological sequels. The current study aimed to estimate the time to initiate trophic feeding and its predictors among preterm neonates admitted in the neonatal intensive care unit of Debre Markos, Felege Hiwot, and Tibebe Ghion comprehensive specialized hospitals. Methods An institutional-based prospective follow-up study was conducted among 210 neonates. The data were collected with interview and chart review, entered into Epi data 3.1 and exported to Stata 14.1 for analysis. Multivariable Cox regression models were fitted to identify predictors of time to initiate trophic feeding. Result A total of 210 neonates were followed for 10136 person-hours of risk time and 191 (90.95%) of neonates were started trophic feeding. The overall incidence of starting trophic feeding was 2 per 100 (95% CI: 2, 2.2) person-hours observations. The median survival time was 42 hours (95% CI: 36, 48). APGAR- score at first minute <7 (AHR: 0.6, 95% CI: 0.44, 0.82), gestational age of <34 weeks (AHR: 0.69, 95% CI: 0.5, 0.94), presence of respiratory distress syndrome (AHR: 0.5, 95% CI: 0.36, 0.68), presence of hemodynamic instability (AHR: 0.37, 95% CI: 0.24, 0.57), presence of perinatal asphyxia (AHR: 0.63, 95% CI: 0.44, 0.89), cesarean section delivery (AHR: 0.63, 95% CI: 0.44, 89) and being delivered within the study hospitals (AHR: 0.54, 95% CI: 0.39, 0.74) were found to be statistically significant predictors of time to initiate trophic feeding. Conclusion There was a significant delay to initiate trophic feeding in the studied hospitals. Gestational age of below 34 weeks, APGAR-score of less than seven, out-born delivery, cesarean delivery, presence of respiratory distress syndrome; perinatal asphyxia, and hemodynamic instability were predictors of delay in starting of trophic feeding. Standardized feeding guideline has to be implemented to overcome delays in enteral feeding initiation.
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Affiliation(s)
| | - Yilikal Tafere
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tewodros Eshete
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Ermias Abebaw
- School of Medicine, Debre Markos University, Debre Markos, Ethiopia
- * E-mail:
| | - Mekonen Adimasu
- Department of Nursing, School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bekalu Endalew
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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D'Costa R, Fucile S, Dickson B, Gallipoli A, Dow KE. Benefits of a Standardized Enteral Feeding Protocol on the Nutrition and Health Outcomes of Very Low Birth Weight Preterm Infants. CAN J DIET PRACT RES 2022; 83:147-150. [PMID: 35503898 DOI: 10.3148/cjdpr-2022-003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: To compare nutrition and health outcomes before and after implementing a standardized enteral feeding protocol on nutrition and health outcomes in very low birth weight preterm infants.Methods: A retrospective chart review was performed evaluating preterm infants, born less than 34 weeks gestation and weighing less than 1500 g, before and after the implementation of a standardized enteral feeding protocol. Outcomes included weaning of parenteral nutrition, initiation and advancement of enteral feeds, initiation of human-milk fortifier (HMF), change in weight z-score and neonatal morbidities.Results: Fifty-six infants (30 in pre-group, 26 in post-group) met the inclusion criteria. Infants in the standardized enteral feeding protocol group started enteral feeds earlier (p = 0.039) and received full HMF fortification at lower weights (p = 0.033) than those in the pre-group. Fewer days on continuous positive airway pressure (p = 0.021) and lower rates of bronchopulmonary dysplasia (p = 0.018) were also observed in the post-group. Weaning of parenteral nutrition and weight z-score were not significantly different between groups. There were no differences in other morbidities.Conclusion: Study results suggest that adopting a standardized enteral feeding protocol may promote early initiation of enteral feeds and fortification.
