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12188 (166, 167, 168) Paper Presentation 1 – Menu Options
(166) Enteral Nutrition of Healthy Premature Low-Birth-Weight Infants
Ksenia Zukowsky, PhD APRN-NNP, Jefferson School of Nursing Thomas Jefferson University, Philadelphia PA
Coauthor: Sharon Kirkby, MSN RN, Alere, Inc., Atlanta, GA
Abstract
Background & Significance
Healthy Peoples 2010 and the American Academy of Pediatrics recommend breastfeeding in the early postpartum period.
Purpose
The purpose of this analysis was to examine the enteral nutrition of a healthy” premature Low- Birth-Weight (LBW) infants: gestation 32 to 34 weeks.
Research Question:
What are “healthy” premature infants feeding in the NICU.
Methods/Design:
Retrospective descriptive study of all 32-34 week singleton infants in a large neonatal database discharged between June 2006-August 2009. Infants were grouped by feeding type: formula exclusively or human milk. T-tests and chi square were used for analysis.
Sample:
"Healthy" cohort was defined as infants who were in room air by DOL 7, no infection, necrotizing enterocolitis, surgery, and feeding was initiated feedings by DOL 3.
Analysis/Results: 2758 of 6318 infants (43.7%) met criteria. 71.3% were fed mostly human milk (≥ 75% their enteral nutrition). Formula was fed exclusively to 28.7%. No differences between infants fed exclusively formula and mostly human milk for gestational age, birth weight, days to room air, and days to start enteral nutrition. Infants fed mostly human milk took longer for first oral and full feeds (p<0.001).
Implications for Practice & Research:
“Healthy” premature LBW infants 32 to 34 gestation, 71.8% were fed mostly human milk from initiation of feeding till discharge. Interdisciplinary teams may need to identify obstacles that cause a delay in first oral feeding and weaning to an open crib overtime with of human milk feeding.
Learning Objectives
1. Cite types of feeding with enteral nutrition of healthy premature low birth-weight (LBW) infants in the NICU.
2. Identify and gain knowledge of types of feeding of enteral nutrition of "healthy" premature LBW infants in the NICU.
Bibliography
American Academy of Pediatrics. (2005) Breast-feeding and the use of Human Milk. Pediatrics 110, 495-506.
Centers for Disease Control, Breastfeeding: Data and Statistics: Breastfeeding Practices — Results from the 2005 National Immunization http://www.cdc.gov/breastfeeding/data/NIS_data/data_2005.htm)
J. A. Hamilton, B.E., Menacker, F., Sutton, P. D. & Mathews, J., (2006) Preliminary Births for 2004: Infant and Maternal Health. National Center for Health Statistics. http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimbirths04/prelimbirths04health.htm
Kochanek, K. D. & Martin, J. A. (2006) Supplemental Analyses of Recent Trends in Infant Mortality http://www.cdc.gov/nchs/products/pubs/pubd/hestats/infantmort/infantmort.htm
Zukowsky, K. (2007). Breast-fed Low- birth-weigh Premature Neonate: developmental Assessment and Nutritional Intake in the First 6 months of Life. Journal Perinatal Neonatal Nurses, vol 21, no 3 242-249.
Zukowsky, K. (2007). Breast-fed Low Birth Weight Premature Infants: A description of nutritional intake in the first six months of life. Newborn and Infant Nursing Reviews, vol 7 no 3 p 161-166.
(167) Physiological Response of Neonates to Human Milk Temperature
Marsha Dumm, MS RD LD , Nationwide Children's Hospital, Columbus, OH
Coauthors:
Joanna Sutton, MSN, Nationwide Children's Hospital, Columbus, OH
Melissa Hamms , MBA BSN RNC, Nationwide Childrens Hospital, Columbus, OH
Nancy Ryan-Wenger PhD RN CPNP FAAN, Nationwide Childrens Hospital, Columbus, OH
Abstract
Background
Limited and conflicting data exist to develop evidence based nursing standards regarding the common practice of warming human milk feedings for neonates.
Purpose
The purpose of this study was to describe current practice of human milk warming and to assess the infant physiologic response to varying temperatures.
Research Question
Is there physiologic benefit to warming feeds and is time spent a value added nursing service?
Methods
Thirty experienced neonatal nurses were followed as feedings were prepared and administered. Variables measured included temperatures of the water bath used for warming, minutes in the water bath, and temperature of the milk at time of feeding. Infant temperature, respiratory rate, oxygen saturation, and heart rate were recorded prior to care time, and 5 minutes and 30 minutes after the feeding was started. Additionally, residuals and emesis were monitored for the 3 hours following the observed feeding and the infants’ usual tolerance compared.
