A Novel Neonatal Feeding Intolerance and Necrotizing Enterocolitis Risk-Scoring Tool Is Easy to Use and Valued by Nursing Staff.

BACKGROUND: Preterm infants are at increased risk of developing feeding intolerance and necrotizing enterocolitis. Comprehensive, targeted nursing assessments can evaluate the risk for and identify early signs of these conditions in an effort to prevent their destructive sequela. PURPOSE: While the long-term goal is to develop a validated risk-scoring tool for the prediction of feeding intolerance and necrotizing enterocolitis, the objective of the preliminary phase presented here is to assess the ease of use and nurses' attitudes toward a novel feeding intolerance and necrotizing enterocolitis risk-scoring tool. METHODS: A novel risk-scoring nursing tool was implemented in a University of Illinois-affiliated 48-bed level III neonatal intensive care unit. Data were collected from the electronic medical record of all preterm infants with parental consent during the initial 6-month study period. Scoring accuracy (accuracy of selection of risk factors based on electronic medical record data), ease of use, and nurses' attitudes toward the tool were assessed at the study site and by evaluators at a national neonatal nursing conference. RESULTS: Fourteen nurses scored 166 tools on the 63 enrolled infants. Sixteen tools (9.6%) contained errors. Mean study site tool ease of use was 8.1 (SD: 2.2) on a 10-point scale. Ninety percent of conference evaluators agreed/strongly agreed that the tool addressed important knowledge gaps. IMPLICATIONS FOR PRACTICE: The tool is easy to use and valued by nurses. Following validation, widespread implementation is expected to be a clinically feasible means to improve infant clinical outcomes for minimal time and financial cost. IMPLICATIONS FOR RESEARCH: Tool validation and refinement based on nursing feedback will improve its broad applicability and predictive utility.

[Not Available]. / Songenent-wohnung 2.0: Was Sonden-dependente Kinder brauchen.

A dramatic increase of home enteral nutrition in pediatric population has been reported over the last decade. Inpatient units discharge more and more children with nasogastric and G- tubes. And for certain percentage the feeding and eating behavior does not improve with time. But longer tube dependency frequently results in general food aversion and refusal. The assessment and treatment, we will line out in this paper, have shown high efficiency for children with feeding tube dependency. To improve the situation of children with feeding tube dependency more treatment facilities are needed. Furthermore early prevention program and feeding tube management should be established to prevent feeding tube dependency.

Not feeding, not coming home: parental experiences of infant feeding difficulties and family relationships in a neonatal unit.

AIM: This study had two main objectives: (1) to describe the experiences of parents who had a child in the Flinders Medical Centre neonatal unit with a feeding difficulty at 36 weeks gestational age and (2) to develop a preliminary model from the data as an account of the parents' experiences to identify considerations for future and current neonatal unit staff. BACKGROUND: Family centred care is an important part of nursing practice. Research looking individually at the neonatal unit experience and childhood feeding difficulties has found that they can be stressful situations for parents. However, very little research has been conducted into parental experiences of feeding infants in a neonatal unit and there is no known research which has specifically looked at the effect on parents of having a child with a feeding difficulty in a neonatal unit. DESIGN: A qualitative phenomenological research design was employed. METHOD: Nine parents whose children had feeding difficulties while in the Flinders Medical Centre neonatal unit, South Australia, participated via retrospective in-depth interviews. RESULTS: Responses were coded to describe parents' experiences and a preliminary model was proposed to explain the data. The main theme linking parental experiences was the desire to take the baby home. The feeding difficulty prevented this from occurring, shifting the feeding interaction from one of relationship development to one of weight gain. CONCLUSION: This research identifies trigger points that may be acted on to encourage positive parent-child feeding interactions. RELEVANCE TO CLINICAL PRACTICE: Family centred care is encouraged in paediatric nursing practice. This research identifies trigger points which may inform clinical practice involving parents of infants with feeding difficulties.

Problems of feeding, sleeping and excessive crying in infancy: a general population study.

OBJECTIVE: To study regulatory problems (RPs) of feeding, sleeping and excessive crying in infancy, and explore the influence of maternal mental health problems and parent-child relationship problems. DESIGN AND SETTING: Data were collected in the general child health surveillance delivered to infant families by community health nurses (CHNs). Information on CHNs' assessments and conclusions were obtained on 2598 infants and merged with data from national registers. Descriptive statistics and logistic regression models were used to study RPs in early and late infancy, and the influences due to child, family and parent-child relationship problems. RESULTS: Combined RPs (C-RPs), defined as two or more simultaneous problems of feeding, sleeping or excessive crying, was identified in 2.9% and 8.6% of the population between age 2-6 and 8-11 months, respectively. Low maternal schooling and immigrant parents were associated with an increased risk of late C-RPs, but RPs in early infancy stand out as the main predictor of late C-RPs OR 3.4 (95% CI 1.8 to 6.6), and the effect of early maternal mental health problems and parent-child relationship problems seem to be mediated by early C-RPs. CONCLUSIONS: Combined problems of feeding, sleeping or excessive crying may exist throughout infancy independently of exposures to maternal mental health problems and parent-child relationship problems. The results indicate that infants with RPs exceeding age 2 months need special attention, in clinical as well as community settings. Suggested intervention includes specific guidance to the parents to help them understand and regulate their infant's sensitivity and reactions.

