Nefrolitíase pediátrica: uma complicação da amamentação ineficaz? / Pediatric nephrolithiasis: a complication of ineffective breastfeeding?

A nefrolitíase constitui-se na formação de conglomerados cristalinos e de matriz orgânica que podem se localizar no trato urinário, com dimensões e localização capazes de conferir significado clínico-patológico. Os fatores dietéticos têm sido mostrados como fatores de risco para a ocorrência de litíase urinária. O presente artigo teve por objetivo relatar e relacionar com a assistência de enfermagem, por meio de um plano de cuidados, um caso ocorrido entre dezembro de 2014 e fevereiro de 2015, em um hospital público do Distrito Federal, Brasil, em que a criança tinha como sintomatologia principal a eliminação de cálculos renais de diferentes tamanhos e em grande quantidade por meio do canal urinário. A associação com o aleitamento materno ineficaz é explicada no sentido em que a habilidade da criança até os seis meses de vida em manejar alguns alimentos distintos do leite materno é limitada, pois seus sistemas digestivo e renal ainda estão imaturos. Os fatos descritos neste estudo evidenciam a importância da atuação profissional no manejo do aleitamento materno exclusivo e no aconselhamento nutricional e de saúde, tendo em vista que estes são fatores modificáveis frente à prevenção de patologias e complicações.

Nephrolithiasis consists of the formation of crystalline clusters and organic matrix that can be located in the urinary tract, with dimensions and location capable of providing clinical and pathological significance. Dietary factors have been shown to be risk factors for the occurrence of urolithiasis. This article aims to describe and relate to nursing care through a care plan, a case occurred between December 2014 and February 2015 in a public hospital in the Distrito Federal, Brazil, in which the child had as main symptoms the elimination of kidney stones of different sizes and in large quantities through the urinary tract. The association with ineffective breastfeeding is explained in the sense that the child's ability to six months of life in handling some distinct breast milk foods is limited because their digestive and renal systems are still immature. The facts described in this study show the importance of professional practice in the management of exclusive breastfeeding and nutrition counseling and health, given that these factors are modifiable front of prevention of diseases and complications.

'The midwives aren't allowed to tell you': perceived infant feeding policy restrictions in a formula feeding culture - the Feeding Your Baby Study.

OBJECTIVE: to explore the expectations and experiences of postnatal mothers in relation to infant feeding, and to identify how care could be improved. DESIGN: this study used a qualitative, exploratory, descriptive design. Data were collected through one to one in-depth semi-structured interviews and focus groups. SETTING: Tayside area of Eastern Scotland. PARTICIPANTS: seven focus group interviews (n=38 participants) and 40 semi-structured one-to-one interviews with mothers with a range of infant feeding experiences i.e. exclusively breast fed; started breast feeding but changed to formula milk before 16 weeks; exclusively formula fed; or who concurrently breast and formula fed their infant. FINDINGS: a principal theme of 'Mixed and missing messages' emerged, incorporating 'Conflicting advice', 'Information gaps' and 'Pressure to breast feed' with a secondary theme of 'Emotional costs'. Several problems were identified with how women were given information, how infant feeding discussions were held, and the type of support available after the infant is born. KEY CONCLUSIONS: there was a strong perception that some midwives are not 'allowed' to discuss or provide information on formula feeding, and the women reported feeling pressurised to breast feed. Current interpretation of guidance from the UNICEF UK Baby Friendly Initiative may be restricting antenatal discussions about infant feeding. The combination of this partial preparation antenatally and postnatal support that was often inconsistent seems to incur a counter-productive emotional cost. IMPLICATIONS FOR PRACTICE: at strategic, policy and practice levels the infant feeding message needs to change to encourage a more woman-centred focus including discussions about the realities of all types of infant feeding. It is important that health providers continue to promote and support breast feeding; and that effective services are provided to women who wish to breast feed to help them to do so. However provision of information about all aspects of feeding is needed as well as support for women who do not wish to breast feed.

Oral feeding readiness in preterm infants: a concept analysis.

Oral feeding readiness in the neonatal intensive care unit (NICU) population of preterm infants is a complex and multifactorial concept that is encountered on a daily basis. The significance of having an understanding of the concept of oral feeding readiness within the context of prematurity is explored using the Wilsonian approach to concept analysis through the identification of characteristics and case examples of oral feeding readiness in preterm infants as directly observed in a level III NICU. Identification of these essential elements provides clarity for determining oral feeding readiness as well as leading to greater consistency in the provision of evidence-based feeding-related care for the preterm infant hospitalized in the NICU. Outcomes of this analysis demonstrated that oral feeding readiness is affected by a combination of neurodevelopmental maturity, behavioral state organization, and physiologic stability as well as being influenced by caregivers and the environment.

