State of the science of care coordination, rurality, and well-being for infants with single ventricle heart disease in the Interstage period, an integrative review.

BACKGROUND: Ensuring the quality of interstage management of infants with single ventricle heart disease (SVHD) residing in rural communities is difficult. Tailored care coordination through parental discharge education, formal and informal care team and family communication, adequate access to healthcare, and informed provider handoffs are crucial to the infant's well-being and survival. OBJECTIVE: To discuss the state of the science related to care coordination factors and infant wellbeing during the interstage period. METHODS: An integrative review approach to synthesize findings across studies was used. Through constant comparative analysis, all articles were read and coded, broken down into "data bits" or key phrases. RESULTS: Four major themes were inductively derived: 1) education and confidence-building, 2) communication for building relationships, 3) social work and related mental health support, and 4) availability of resources. CONCLUSIONS: Despite advances in cardiac surgery and related interventions, a clear gap exists regarding care coordination factors and infant well-being, especially in rural communities.

Relationship of Necrotizing Enterocolitis Rates to Adoption of Prevention Practices in US Neonatal Intensive Care Units.

BACKGROUND: Applying quality improvement methods has reduced necrotizing enterocolitis (NEC) in some neonatal intensive care units (NICUs) by 40% to 90%. PURPOSE: This study was conducted to (1) examine relationships between adoption of prevention practices using the NEC-Zero adherence score and NEC rates, and (2) describe implementation strategies NICUs use to prevent NEC. METHODS: A descriptive cross-sectional correlational study was completed among US quality improvement-focused NICUs. Relationships of the NEC-Zero adherence score to NEC rates were examined. Subgroup analyses explored relationships of a human milk adherence subscore and differences between high NEC rate (≥8%) and low NEC rate (≤2%) NICUs. RESULTS: NICUs (N = 76) ranged in size from 18 to 114 beds. The mean adherence score was 7.3 (standard deviation = 1.7; range, 3-10). The 10-point adherence score was not related to the NEC rate. The human milk subscore related to lower NEC rates (Rho = -0.26, P = .049), as was colostrum for oral care (Rho = -0.27, P = .032). The units that used a feeding protocol showed higher NEC rates (Rho = 0.27, P = .03), although very few addressed the use of effective implementation strategies to track adherence or to ensure consistency among clinicians. The units that used colostrum for oral care were more likely to adopt strategies to limit inappropriate antibiotic exposure (Rho = 0.34, P = .003). IMPLICATIONS FOR PRACTICE: Broader use of evidence-based implementation strategies could bolster delivery of NEC prevention practices. Maternal lactation support is paramount. IMPLICATIONS FOR RESEARCH: Future studies are needed to identify how individual clinicians deliver prevention practices, to find the extent to which this relates to overall delivery of prevention, and to study effects of bundles on NEC outcomes.

Promoting Breast Milk Nutrition in Infants With Cleft Lip and/or Palate.

BACKGROUND: The orofacial defect of cleft lip/palate (CL/P) involves an altered physiological anatomy that affects the infant's feeding ability. Infants have cleft lip (CL), cleft palate (CP), or both (CL/P). Dysfunction in the seal, as with cleft lip, or in the ability to coordinate muscle movement to generate negative pressure, as with cleft palate, leads to feeding issues that may compromise growth and affect bonding. PURPOSE: The purpose of this article is to present (1) scientific evidence that supports clinical feeding practices for the infant with CL/P and (2) teaching strategies for staff and parents. METHODS: Evidence was synthesized using a narrative review of randomized controlled trials, qualitative studies, systematic reviews, professional guidelines, and position statements. Findings were used to present specialized equipment and feeding techniques to support human milk feeding. FINDINGS: Special considerations for feeding infants with CL/P include assessing the infant's sucking ability, demonstrating proper breastfeeding positioning, supporting mothers to establish and maintain their milk supply, considering adaptive feeding equipment (ie, specialized bottles and nipples), and education about the benefits of human milk. IMPLICATIONS FOR PRACTICE AND RESEARCH: Support from healthcare professionals, particularly lactation specialists and nursing staff, is critical. Breastfeeding and the use of human milk should be prioritized and supported. Research is needed to explore environmental, genetic, and nutritional causes (eg, folic acid deficiency) of orofacial defects.

Colostrum as oral immune therapy to promote neonatal health.

It is well known that the immune response is blunted and underdeveloped in the premature infant, but human milk supports the infant's growth, function, and effectiveness. Thus, own mother's colostrum (OMC) administered oropharyngeally has potential to deliver oral immune therapy (C-OIT) even before enteral feedings have begun. Colostrum interacts with lymphoid tissue in the oropharynx and gut. Colostrum as oral immune therapy is delivered by swabbing the cheeks in the first days of life. Little formal study has evaluated its effectiveness. However, small studies demonstrate that it is a practice that is safe, feasible, and well tolerated even by the smallest premature infants. Encouraging preliminary evidence supports the effect of C-OIT to reduce the time to full enteral feedings. Effects on other outcomes is unclear, in part because existing studies are underpowered to detect significant differences on outcomes like necrotizing enterocolitis, sepsis, and death. Another limitation in the evidence base is that adherence to the intervention and the number of doses of colostrum infants received in the studies is not consistently made clear. More well-designed studies are needed to demonstrate the impact on neonatal complications and how C-OIT supports the infant's immune development. Quality improvement and time series reports of differences pre- and postimplementation of OMC given orally should minimally include statistics for adherence to the intervention and/or the number of doses an infant received as a covariate. Even so, OMC is an immune therapy that poses little risk yet offers likely cost-effective benefit for vulnerable infants.