Improving Feeding Outcomes in the NICU: Moving From Volume-Driven to Infant-Driven Feeding

2010 ◽  
Vol 19 (3) ◽  
pp. 68-74 ◽  
Author(s):  
Catherine S. Shaker
Keyword(s):  
Intensive Care Unit ◽  
Dynamic Systems ◽  
Neonatal Intensive Care ◽  
Well Being ◽  
Dynamic Systems Theory ◽  
Feeding Problems ◽  
Care Giving ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Current research on feeding outcomes after discharge from the neonatal intensive care unit (NICU) suggests a need to critically look at the early underpinnings of persistent feeding problems in extremely preterm infants. Concepts of dynamic systems theory and sensitive care-giving are used to describe the specialized needs of this fragile population related to the emergence of safe and successful feeding and swallowing. Focusing on the infant as a co-regulatory partner and embracing a framework of an infant-driven, versus volume-driven, feeding approach are highlighted as best supporting the preterm infant's developmental strivings and long-term well-being.

scholarly journals Fathers’ experiences of feeding their extremely preterm infants in family-centred neonatal intensive care: a qualitative study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Evalotte Mӧrelius ◽  
Sofia Brogren ◽  
Sandra Andersson ◽  
Siw Alehagen
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Shared Responsibility ◽  
Oral Feeding ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Feeding Process

Abstract Background Extremely preterm infants need advanced intensive care for survival and are usually not discharged before they reach the time of expected birth. In a family-centred neonatal intensive care unit both parents are involved at all levels of care including the feeding process. However, studies focusing on fathers in this situation are scarce. The purpose of this study was to explore the experiences of feeding extremely preterm infants in a neonatal intensive care unit from fathers’ perspectives. Methods The study adopts a qualitative inductive method, reported according to the COREQ checklist. Seven fathers of extremely preterm infants (gestational age 24–27 weeks) in neonatal intensive care in Sweden were interviewed by telephone after discharge in 2013–2014. The interviews were analysed using a qualitative content analysis and confirmed by triangulation in 2021. Results Six sub-categories and two generic categories formed the main category: “a team striving towards the same goal”. The fathers were equally involved and engaged members of the feeding team all hours of the day. The fathers shared responsibility and practical duties with the mothers, and they provided as much support to the mothers as they could. However, the fathers found it difficult to support and encourage the mothers to breastfeed and express breastmilk when the breastmilk production was low. The fathers experienced a loss when breastfeeding was not successful. Conclusions The findings indicate that fathers want to be involved with infant care, including night-time feeds, and long and demanding feeding processes. Fathers and staff need to collaborate to provide the best support to mothers during the feeding process. This study may inspire hospital staff to acknowledge and support fathers to become more involved in the oral feeding process when an infant is born extremely preterm.

scholarly journals Ten-Year Trend of Retinopathy of Prematurity Among Extremely Preterm Infants in One Neonatal Intensive Care Unit in China

2021 ◽  
Vol 9 ◽  
Author(s):  
Yi Dai ◽  
Li Zhu ◽  
Yequn Zhou ◽  
Chao Chen ◽  
Shulian Zhang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Survival Rate ◽  
Neonatal Intensive Care Unit ◽  
Oxygen Saturation ◽  
Retinopathy Of Prematurity ◽  
Neonatal Intensive Care ◽  
Statistical Significance ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Background: Extremely preterm (EP) infants are at the highest risk of retinopathy of prematurity (ROP). With more EP infants survived in China, recent data of ROP is lacking. The aim of the study is to report the trend of incidence of ROP among EP infants in a large neonatal intensive care unit in China over the past 10-year period, in relation with the overall survival rate and the change of oxygen saturation targets.Methods: This retrospective cohort study enrolled all EP infants born before 28 weeks' gestation and admitted to one of the largest tertiary neonatal intensive care units in China from 2010 to 2019. Data were compared between two time periods according to different oxygen saturation targets: 2010–2014 (P1) with low saturation target and 2015–2019 (P2) with higher target.Results: Of 630 EP infants admitted during the 10 years, 447 (71.0%) infants survived to discharge. The survival rate increased significantly from 61.6% in P1 to 75.8% in P2 (P < 0.05). Of the 472 infants who had ROP data, 318 (67.4%) developed ROP of any stage, 67 (14.2%) developed severe ROP, and 44 (9.3%) received treatment. The incidence of any ROP increased significantly from 51.7% in P1 to 74.3% in P2 (P < 0.05). The incidence of severe ROP increased from 11.0% in P1 to 15.6% in P2, and ROP treatment increased from 6.9% in P1 to 10.4% in P2, but neither reached statistical significance (both P > 0.05).Conclusions: We observed an increasing trend in the incidence of ROP across the 10-year period in one of the largest neonatal care units in China. The increased survival rate and the use of high-target oxygen saturation in the later period may partly explain this trend. Further investigations are needed to improve the care practices and to reduce the incidence of severe ROP.