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Affiliation(s)
- Rhea D'Costa
- Department of Pediatrics, Queen's University, Kingston, ON
| | - Sandra Fucile
- Department of Pediatrics, Queen's University, Kingston, ON.,School of Rehabilitation Therapy, Queen's University, Kingston, ON
| | - Brittany Dickson
- Neonatal Intensive Care Unit, Kingston Health Sciences Centre, Kingston, ON
| | | | - Kimberly E Dow
- Department of Pediatrics, Queen's University, Kingston, ON
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Raduma OS, Jehangir S, Karpelowsky J. The effect of standardized feeding protocol on early outcome following gastroschisis repair: A systematic review and meta-analysis. J Pediatr Surg 2021; 56:1776-1784. [PMID: 34193345 DOI: 10.1016/j.jpedsurg.2021.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 04/27/2021] [Accepted: 05/25/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Improved post-operative outcomes following gastroschisis repair are attributed to advancement in perioperative and post-operative care and early enteral feeding. This study evaluates the role of standardized postoperative feeding protocols in gastroschisis. STUDY DESIGN A systematic review and meta-analysis of studies published from January 2000 to April 2019 in MEDLINE, EMBASE, Cochrane Library databases and Google Scholar was conducted. Primary outcomes were duration to full enteral feeding and cessation of parenteral nutrition. Secondary outcomes included days to first enteral feeding, length of stay, compliance, complication and mortality rates. Meta-analysis was done using the RevMan Analysis Statistical Package in Review Manager (Version 5.3) using a random effects model and reported as pooled Risk Ratio and Mean Difference. p-value < 0.05 was considered statistically significant. RESULTS Eight observational cohort studies were identified and their data analyzed. Significant heterogeneity was noted for some outcomes. Standardized feeding protocols resulted in fewer days to first enteral feeding by 3.19 days (95% CI: -4.73, -1.66, p < 0.0001) than non-protocolized feeding, less complication rates, reduced mortality and better compliance to care. The duration of parenteral nutrition and time to full enteral feeding were not significantly affected. CONCLUSION Protocolized feeding post-gastroschisis repair is associated with early initiation of enteral feeding. There is a likelihood of reduced rates of sepsis; shorter duration of parenteral nutrition, length of hospital stay and time to full enteral feeding. However, the latter trends are not statistically significant and will require further studies best accomplished with a prospective randomized trial or more cohort studies.
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Affiliation(s)
- Ochieng Sephenia Raduma
- Department of Surgery, Defence Forces Memorial Hospital, Nairobi, Kenya; Division of Surgery, University of Sydney, NSW, Australia; Division of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia
| | - Susan Jehangir
- Department of Paediatric Surgery, The Children's hospital at Westmead, NSW, Australia; Christian Medical College, Vellore, Tamil Nadu, India
| | - Jonathan Karpelowsky
- Division of Surgery, University of Sydney, NSW, Australia; Department of Paediatric Surgery, The Children's hospital at Westmead, NSW, Australia; Division of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia.
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Abstract
Necrotizing enterocolitis (NEC) is an inflammatory disease affecting premature infants. Intestinal microbial composition may play a key role in determining which infants are predisposed to NEC and when infants are at highest risk of developing NEC. It is unclear how to optimize antibiotic therapy in preterm infants to prevent NEC and how to optimize antibiotic regimens to treat neonates with NEC. This article discusses risk factors for NEC, how dysbiosis in preterm infants plays a role in the pathogenesis of NEC, and how probiotic and antibiotic therapy may be used to prevent and/or treat NEC and its sequelae.
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Affiliation(s)
- Jennifer Duchon
- Division of Newborn Medicine, Jack and Lucy Department of Pediatrics, Icahn School of Medicine at Mount Sinai, 1000 10th Avenue, New York, NY 10019, USA
| | - Maria E Barbian
- Division of Neonatal-Perinatal Medicine, Emory University School of Medicine and Children's Healthcare of Atlanta, 2015 Uppergate Drive Northeast, 3rd Floor, Atlanta, GA 30322, USA
| | - Patricia W Denning
- Division of Neonatal-Perinatal Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Emory University Hospital Midtown, 550 Peachtree Street, 3rd Floor MOT, Atlanta, GA 30308, USA.