Examination of the effect of BornFree ActiveFlow baby bottles on infant colic.

Despite its benign, natural course, colic is a significant problem in babies and imparts a psychological and physical burden to parents. This study has examined the relief of colic symptoms when using BornFree ActiveFlow baby bottles by comparing observed symptoms of 30 otherwise healthy newborns (ages 2-21 weeks) who had all been diagnosed as having colic symptoms. Twenty of the babies were switched to feeding with BornFree bottles (the experimental group), while the other 10 babies continued feeding with bottles by other manufacturers (the control group). A significant improvement was exhibited in the experimental group after 1 week of feeding with BornFree bottles, with a further significant improvement in the second week. Although they had different venting systems, the control group maintained the same level of colic symptoms as in the beginning of the study. We conclude that using BornFree baby bottles can effectively reduce colic symptoms in diagnosed babies.

Supporting oral feeding in fragile infants: an evidence-based method for quality bottle-feedings of preterm, ill, and fragile infants.

Successful oral feeding of preterm and other ill and fragile infants is an interactive process that requires (1) sensitive, ongoing assessment of an infant's physiology and behavior, (2) knowledgeable decisions that support immediate and long-term enjoyment of food, and (3) competent skill in feeding. Caregivers can support feeding success by using the infant's biological and behavioral channels of communication to inform their feeding decisions and actions. The Supporting Oral Feeding in Fragile Infants (SOFFI) Method is described here with text, algorithms, and reference guides. Two of the algorithms and the reference guides are published separately as Philbin, Ross. SOFFI Reference Guides: Text, Algorithms, and Appendices (in review). The information in all of these materials is drawn from sound research findings and, rarely, when such findings are not available, from expert, commonly accepted clinical practice. If the quality of a feeding takes priority over the quantity ingested, feeding skill develops pleasurably and at the infant's own pace. Once physiologic organization and behavioral skills are established, an affinity for feeding and the ingestion of sufficient quantity occur naturally, often rapidly, and at approximately the same postmenstrual age as volume-focused feedings. Nurses, therapists, and parents alike can use the SOFFI Method to increase the likelihood of feeding success in the population of infants at risk for feeding problems that emerge in infancy and extend into the preschool years.

Understanding cleft lip and palate. 3: feeding the baby.

The third paper in this series on cleft lip and palate gives an overview of feeding a baby with a cleft lip and/or palate. It includes a description of the feeding assessment that all babies receive from the Cleft Specialist Nurse, the different methods of feeding that are likely to succeed with each cleft type, and other associated care and interventions.

Nasogastric feeding for infants who have undergone palatoplasty for a cleft palate.

Almost 1,000 babies are born each year with some form of cleft, whether it is a palate, lip or a combination. However, with the advent of new regional cleft centres and specialist professionals caring for larger numbers of children with a cleft lip and palate, the long-term outcomes of these patients should show improvement. The nursing care on paediatric wards will make an important contribution to these outcomes. In this article, post-operative feeding, analgesia and inpatient stays following cleft palate repair are examined. In a post-palatoplasty study of 68 babies, 34 who were fed orally and 34 nasogastrically, the babies who were fed nasogastrically were more settled, needed less analgesia and were discharged earlier. The parents of these babies were more relaxed knowing their child was fed and had adequate analgesia, and nurses believed they were able to give these babies a better quality of care.

A review of psychometric properties of feeding assessment tools used in neonates.

OBJECTIVE: To appraise the psychometric properties of clinical feeding assessment tools used in a neonatal population. DATA SOURCES: PubMed, OvidMedline, CINHAL, and PsycINFO databases from 1980 to 2007. Reference lists of all identified articles were also reviewed. STUDY SELECTION: Research reports written in English that utilized or validated clinical feeding assessment tools. DATA EXTRACTION: In total, 941 articles were reviewed. Seven neonatal clinical feeding assessment tools were identified and categorized into three groups: tools used for assessing either bottle-feeding or breastfeeding behaviors, tools used only for assessing bottle-feeding behaviors, and tools used only for assessing breastfeeding behaviors. RESULTS: The psychometric properties of none of the seven assessment tools identified were satisfactory, and the limited representativeness of the samples of the psychometric research was noted in all assessment tools identified. The Neonatal Oral-Motor Assessment Scale appeared to have been examined more thoroughly and showed more consistent results in psychometric properties than the others, despite its own limitations. CONCLUSIONS: A psychometrically sound neonate feeding assessment tool has not yet been empirically validated. Clinicians who use these tools for clinical and research purposes should take into account this lack of evidence of psychometric soundness and interpret results of assessment with precautions. Well-designed research is needed to study the scientific integrity of these instruments for program evaluations in neonatal care.