Analysis
Wide variations in temperatures of water bath, the warmed milk and the warming times were observed. Examination of the data is in progress but preliminary analysis reveals a decrease in axillary temperature of 0.2°C or greater at five minutes after the start of the feed in 13.3% of the infants and at 30 minutes after the start of the feed in 16.7% of the infants. Nursing interventions of increased incubators temperatures or additional swaddling in response to infant temperatures were noted
Implications for practice
Evidence based standards for the practice of warming human milk feedings should be developed.
Learning Objectives
1. Identify 3 neonatal responses to cold stress.
2. Discuss practices of warming human milk for infant feedings.
3. Describe physiologic effects of variations in milk temperatures on neonates.
Bibliography
Gonzales,I.,Duryea,E.J.,Vasquez,E.,Geraghty,N.(1995) Effect of enteral feeding temperature on feeding tolerance in preterm infants. Neonatal Network,14(3),39-43.
Eckburg,J.et al.(1987)Effects of formula temperature on postprandial thermogenesis and body temperature of premature infants. Journal of Pediatrics,111(4),588-556.
Blumenthal,I.,Lealman,G.,Shoesmith,D.(1980)Effect of feeding temperature and phototherapy on gastric emptying. Archives of Disease in Childhood, 55(1),562-574.
Altimier,L.,Brown,B.,Tedeschi,L.(2006) NANN Guidelines for neonatal nursing policies, procedures, competencies, and clinical pathways. National Association of Neonatal Nurses. Glenview, Illinois.
Robbins,S.T.,Beker,L.T.(2004)Infant Feedings:Guidelines for preparation of formula and breastmilk in health care facilities.American Dietetics Association. Chicago, Illinois.
(168) Transition from Gavage to Nipple Feeding for Preterm Infants with Bronchopulmonary Dysplasia
Gail McCain, PhD, University of Miami, Coral Gables, FL
Coauthor: Teresa Del Moral, MD MPH, University of Miami, Miami, FL
Abstract
Preterm infants with bronchopulmonary dysplasia (BPD) have difficulty making the transition from gavage to nipple feeding because of respiratory distress. It was hypothesized that infants assigned to the experimental feeding protocol would require fewer days to attain nipple feeding and have a satisfactory weight gain compared with control infants. Barnard's model of reciprocal interaction between caregiver and infant was the framework. Nurses assigned to the experimental protocol used infant behavioral and cardio-respiratory responses to regulate frequency, length, and volume of feedings to minimize distress, fatigue, and hypoxemia. The control condition followed the standard care of gradually increasing scheduled nipple feedings. The setting was a 120 bed neonatal intensive care unit. A randomized, experimental design included 42 infants who were assigned to the control condition and 44 to the experimental protocol. Mean gestational ages at birth and birth weights were 25 + 1.54 weeks and 784 gm for the controls, and 25 + 1.48 weeks and 787 gm in the experimental group. Experimental infants reached full, nipple feedings at a M = 5.93(0.74) days, while control infants took a M = 12.33 (0.82) days (F[1, 85] = 40.21, p < .0001). The average daily weight gain was satisfactory for both groups with control infants gaining 27 + 1.46 gm and experimental infants 25 + 1.48 gm. The use of the experimental feeding method holds promise for helping preterm infants with BPD transition from gavage to nipple feeding in a manner that uniquely considers the infant's signs of chronic respiratory distress.
Learning Objectives
1. Describe bio-behavioral and cardio-respiratory responses to nipple feeding for preterm infants with bronchopulmonary dysplasia (BPD).
2. Examine a semi-demand method for transitioning preterm infants with BPD from gavage to nipple feeding.
Bibliography
McCain, G.C., Knupp, A.M., Fontaine, J.L., Pino, L.D., & Vasquez, E.P. (in press). Heart rate variability responses to nipple feeding for preterm infants with bronchopulmonary dysplasia: Three case studies. Journal of Pediatric Nursing.
McCain, G.C., Fuller, E.O., & Gartside, P.S. (2005). Heart rate variability and feeding bradycardia in healthy preterm infants during transition from gavage to oral feeding. Newborn and Infant Nursing Reviews, 5, 124-132.
Mizuno, K., Nishida, Y., Taki, M. Hibino, S., Murase, M., Sakurai, M...Itabashi, K. (2007). Infants with bronchopulmonary dysplasia suckle with weak pressures to maintain breathing during feeding. Pediatrics, 120, e1035-e1042.
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