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5
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Arora S, Yadav P, Bajaj H, Thakur AS, Mittal M, Gupta MR, Jose A, Arora R. Improving clinical outcomes of very low birth weight infants: Implementation of standardized management guidelines in tertiary care hospital in Haryana. Int J Pediatr Adolesc Med 2020; 7:174-180. [PMID: 33319015 PMCID: PMC7729219 DOI: 10.1016/j.ijpam.2019.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/02/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Standardized written guidelines and protocols in NICU are known to impact neonatal outcomes and improve survival. OBJECTIVE To study and compare the morbidity and mortality outcomes of very low birth weight (VLBW) neonates before and after introduction of structured approach to standardized management guidelines on four interventions in a tertiary care hospital in North India. METHODOLOGY Structured approach to standardized management guidelines on four interventions were implemented for VLBW infants in NICU. a) Humidified and Heated High Flow Nasal Cannula (HHHFNC) as the initial mode of ventilator support in preterm VLBW babies. b) Expressed breast milk for feeding preterm VLBW babies and absolutely no formula milk. c) Hand washing and following "Bundle Care Approach" for Central lines as the cardinal cornerstones for maintaining strict asepsis. d) Development and supportive care to be regularly followed. Data was collected prospectively from July 2015 to December 2016 (Intervention Group) and compared with retrospective matched controls from the previous year (July 2014-June 2015) (Control Group). RESULTS There was a significant decrease in culture positive sepsis in the intervention group compared to control group (3 (2.97%) CI:0.006-0.08 vs 11 (19.64%) CI:0.10-0.32; P = .0004). There was no significant difference in the mortality (5.35% vs3.96% P = .74) amongst the two groups. CONCLUSION Implementing structured approach to above mentioned interventions in the form of standardized management guidelines for preterm VLBW neonates was associated with significant reduction in culture proven sepsis and mechanical ventilation days without affecting mortality or other co-morbidities.
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Affiliation(s)
- Sunaina Arora
- DCH, DNB Pediatrics, Apollo Cradle Hospital, Gurgaon, SCO-1,2 and 3. Apollo Cradle Hospital, Gurgaon Haryana, 122001, India
| | - Pankaj Yadav
- DNB Paediatrics, IAP Neonatology Fellow, Apollo Cradle, Gurgaon, India
| | | | | | | | | | - Abhilash Jose
- GNM Nursing, Nursing Head NICU, Apollo Cradle, Gurgaon, India
| | - Rohit Arora
- Neonatology, Apollo Cradle, Gurgaon, Clinical/ Research Fellow NPM Program, University of Western Ontario, Canada
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Cormack B, Oliver C, Farrent S, Young J, Coster K, Gilroy M, Page D, Little H, McLeod G. Neonatal dietitian resourcing and roles in New Zealand and Australia: A survey of current practice. Nutr Diet 2019; 77:392-399. [PMID: 31762224 DOI: 10.1111/1747-0080.12592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/05/2019] [Accepted: 10/21/2019] [Indexed: 11/26/2022]
Abstract
AIM Dietitian-led implementation of evidence-based nutrition support practices improves nutrient intakes, clinical outcomes and growth, decreases length of stay and related costs, and reduces intravenous nutrition costs and prescription errors. We aimed to investigate current neonatal dietitian resourcing and roles in New Zealand and Australian neonatal units, and to compare this with dietitian workforce recommendations and previously reported survey data. METHODS A two-part electronic survey was emailed to 50 Australasian Neonatal Dietitians Network members and other dietitians working in neonatal intensive care or special care baby units in New Zealand and Australia. The survey ran from July to October 2018. Descriptive statistics were used to examine the distribution of responses. Responses were compared with other similar surveys and British Dietetic Association workforce recommendations. RESULTS There was an 88% response rate for Part 1. Forty-eight percent of respondents had worked in neonatology for more than 5 years. Ward rounds were attended weekly or more often by 43% of respondents. One-third regularly attended neonatal conferences or grand rounds. The majority spent less than 25% of their neonatal service allocation on teaching, developing policy or research. All respondents reported their unit had written enteral feeding guidelines. The neonatal dietitian workforce is at 23% of recommended levels. CONCLUSIONS Australasian neonatal dietitians have great potential to add value in neonatal units which has not yet been fully realised. Funding reallocation, upskilling and on-going professional development are needed to ensure the neonatal dietitian workforce is at the recommended level to be safe, sustainable and effective.
