Cue-based feeding for preterm infants: a prospective trial.

We set out to test whether premature infants were able to be fed orally on feeding cues and be discharged home earlier than infants fed by traditional feeding regimens. Attainment of adequate growth, adverse events, and nursing time to provide care were also assessed. After screening, the recruited premature infants (< 36 wks post-conceptual age [PCA]) were divided into two feeding regimens. A control group of 40 infants was fed using an initial combination of scheduled gavage and bottle feeding and then graduating to demand feeds. The intervention group comprised 39 neonates who had gavage feeds discontinued at study entrance and fed orally on cues. Outcomes measured were: weight gain in grams/kg/day, length of stay (in days) after enrollment, PCA on entrance and at discharge, adverse events during feeding, number of cues per feed in the intervention group, and resource utilization using nurse/patient ratios. Differences between groups were evaluated using Mann-Whitney U test, Fisher's exact test, and regression analysis. Two-tailed P values of < 0.05 were considered significant. There was no difference between groups in the mean weight gain; in the control group mean weight gain was 12.5 gm/kg/day and in the intervention group 12.1 gm/kg/day ( P = 0.83). The average length of stay in the control group of 14.5 days was significantly longer than the 10.0 days in the intervention group ( P = 0.009). This difference remained significant after adjusting for gestational age at birth in regression analysis. The average total number of adverse events in the control group (12.5 events) was significantly greater than in the intervention group (3.5 events; P = 0.007). The mean PCA on study entry was 34.4 wks in both groups and on exit 36.5 wks in the control group and 35.8 wks in the intervention group, a significant difference ( P = 0.02), The intervention group elicited 2.8 cues/feed. The nurse to patient ratios was equal in both groups throughout the study period. Cue-based feeding was possible for premature infants with similar weight gain as traditional feeding without affecting workload. Hospitalization and adverse events were decreased.

Ethnic differences in 1-year mortality among patients hospitalised with heart failure.

OBJECTIVE: The incidence of cardiovascular disease and the prevalence of risk factors have been shown to differ significantly across ethnic groups. The objective of this study was to examine the impact of ethnicity on 1-year mortality among patients with heart failure in a single payer healthcare system with universal access. DESIGN, SETTING AND PATIENTS: Alberta residents aged 20 years or older hospitalised with heart failure between 1 April 1999 and 31 December 2005 are included. Previously validated algorithms were used to assign ethnicity based on patient surname. Patients were categorised as white, Chinese or East Indian. MAIN OUTCOME MEASURE: One-year mortality after adjusting for baseline differences. RESULTS: 52 980 white, 851 Chinese, and 377 East Indian individuals were hospitalised with heart failure. Chinese patients were the oldest and had the highest rates of renal disease. East Indian patients were the youngest and had the highest rates of ischaemic heart disease and diabetes. One-year mortality rates were 31.0% among white patients, 38.7% among Chinese and 26.5% among East Indian patients (p<0.01). Adjusted HR (and 95% CI) for 1-year mortality among Chinese compared with white patients was 1.34 (1.20 to 1.49) and among East Indian compared with white patients it was 1.04 (0.85 to 1.27). These findings were consistent across various subgroups, including patients with incident heart failure. CONCLUSIONS: Ethnicity appears to modulate patient outcomes in heart failure. Chinese patients have significantly higher 1-year mortality rates compared with white patients; there appear to be no differences in mortality among East Indian and white patients.