Multiple factors related to bottle-feeding performance in preterm infants.

BACKGROUND: A great deal of attention has focused on understanding preterm infant feeding behaviors and on strategies to support the preterm infant during this period; however, comprehensive descriptions of the feeding behavior of preterm infants that incorporate an examination of multiple subsystem levels are lacking. OBJECTIVE: To examine various physical indicators related to preterm infants' bottle-feeding performance. METHODS: This was a retrospective, descriptive, exploratory study using a convenience sample. Medical records of 116 preterm infants were reviewed from the initiation of bottle-feeding until discharge from the neonatal intensive care unit. This study examined bottle-feeding performance (volume intake in milliliters per minute) as well as postmenstrual age, weight at each observed feed, oral motor skills, signs of distress, feeding techniques, feeding experience, gender, and Apgar scores at 5 minutes. Oral motor skills were measured by the Neonatal Oral Motor Assessment Scale. RESULTS: Linear mixed-effects models were used to examine the relationship between bottle-feeding performance and the remaining variables. Postmenstrual age, weight at each observed feed, oral motor skills, feeding experience, and feeding techniques were found to be significant predictors of feeding performance at the .05 level. CONCLUSIONS: Multiple factors, both intrinsic and extrinsic, play a role in determining an infant's bottle-feeding performance. In addition to age and weight, the presently employed conventional criteria, oral motor skills, feeding practice, and feeding techniques also contribute to infants' feeding performance. Arbitrary age (34 weeks gestational age) and weight criteria (1,500 g) should not be the only indicators for oral feeding.

Use of the six sigma methodology to reduce incidence of breast milk administration errors in the NICU.

Breast milk is the optimal source of nutrition for infants. According to research, neonates fed breast milk have a reduced risk of sepsis, increased feeding tolerance, a decreased incidence of necrotizing enterocolitis, and better neurodevelopmental outcomes. Unfortunately, researchers have not identified practices to reduce or eliminate the risk for errors in breast milk administration. This article discusses the potential hazards of incorrect administration of breast milk. It then describes how the tertiary care center at Children's Hospital of Illinois implemented a policy utilizing six sigma quality improvement methodologies to improve breast milk administration. Since implementation of this policy, the NICU at our hospital has reduced the risk of breast milk administration errors to less than 3.4 mistakes per million opportunities.

An evidence-based approach to nipple feeding in a level III NICU: nurse autonomy, developmental care, and teamwork.

Historically, nipple feeding in the NICU has been initiated and advanced by physician order based on nursing observation and suggestions. The growing evidence base regarding nipple feeding readiness and progression, contingent caregiving, and nurse autonomy in decision making prompted our Level III NICU to reconsider our process. A literature review and discussions resulted in new protocols for initiating and advancing nipple feedings for three distinct groups: healthy preterm infants, preterm infants with complicated medical courses, and sick term or posttcrm infants. Through incorporating contingent earegiving, greater autonomy for the bedside nurse, developmental support, and collaboration, we expect to improve outcomes, comnuinication, and problem solving.

Contemporary aspects of infant feeding.

Early dietary influences, even before birth, can have an effect on growth, which in turn has a profound influence on adult health. Formula-fed infants have a different growth pattern from that of breast-fed babies and a greater risk of developing obesity. However, infant formulas, when correctly prepared and handled, are a safe alternative for mothers who do not wish to or are unable to breast feed. A balanced view of the nutritional benefits of breast milk and infant feed formulas allows professionals to share sound advice with mothers.

Clinical coordination of research.

A feeding study conducted at a tertiary care center's neonatal intensive care unit tested a predictive model of bottle-feeding readiness and feeding outcomes. The study examined how bottle-feeding experience influences both bottle-feeding readiness and outcomes. The clinical coordinator played an integral role in the success of the research by coordinating the education of nurses, data collectors, and families; communicating with various interest groups; managing recruitment, enrollment, and participant tracking; and overseeing data collection.