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Affiliation(s)
- Barbara Cormack
- Starship Child Health, Auckland City Hospital, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Colleen Oliver
- The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Shelley Farrent
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Jacqui Young
- Sunshine Hospital, Melbourne, Victoria, Australia
| | - Keryn Coster
- The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Melissa Gilroy
- Mater Health, Mater Mothers and Mater Mothers Private Hospitals, Brisbane, Queensland, Australia
| | - Denise Page
- Mater Health, Mater Mothers and Mater Mothers Private Hospitals, Brisbane, Queensland, Australia
| | - Helen Little
- Christchurch Women's Hospital, Christchurch, New Zealand
| | - Gemma McLeod
- King Edward Memorial and Princess Margaret Hospitals, Perth, Western Australia, Australia.,The University of Western Australia, Perth, Western Australia, Australia
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Gephart SM, Hanson C, Wetzel CM, Fleiner M, Umberger E, Martin L, Rao S, Agrawal A, Marin T, Kirmani K, Quinn M, Quinn J, Dudding KM, Clay T, Sauberan J, Eskenazi Y, Porter C, Msowoya AL, Wyles C, Avenado-Ruiz M, Vo S, Reber KM, Duchon J. NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis. Matern Health Neonatol Perinatol 2017; 3:23. [PMID: 29270303 PMCID: PMC5733736 DOI: 10.1186/s40748-017-0062-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/28/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although decades have focused on unraveling its etiology, necrotizing enterocolitis (NEC) remains a chief threat to the health of premature infants. Both modifiable and non-modifiable risk factors contribute to varying rates of disease across neonatal intensive care units (NICUs). PURPOSE The purpose of this paper is to present a scoping review with two new meta-analyses, clinical recommendations, and implementation strategies to prevent and foster timely recognition of NEC. METHODS Using the Translating Research into Practice (TRIP) framework, we conducted a stakeholder-engaged scoping review to classify strength of evidence and form implementation recommendations using GRADE criteria across subgroup areas: 1) promoting human milk, 2) feeding protocols and transfusion, 3) timely recognition strategies, and 4) medication stewardship. Sub-groups answered 5 key questions, reviewed 11 position statements and 71 research reports. Meta-analyses with random effects were conducted on effects of standardized feeding protocols and donor human milk derived fortifiers on NEC. RESULTS Quality of evidence ranged from very low (timely recognition) to moderate (feeding protocols, prioritize human milk, limiting antibiotics and antacids). Prioritizing human milk, feeding protocols and avoiding antacids were strongly recommended. Weak recommendations (i.e. "probably do it") for limiting antibiotics and use of a standard timely recognition approach are presented. Meta-analysis of data from infants weighing <1250 g fed donor human milk based fortifier had reduced odds of NEC compared to those fed cow's milk based fortifier (OR = 0.36, 95% CI 0.13, 1.00; p = 0.05; 4 studies, N = 1164). Use of standardized feeding protocols for infants <1500 g reduced odds of NEC by 67% (OR = 0.33, 95% CI 0.17, 0.65, p = 0.001; 9 studies; N = 4755 infants). Parents recommended that NEC information be shared early in the NICU stay, when feedings were adjusted, or feeding intolerance occurred via print and video materials to supplement verbal instruction. DISCUSSION Evidence for NEC prevention is of sufficient quality to implement. Implementation that addresses system-level interventions that engage the whole team, including parents, will yield the best impact to prevent NEC and foster its timely recognition.