An experience-based treatment model for children unwilling to eat.

Background Guidance during Meals is a two-week inpatient intervention undertaken at the Folke Bernadotte Regional Habilitation Centre, Sweden, to help parents deal with children's eating problems. Parents are given advice about medical and/or behavioural reasons for food selectivity and possible treatment strategies. Aims To identify the way parents handle mealtimes and associated difficulties and investigate parents' opinion on children's progress using Guidance during Meals. Method A questionnaire, consisting of 30 statements and answered by 41 parents, was used to investigate parents' opinions regarding the success of the intervention in altering their child's eating habits at home. Findings Most parents thought that the intervention had helped them and their child, by teaching them how to guide their child during mealtimes, what made it easier for their child to eat, and how to communicate with their child in an encouraging way. Most children retained their increased interest in eating once back at home. These results were not dependent on time of onset of eating problems, number of intervention periods, length of time since the intervention, or gastrostomy. Conclusion The Guidance during Meals intervention helps parents develop knowledge about factors that hinder or facilitate eating in their child and tools that can help their child finish meals, and gives them a sense of hope that positive change can occur.

Assessment of eating and drinking in a child with a gastrostomy.

During periods of short-term (respite) care a full and comprehensive assessment is essential if the wellbeing of a child with complex healthcare needs is to be maintained or advanced in the parents' absence. Eating and drinking is just one component of an holistic assessment carried out at The Children's Trust in Tadworth. There is an increasing use of different gastrostomy devices, feed products and regimes to meet the individual needs of a child and his/her family. The assessment tool used reflects the tension of using an holistic approach while trying to unravel or breakdown complex care needs into manageable 'chunks' for documentation purposes. The role of the parents is pivotal in ensuring the success of the assessment process.

Jejunostomy enteral feeding in children: outcome and safety.

BACKGROUND: The aim of this study was to report on the clinical outcome and safety of jejunostomy tube feeding used in our clinical setting for more than 14 years. MATERIAL AND METHODS: A retrospective study of all children who underwent a surgical catheter jejunostomy placement between July 1996 and March 2010 was conducted. Data were collected regarding the outcome and complications. RESULTS: Thirty-three children (14 girls) were included. The median age at the time of primary surgery was 1.43 years (range, 0.15-17.7 years), and the median time of follow-up was 2.34 years (range, 0.27-12.6 years). Seventeen children were severely neurologically impaired (NI). Surgical insertion of a jejunostomy tube was performed due to 1 or more of the following indications: gastroesophageal reflux disease (GERD), failure to thrive, recurrent pneumonia, esophageal disease, or oral feeding difficulties. The effect of the indications showed a reduction in GERD and pneumonia. Feeding difficulties also decreased. Weaning was possible in 12 of 16 children without NI but in only 2 of 17 with NI. Major complications requiring surgical reoperation affected 8 children. No mortality was related to the jejunostomy feeding catheter. CONCLUSION: In selected cases, surgically placed jejunostomy tubes for feeding in children is an effective and safe method to overcome GERD, feeding difficulties, or recurrent pneumonia without major surgery.

A new grading of Pierre Robin sequence.

OBJECTIVE: Pierre Robin sequence (PRS) involves the triad of micrognathia, glossoptosis, and cleft palate. Neonates with PRS suffer from two problems--airway obstruction and feeding difficulties--but the severity of these problems varies greatly. The resultant varying definitions of PRS have resulted in inconsistent management of those babies given the diagnosis. This in turn makes comparison of published data and communication between clinicians difficult. Historically at Birmingham Children's Hospital, the cleft team only identified babies presenting with cleft palate and severe respiratory distress as "true" PRS. These babies were admitted to the high-dependency neonatal ward for airway assessment and management. Babies with a mild degree of respiratory obstruction but who were managed successfully at home were not classified as having PRS despite needing considerable input from the Cleft Clinical Nurse Specialist. A system of classifying babies with PRS based on the severity of their symptoms and signs and treatment required was therefore devised and is described in this paper. RESULTS: Since implementation, this new classification of babies with PRS into three grades has clarified care pathways and enhanced communication between the Cleft Clinical Nurse Specialists and other health professionals involved with the care of these babies.