A survey of neonatal nutrition policies and practices in the UK and Eire.

Optimal nutrition is one of the fundamental components for infants to reach their full growth and neurodevelopmental potential. Best practice is facilitated by a contemporaneous, multidisciplinary, evidence-based nutrition policy. Such evidence has recently been reviewed. We have assessed: the prevalence of nutrition policies in neonatal units in the UK and Eire; their application to hypothetical cases; the availability of dietetic input; and whether any differences existed between non-regional and regional units. A standardized questionnaire was devised by a multidisciplinary group and posted to all 255 neonatal units in the UK and Eire in 2002. Replies from 67 neonatal units were received: 48 out of 233 non-regional and 19 out of 22 regional units. A feeding policy was present in 33 units, and regular access to dietitians occurred in 37 units. For a hypothetical infant less than 28 weeks' gestation, enteral feeds would be commenced at 0-2 days in 81% of non-regional and 94% of regional units (P = ns), and be continuous in 11% of non-regional and 32% of regional units, and bolus feeding in 89% of non-regional and 68% of regional units (P = ns). Routine fortification of breastmilk would occur more frequently in non-regional units (96%) than in regional units (79%) (P = 0.050). Vitamin and iron supplements would be given to infants receiving postdischarge or high-energy milks in 68% of non-regional units and in 79% of regional units (P = ns). Calorie counts (63% regional vs. 8% non-regional, P < 0.001), and daily weights (68% regional vs. 33% non-regional, P = 0.014), were used more frequently in regional units. Many units surveyed did not have a nutrition policy. Many infants receive unnecessary additional vitamins and supplements. Practice is variable throughout the country, but we found no evidence of major differences between regional and non-regional units, apart from their monitoring of growth and rates of breastmilk fortifier usage.

General paediatricians and the case of resolving peanut allergy.

Children with peanut allergy are almost always advised to avoid nuts for life. There have been recent reports from academic centres that in some cases the allergy might resolve and thus these dietary restrictions can be lifted. To evaluate resolution of peanut allergy in a selected group of children in a general paediatric setting. Children 4-16 yr old with a clear history of an allergic reaction to peanuts who had not had any reaction in the previous 2 yr were eligible. Specific immunoglobulin E (IgE) or skin prick test (SPT) at the time of diagnosis was sought. A SPT and specific IgE was then done and if this was

Education and evidence are needed to improve neonatal parenteral nutrition practice.

BACKGROUND: Parenteral nutrition (PN) is an essential component of neonatal care for those infants who are unable to tolerate adequate enteral feeding. Its use is not without complications such as biochemical derangements, sepsis, thrombosis, extravasation of fluid, and death. Such complications can be reduced by meticulous management of PN in response to biochemical abnormalities, nutrition teams, policies to reduce sepsis, and staff training to be more aware of pericardial and pleural effusions. We ascertained the current practices in PN administration and management of complications in all neonatal units with 6 or more intensive care cots in England, Scotland, and Wales. METHODS: Telephone survey of middle grade doctors (Specialist Registrars) working in all 57 neonatal units was conducted using a standard questionnaire. The questions were focused around practical issues and problems that are commonly encountered with PN practice, including composition, complications, and nutrition support. RESULTS: A response was obtained from 95% of the units contacted and a wide range of practices observed. Thirty-three percent of units delay protein (nitrogen) until > 48 hours after birth. Lipid infusions are stopped in proven or suspected sepsis in just over half of all units. In hyperglycemic preterm infants, 25 units decrease their glucose infusion, 21 commence insulin, and 8 have no policy. Two thirds of middle grade doctors had no idea of the amount of protein or nitrogen to prescribe for these infants, and only one-third involve a pharmacist in the PN prescribing. CONCLUSIONS: There is a diverse practice and knowledge with a concerning lack of education in nutrition among the middle grade doctors in England, Scotland, and Wales. The management of common complications such as sepsis and hyperglycemia are highly variable. Improved staff training and production of unified evidence-based guidelines need urgent consideration.