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Affiliation(s)
- Sheila M. Gephart
- Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA
| | | | | | | | | | | | - Suma Rao
- Banner Health, Banner University Medical Center-Phoenix, Phoenix, AZ USA
- Phoenix Perinatal Associates, Mesa, AZ USA
- Clinical Assistant Professor and Vice-Chair, Department of Pediatrics, The University of Arizona, Tucson, AZ USA
| | - Amit Agrawal
- Banner Health, Thunderbird Medical Center, Glendale, AZ USA
- Envision Physician Services, Lawrenceville, GA USA
| | - Terri Marin
- Augusta University College of Nursing, Athens, GA USA
| | - Khaver Kirmani
- Banner Health, Cardon Children’s Medical Center, Mesa, AZ USA
- Phoenix Perinatal Associates, Mesa, AZ USA
| | - Megan Quinn
- Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA
- Banner Health, Cardon Children’s Medical Center, Mesa, AZ USA
| | - Jenny Quinn
- Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA
- NorthBay Medical Center, Fairfield, CA USA
| | - Katherine M. Dudding
- Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA
| | | | - Jason Sauberan
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA USA
| | - Yael Eskenazi
- Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA
| | - Caroline Porter
- Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA
| | | | - Christina Wyles
- Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA
| | | | - Shayla Vo
- Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA
| | - Kristina M. Reber
- Nationwide Children’s Hospital and The Ohio State Wexner Medical Center, Columbus, OH USA
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Savoie KB, Bachier-Rodriguez M, Jones TL, Jeffreys K, Papraniku D, Sevilla WMA, Tillman E, Huang EY. Standardization of Feeding Advancement After Neonatal Gastrointestinal Surgery. Nutr Clin Pract 2016; 31:810-818. [DOI: 10.1177/0884533616658766] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Kate B. Savoie
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
| | - Marielena Bachier-Rodriguez
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
| | - Tamekia L. Jones
- Children’s Foundation Research Institute, Departments of Pediatrics & Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kristen Jeffreys
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
| | - Dita Papraniku
- Dietetics and Nutrition, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
| | - Wednesday Marie A. Sevilla
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
| | - Emma Tillman
- Department of Clinical Pharmacy, Indiana University Health, Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Eunice Y. Huang
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
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Abstract
The issue of health literacy is focused on whether health consumers understand and are able to apply the information provided to them. In the neonatal setting, limited parent and caregiver health literacy can result in increased stress and poor compliance with instructions. Health literacy and patient education go hand in hand. This article includes an overview of health literacy and how it applies to the neonatal setting. Information is provided to assist with assessing for health literacy. Hints and resources are also provided for improving patient and family education.
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Prevention of postnatal growth restriction by the implementation of an evidence-based premature infant feeding bundle. J Perinatol 2015; 35:642-9. [PMID: 25880797 DOI: 10.1038/jp.2015.35] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 02/23/2015] [Accepted: 03/09/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To develop an evidence-based feeding bundle to safely decrease the rate of PNGR in VLBW infants. STUDY DESIGN The bundle was developed and implemented in January 2010, followed by 3 years of monitoring bundle compliance and infant outcomes (days to first feed (FD), days to reach full feeds (FF), and birth-discharge growth trajectories (delta z-score)). RESULTS Data were collected on 482 infants (119 pre-bundle). PNGR decreased from 35% to 19% (P<0.01) and weight delta z-score improved from -0.82 to -0.45 (P<0.001). Percentage of infants with head circumference (HC) below 10th percentile at discharge decreased from 21% to 9% (P<0.01) and HC delta z-score improved from -0.65 to -0.17 (P<0.001). FD and FF also decreased significantly. Rates of necrotizing enterocolitis, peak alkaline phosphatase and peak direct bilirubin levels all trended downward. CONCLUSIONS An evidence-based, standardized feeding bundle was safe and effective in reducing the rate of PNGR and in improving head growth in VLBW infants.
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Impact of standardized feeding guidelines on enteral nutrition administration, growth outcomes, metabolic bone disease, and cholestasis in the NICU. J Pediatr Gastroenterol Nutr 2014; 59:93-8. [PMID: 24517917 DOI: 10.1097/mpg.0000000000000314] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The objectives of this study were to determine whether the implementation of standardized feeding guidelines (SFGs) in a neonatal intensive care unit had an impact on the administration of enteral nutrition, growth, and bone and liver health. METHODS This was a retrospective chart review of infants ≤ 32 weeks' gestation and ≤ 1500 g at birth who received enteral nutrition either via traditional care (TC) or via SFGs. The outcomes of the study were to determine the day of life the first enteral feedings were started, the day of life full, fortified enteral feedings were established, the day of life the infant returned to birth weight, the change in weight z score from birth to day of life 30, and the presence of metabolic bone disease and cholestasis. RESULTS There were 128 infants in the TC group and 125 infants in the SFG group. Based on the Cox regression, no significant differences were found between the 2 groups in the length of time to the first feed (P=0.110; CI 1.03-1.70), in the length of time to full, fortified enteral feedings (P=0.334; CI 0.87-1.44), in the length of time to return to birth weight (P=0.545; CI 0.77-1.28), incidence of metabolic bone disease (P=0.990), or incidence of cholestasis (P=0.926). CONCLUSIONS This study provides preliminary evidence that SFGs have an effect on enteral nutrition administration, growth, and morbidity for preterm infants. Although the findings were not statistically significant, they are clinically relevant.