scholarly journals The Risk of Necrotizing Enterocolitis following the Administration of Hyperosmolar Enteral Medications to Extremely Preterm Infants

Neonatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Faiza Latheef ◽  
Hanna Wahlgren ◽  
Helene Engstrand Lilja ◽  
Barbro Diderholm ◽  
Mattias Paulsson
Keyword(s):  
Clinical Practice ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Neonatal Intensive Care ◽  
Significant Risk ◽  
Quality Register ◽  
Increased Risk ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Hyperosmolar Solutions

<b><i>Introduction:</i></b> Necrotizing enterocolitis (NEC) is a disease predominantly affecting preterm infants. The administration of hyperosmolar solutions could lead to the development of NEC. The objective of this study was to measure the osmolality of enteral medications used in clinical practice and to assess the risk of NEC following exposure to hyperosmolar medications. <b><i>Methods:</i></b> A retrospective cohort study in extremely preterm infants (gestational age &#x3c;28 weeks) born between 2010 and 2016 at a tertiary neonatal intensive care unit in Sweden. 465 infants were identified via the Swedish Neonatal Quality register. Data relating to enteral administrations received during a two-week period were collected from the medical records. The osmolalities of medications were measured using an osmometer. Logistic regression was used to calculate the odds ratio of developing NEC. <b><i>Results:</i></b> A total of 253 patients met the inclusion criteria. The osmolalities of 5 commonly used medications significantly exceeded the recommended limit of 450 mOsm/kg set by the American Academy of Paediatrics (AAP). Most patients (94%) received at least one hyperosmolar medication. No significant risk of developing NEC could be found. <b><i>Conclusion:</i></b> The medications used in clinical practice can significantly exceed the limit set by the AAP. This study does not indicate an increased risk of developing NEC in extremely preterm infants following exposure to hyperosmolar medications. Further studies in larger cohorts are needed to determine the specific cut-off level of osmolality in relation to the pathogenesis of NEC.

scholarly journals Regional variation in cost of neonatal intensive care for extremely preterm infants

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Asaph Rolnitsky ◽  
David Urbach ◽  
Sharon Unger ◽  
Chaim M. Bell
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Preterm Infants ◽  
Gestational Age ◽  
Regional Variation ◽  
Neonatal Intensive Care ◽  
Cost Optimization ◽  
Program Cost ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract Background Regional variation in cost of neonatal intensive care for extremely preterm infant is not documented. We sought to evaluate regional variation that may lead to benchmarking and cost saving. Methods An analysis of a Canadian national costing data from the payor perspective. We included all liveborn 23–28-week preterm infants in 2011–2015. We calculated variation in costs between provinces using non-parametric tests and a generalized linear model to evaluate cost variation after adjustment for gestational age, survival, and length of stay. Results We analysed 6932 infant records. The median total cost for all infants was $66,668 (Inter-Quartile Range (IQR): $4920–$125,551). Medians for the regions varied more than two-fold and ranged from $48,144 in Ontario to $122,526 in Saskatchewan. Median cost for infants who survived the first 3 days of life was $91,000 (IQR: $56,500–$188,757). Median daily cost for all infants was $1940 (IQR: $1518–$2619). Regional variation was significant after adjusting for survival more than 3 days, length of stay, gestational age, and year (pseudo-R2 = 0.9, p < 0.01). Applying the model on the second lowest-cost region to the rest of the regions resulted in a total savings of $71,768,361(95%CI: $65,527,634–$81,129,451) over the 5-year period ($14,353,672 annually), or over 11% savings for the total program cost of $643,837,303 over the study period. Conclusion Costs of neonatal intensive care are high. There is large regional variation that persists after adjustment for length of stay and survival. Our results can be used for benchmarking and as a target for focused cost optimization, savings, and investment in healthcare.

