Oropharyngeal Colostrum Administration in Very Low Birth Weight Infants: A Randomized Controlled Trial.

OBJECTIVES: Studies have confirmed the safety of oropharyngeal administration of colostrum in very low birth weight infants. However, the effect of oropharyngeal administration of colostrum on immune system is inconclusive. This study aims to evaluate the effect of oropharyngeal administration of colostrum on secretory immunoglobulin A and lactoferrin in very low birth weight infants. DESIGN: Randomized controlled trial. SETTING: Forty-bedded neonatal ICU in a university children's hospital in the People's Republic of China. PATIENTS: Very low birth weight infants were allocated to the study group (n = 32) and control group (n = 32). INTERVENTION: The intervention was oropharyngeal administration of 0.2 mL of their mother's colostrum every 4 hours for 7 days. The control group received saline solution. MEASUREMENTS AND MAIN RESULTS: Secretory immunoglobulin A and lactoferrin in urine and saliva were measured within 24 hours of life (baseline) and at 7 and 21 days. Primary outcomes were changes of secretory immunoglobulin A and lactoferrin in urine and saliva between baseline and at 7 and 21 days. Infant's clinical data were also collected during hospitalization. Change from baseline in lactoferrin in saliva at 7 days (5.18 ± 7.07 vs -1.74 ± 4.67 µg/mL; p < 0.001) and 21 days (5.31 ± 9.74 vs -1.17 ± 10.38 µg/mL; p = 0.02) shows statistic difference. No differences were found of lactoferrin in urine and also no differences of secretory immunoglobulin A in urine and saliva. There were also no differences between days to full enteral feeding, occurrence rate of clinical sepsis, proven sepsis, and necrotizing enterocolitis. CONCLUSIONS: Oropharyngeal administration of colostrum can increases the level of lactoferrin in saliva in very low birth weight infants. No effect could be documented of secretory immunoglobulin A and lactoferrin in urine. Larger trials are needed to better describe the benefit of oropharyngeal administration of colostrum, if any, in very low birth weight infants.

'You learn to smile with your eyes', exploring the impact of enhanced personal protective equipment on primary care dental practitioners in the UK: An interpretative phenomenological study.

OBJECTIVE: The aim of the study was to explore how dental practitioners in primary care settings perceive the impact of enhanced personal protective equipment (PPE) upon patient communication and wider clinical practice. METHODS: This study utilized a qualitative approach, rooted in critical realism. An interpretative phenomenological analysis (IPA) methodology was adopted as the study method. In accordance with IPA, in-depth semi-structured interviews were conducted. Eight dental practitioners were recruited, with data analysis conducted according to the principles of IPA. RESULTS: Three themes were synthesized (related to communication and clinical practice): (1) Impaired communication and relationship building; (2) Physical impacts and required adjustments when wearing enhanced-PPE; and (3) Psychological stress of implementing enhanced-PPE. Theme one reflects changes to the dynamic of communication between patients and colleagues brought about by enhanced-PPE. Theme two describes the physical and psychological strains of providing care in enhanced-PPE and the ways through which practitioners tried to overcome these challenges. Theme three explores how the roll-out and guidance related to the use of enhanced-PPE affected clinical practice. CONCLUSIONS: Dental Practitioners described several barriers to communication as well as physical and mental stressors caused by enhanced-PPE, all of which were perceived to impact upon the quality of care provided to patients. Further research is required to develop effective interventions to mitigate the impact of enhanced-PPE upon clinical practice and to explore the long-term impact of enhanced-PPE on clinical practice, post-COVID.