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12
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Preventing necrotizing enterocolitis with standardized feeding protocols: not only possible, but imperative. Adv Neonatal Care 2013; 13:48-54. [PMID: 23360859 DOI: 10.1097/anc.0b013e31827ece0a] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Enteral feeding practices in the NICU: results from a 2009 Neonatal Enteral Feeding Survey. Adv Neonatal Care 2012; 12:46-55. [PMID: 22301544 DOI: 10.1097/anc.0b013e3182425aab] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE : The purpose of this study was to examine the current management of the enteral feeding regimens of premature infants cared for in the neonatal intensive care unit (NICU). SUBJECTS : The study included responses from 70 neonatal nurses who participated in a 2009 Neonatal Enteral Feeding Survey distributed electronically to the National Association of Neonatal Nurses membership. These respondents were representative of both the United States and Canada, with 29 US states represented. The majority of respondents (95.7%) reported current nursing employment in a level III NICU. DESIGN : Survey research was used in this exploratory study. The survey, Enteral Tube Feeding Practices in the Neonatal Intensive Care Unit, was developed in collaboration with expert neonatal nurses and nutritionists, pilot tested, and distributed via electronic means. METHODS : Survey research was conducted according to the Dillman methodology. Data analysis included descriptive statistics and univariate analysis of variance assessing for significant differences in specific neonatal feeding practices reported. Thematic analysis was used to analyze the qualitative data reported. OUTCOME MEASURES : The outcome measures included the survey responses to the questions asked about the implementation of an enteral feeding protocol and various aspects of enteral feeding practices in the NICU. RESULTS : The majority of participants (60.9%) reported that an enteral feeding protocol was implemented in practice, but that it was inconsistently followed because of individual physician or nurse practice patterns, or highly individualized feeding plans required of specific clinical care needs of the patient. Respondents indicated that gestational age was the leading criteria used to initiate feedings, and patent ductus arteriosis treatment was the primary contraindication to enteral feedings. The leading factor reported to delay or alter enteral feedings was the presence of gastric residuals. Survey data indicated that other contraindicating factors to enteral feeding are variable across NICUs and, as reported, are often inconsistent with the current research published to date. CONCLUSIONS : Research is needed to provide a foundation on which to develop effective enteral feeding protocols that are appropriate for the diversity of infants cared for in the NICU. Such research findings will culminate in the development and implementation of enteral feeding protocols in the NICU, which will result in improved nutrition, growth, and development outcomes for premature infants.
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14
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[Role of nursing in the development of breastfeeding in the premature newborn]. ENFERMERIA CLINICA 2010; 20:119-25. [PMID: 20189860 DOI: 10.1016/j.enfcli.2010.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 01/16/2010] [Accepted: 01/21/2010] [Indexed: 11/20/2022]
Abstract
The birth of a premature infant creates anxiety and uncertainty for the parents, who may go through the same grieving process as parents who have lost a baby. Breastfeeding is considered a natural act, although it is not always an easy one for mother and premature infant to establish. Providing breast milk is one of the most important psychological benefits a mother can give her premature infant. Breast milk can be considered the ideal nutrition for preterm infants. Involving the parent in the child's care helps increase parental feelings of control. Neonatal nurses are in a unique position to help minimize parental stress by providing information. It is the responsibility of health professionals who care for premature infants to provide accurate information regarding the benefits and methods of breastfeeding, so that the mother can make an informed choice. The existence of a standardized care plan could assist in establishing breastfeeding in the pre-term newborn, to unify and guide practitioners in making decisions. The aim of this article is to describe the actions needed to be made by nursing staff to achieve successful breastfeeding. We present a standardized care plan that follows the NANDA (North American Nursing Diagnosis Association), NOC (Nursing Outcomes Classification), and NIC (Nursing Interventions Classification) and show how these needs could be managed by nursing professionals.