Parent Psychological Distress in the Neonatal Intensive Care Unit Within the Context of the Social Ecological Model: A Scoping Review

2018 ◽  
Vol 24 (6) ◽  
pp. 495-509 ◽  
Author(s):  
Kristy Loewenstein
Keyword(s):  
Mental Health ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Psychological Distress ◽  
Neonatal Intensive Care Unit ◽  
Scoping Review ◽  
Neonatal Intensive Care ◽  
Family Cohesion ◽  
Ecological Model ◽  
Well Being

BACKGROUND: Neonatal intensive care unit (NICU) parents are at risk for psychological distress and impaired mental health, and statistics related to parent psychological distress vary. OBJECTIVE: To determine the scope of literature regarding the mental health and psychosocial well-being of parents in the NICU. DESIGN: A scoping review within the Arksey and O’Malley framework and the SEM was undertaken to answer, “What factors contribute to parent’s mental health in the NICU?” A systematic review of the literature was performed using the PRISMA methodology. RESULTS: Common socioeconomic factors and infant and parent characteristics may place parents at a greater risk for developing distress. History of mental illness, family cohesion, birth trauma, altered parenting role, gestational age, birth weight, and severity of prematurity/illness emerged as themes. CONCLUSION: Further research is required to provide a standard for the screening and assessment of parents’ mental health and psychosocial well-being during a NICU hospitalization. The experiences of nonbirth parents in the NICU should be explored to examine the effects of the hospitalization on all types of parents.

The prevalence of feeding problems in children formerly treated in a neonatal intensive care unit

2017 ◽  
Vol 37 (5) ◽  
pp. 578-584 ◽  
Author(s):  
M Hoogewerf ◽  
H J ter Horst ◽  
H Groen ◽  
T Nieuwenhuis ◽  
A F Bos ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Feeding Problems

Adapting the Six-Part Storymaking Method for use with siblings of infants on the neonatal intensive care unit

2020 ◽  
Vol 7 (2) ◽  
pp. 223-242
Author(s):  
Rebecca Ann Versaci
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Emotional Expression ◽  
Neonatal Intensive Care ◽  
Well Being ◽  
Hospital Staff ◽  
Case Vignette ◽  
Profound Influence ◽  
Insight Into

When an infant is hospitalized on the neonatal intensive care unit (NICU) it can have a profound influence on the psychosocial well-being of the infant and their older sibling(s). This article presents a case vignette of the use of the Six-Part Storymaking Method with the sibling of an infant hospitalized on the NICU. The article reviews the therapeutic aims and benefits of the intervention, including: supporting emotional expression, providing opportunity for the sibling to be deeply witnessed by caregivers, therapist and hospital staff, empowering the sibling to inhabit the big sibling role and fostering insight into the sibling’s thoughts, feelings and behaviours as related to their infant’s hospitalization. Considerations for facilitation and assessment are also discussed.

Treatment of Attachment Disorder of Infancy in a Neonatal Intensive Care Unit

PEDIATRICS ◽  
1993 ◽  
Vol 91 (1) ◽  
pp. 139-142
Author(s):  
MARLENE S. GOODFRIEND
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Failure To Thrive ◽  
Reactive Attachment Disorder ◽  
Feeding Problems ◽  
Medical Problems ◽  
Attachment Disorder ◽  
Reactive Attachment

As a psychiatric consultant in an inner-city level III neonatal intensive care unit (NICU), I have seen several cases involving premature infants who did not have a caring, consistent adult in their lives. This neglect appeared to contribute to the development of behavior problems (eg, irritability) or feeding problems (eg, failure to thrive), and sometimes an infant failed to progress medically or experienced an exacerbation of medical problems. These infants were assigned the diagnosis of reactive attachment disorder of infancy. This is a recognized psychiatric entity that is defined, as follows, in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed, revised):

scholarly journals Near-Infrared Spectroscopy in Extremely Preterm Infants

2021 ◽  
Vol 8 ◽  
Author(s):  
Leeann R. Pavlek ◽  
Clifford Mueller ◽  
Maria R. Jebbia ◽  
Matthew J. Kielt ◽  
Omid Fathi
Keyword(s):  
Infrared Spectroscopy ◽  
Preterm Infants ◽  
Near Infrared Spectroscopy ◽  
Neonatal Intensive Care ◽  
Near Infrared ◽  
Tissue Oxygen Saturation ◽  
Tissue Oxygen ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Potential Applications

With advances in neonatal care, survival of premature infants at the limits of viability has improved significantly. Despite these improvement in mortality, infants born at 22–24 weeks gestation are at a very high risk for short- and long-term morbidities associated with prematurity. Many of these diseases have been attributed to abnormalities of tissue oxygenation and perfusion. Near-infrared spectroscopy utilizes the unique absorption properties of oxyhemoglobin and deoxyhemoglobin to provide an assessment of regional tissue oxygen saturation, which can be used to calculate the fractional tissue oxygen extraction. This allows for a non-invasive way to monitor tissue oxygen consumption and enables targeted hemodynamic management. This mini-review provides a brief and complete overview of the background and physiology of near-infrared spectroscopy, practical use in extremely preterm infants, and potential applications in the neonatal intensive care unit. In this mini-review, we aim to summarize the three primary application sites for near-infrared spectroscopy, disease-specific indications, and available literature regarding use in extremely preterm infants.

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