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Smith JR, Donze A, Cole FS, Johnston J, Giebe JM. Neonatal advanced practice nurses as key facilitators in implementing evidence-based practice. Neonatal Netw 2009; 28:193-201. [PMID: 19451083 DOI: 10.1891/0730-0832.28.3.193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
EVIDENCE-BASED PRACTICE (EBP) is a process that utilizes the best available evidence, expert opinion, and patient preference to guide clinical practice decisions. Although the process itself is relatively straightforward and understandable (See Five Steps of Evidence-Based Practice), implementation requires an infrastructure and knowledge base that can support all five steps of the EBP process.
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Smith JR, Jamerson PA, Bernaix LW, Schmidt CA, Seiter L. Fathers' perceptions of supportive behaviors for the provision of breast milk to premature infants. Adv Neonatal Care 2006; 6:341-8. [PMID: 17208165 DOI: 10.1016/j.adnc.2006.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To explore fathers' perceptions of behaviors used to support the provision of breast milk to hospitalized premature infants. SUBJECTS Sixteen English-speaking fathers who, each were at least 15 years of age, had a hospitalized premature infant between 24 and 32 weeks gestation and a partner who had decided to provide breast milk. DESIGN As part of a larger, exploratory study, a qualitative descriptive study was conducted to analyze fathers' perceived contributions to the process of providing breast milk. METHODS Fathers were interviewed with a semi-structured interview guide. All interviews were audiotaped, and verbatim transcripts were analyzed by using qualitative descriptive methods. MAIN OUTCOME MEASURE Supportive behaviors as identified by fathers of hospitalized premature infants. PRINCIPAL RESULTS Fathers described 3 types of behaviors used to support the provision of breast milk to their hospitalized premature infants: assistance with the pumping process, assumption of additional daily domestic responsibilities, and provision of moral support. CONCLUSIONS Results from this study suggest several significant behaviors that fathers perceived they performed to support their partners' efforts to provide breast milk to their hospitalized premature infants.
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Affiliation(s)
- Joan R Smith
- St. Louis Children's Hospital, One Children's Place, NICU/5E-10, St. Louis, MO 63110, USA.
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Abstract
PURPOSE OF REVIEW This review summarizes recent knowledge and clinical practice for pediatric patients suffering extensive intestinal resection causing short bowel syndrome. This condition requires the use of parenteral nutrition, as long as intestinal failure persists, and may be, in some selected cases, an indication for intestinal transplantation. RECENT FINDINGS Biological evaluation of intestinal failure is becoming possible with the use of plasma citrulline as a marker of intestinal mass. Few epidemiological data are available; some indicate an increased incidence of short bowel syndrome-related gastroschisis and persistent high incidence of necrotizing enterocolitis. Morbidity and mortality data in pediatric patients with short bowel syndrome are limited, while long-term outcome is better documented from recently reported cohorts. Non-transplant surgery is one of the best options for patients with unadapted short bowel syndrome. Isolated liver transplantation may be avoided. The use of trophic factors for enhancing mucosal hyperplasia still remains disappointing. SUMMARY The management should include therapies adapted to each stage of intestinal failure, based on a multidisciplinary approach in centers involving pediatric surgery, pediatric gastroenterology, parenteral nutrition expertise, home-parenteral nutrition program, and liver-intestinal transplantation experience. If managed appropriately, the prognosis of short bowel syndrome is excellent, with limited indications for intestinal and/or liver transplantation. Timing for patient referral in specialized centers remains an issue.
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Affiliation(s)
- Olivier Goulet
- Integrated Program of Intestinal Failure, Home Parenteral Nutrition, and Intestinal Transplantation, National Reference Center for Rare Digestive Diseases, Necker Hospital for Sick Children, University of Paris, France.
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Abstract
Human milk is the preferred form of nutrition for all infants including those born preterm or otherwise ill. However, without the commitment of knowledgeable healthcare providers to ensure success during mother-infant separation, many infants fail to receive their mother's own milk. Care of the mother-infant dyad during infant illness requires vigilant monitoring of the lactation experience and the commitment of healthcare providers to take a family through the step-by-step process needed to ensure positive outcomes related to the use of human milk and breast-feeding for vulnerable infants. The science tells us that human milk is the best form of nutrition for all infants. As practitioners we must be doing everything in our power to make sure the infants we care for are able to receive their mother's own milk.
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Affiliation(s)
- Diane L Spatz
- University of Pennsylvania School of Nursing and The Children's Hospital of Philadelphia, Philadelphia, USA.
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