Donna A. Dowling

Cup-Feeding for Preterm Infants: Mechanics and Safety:

Cup-feedingis recommended for breastfed preterm infants to avoid artificial nipples. However, the oral mechanisms used in cup-feeding, or its safety and efficacy, have not been described. The authors measured sipping, breathing, Sa0 2,band volume of intake during15 cupfeeding sessions for 8 infants (mean gestational age at birthwas 30.6 weeks). Mean duration of sippingb ursts and pauseswas 3.6 seconds and 28.1 seconds, respectively. Mean breathingrate duringb ursts and pauses was similar (46.2 ± 24.3 vs 45.7 ± 17.7, respectively), with Sa02 = 90% duringall bursts. Mean duration of cup-feedings was 15.2 ± 3.9 minutes (range, 11.0-23.3), whereas mean volume of intake was only 4.6 ± 2.2 mL (range, 1.5-8). For the 15 sessions, 38.5% of milk taken from the cup was recovered on the bib. Although infants remain physiologically stable, cup-feeding has questionable efficacy and efficiency. Differentiating between actual intake versus spillage of milk merits attention.

Cup versus bottle feeding for hospitalized late preterm infants in Egypt: A quasi-experimental study

BackgroundAlthough previous studies have demonstrated beneficial breastfeeding outcomes when cup feeding rather than bottle feeding was used for feeding preterm infants, cup feeding has not been implemented in Egypt. The aim of the current study was to examine the effect of using cup feeding as an exclusive method of feeding preterm infants during hospitalization on breastfeeding outcomes after discharge.MethodsA quasi-experimental design, with the control group studied first, was used to examine the effect of cup feeding for preterm infants on breastfeeding outcomes after discharge. Sixty preterm infants (mean gestational age was 35.13 weeks and mean birth weight was 2150 grams) were recruited during Neonatal Intensive Care Unit (NICU) stay. Control group infants (n = 30) received only bottle feedings during hospitalization and the experimental group (n = 30) received only cup feedings during hospitalization. Both groups were followed up after discharge for six weeks to evaluate infants breastfeeding behavior and mothers breastfeeding practices. Data were analyzed using descriptive statistics and repeated measures ANOVA for testing the differences between the cup feeding and bottle feeding groups over six weeks after discharge.ResultsCup fed infants demonstrated significantly more mature breastfeeding behaviors when compared to bottle fed infants (p < 0.01) over six weeks, and had a significantly higher proportion of breast feedings one week after discharge (p = 0.03).ConclusionCup fed infants were more exclusively breast fed one week after discharge, supporting the Baby Friendly Hospital Initiative recommendations for using cup feeding and avoiding bottle feeding when providing supplementation for preterm infants. The current study provides initial evidence for the implementation of cup feeding as a method of supplementation for late preterm infants during hospitalization.Trial RegistrationClinical Trial NCT00756587.

Maternal kangaroo (skin-to-skin) care in the NICU beginning 4 hours postbirth.

Kangaroo care (KC) for preterm infants is becoming well known in the United States. Typically, KC is given by mothers in the neonatal intensive care unit (NICU) beginning days or weeks postbirth. This case report documents KC beginning at 4.5 hours postbirth with a healthy mother whose 32-week, 1,953 gram infant required initial care in the NICU. The nurses role in supporting this care is described. Both parents experienced KC with their son and were soon convinced of the exceptional benefits he received. The infant was transferred to intermediate care on Day 2, regained his birth weight by Day 12, was discharged home on Day 21. He was breast-feeding exclusively at 40 weeks corrected age, and had Bayley mental and motor development scores within normal limits at 6 months corrected age.

Explanation for Cessation of Breastfeeding in Mothers of Twins

This study used content analysis to examine reasons for cessation of breastfeeding of twins by 2 time points: 9.4 weeks and 28.3 weeks of age. From a convenience sample of 123 mothers, 110 initiated breastfeeding for their twins. Thirty women had stopped breastfeeding by time 1, with an additional 37 women stopping by time 2. Three major themes were identified regarding weaning: factors related to breastfeeding process, to mother’s role and health, and to infant behavior and health. Subcategories were identified for each theme, with additional subcategories emerging at time 2. Cited reasons are similar to those given by singleton mothers; however, mothers of twins identified unique issues related to infants’ behaviors, challenges presented by growth and development, and time commitments that interfered with breastfeeding continuation. Implications of the study suggest the need for continued lactation support as the twins grow and develop and new breastfeeding issues arise.

Kangaroo Skin-to-Skin Care for Premature Twins and their Adolescent Parents

Risk factors associated with prematurity and adolescent parenting greatly increase when combined with multiple birth. Kangaroo care (KC) for preterm infants is well documented, although KC with twins or with adolescent parents is mentioned only briefly. In this case study, adolescent parents experience KC with their 32-week twin sons beginning 19 hours postbirth. These young parents interacted with, responded to, and took responsibility for their newborn sons, behaviors that are sometimes difficult for adolescent parents. Thus, KC appeared to be an effective intervention for these adolescent parents. Additionally, three kinds of KC with twins were identified: separate, sequential, and shared.

Reliability and validity of the Preterm Infant Feeding Survey: instrument development and testing.

No instruments have been located that examine attitudes concerning feeding decisions of mothers of preterm infants. The purpose of this study was to describe the development and psychometric testing of the Preterm Infant Feeding Survey (PIFS). The PIFS was adapted from the Breastfeeding Attrition Prediction Scale. The five-subscale, 78-item PIFS was tested with 105 mothers of preterm infants shortly after hospital admission. Individual subscale Cronbach’s alpha values ranged from .75 to .82. Factor analysis demonstrated a five-factor solution. The PIFS is the first instrument to examine factors that contribute to feeding decisions of mothers of high-risk preterm infants; this knowledge will support the planning of interventions to improve breastfeeding outcomes for this population. Further psychometric testing with larger samples is recommended.

Supports and Barriers to Successful Progression in a DNP Program: Students' and Graduates' Perspectives.

This study examined the supports, barriers, and strategies to successful progression in a DNP program using a nationwide online survey of DNP students and graduates. Subjects (n = 172) had a mean age of 46.2 years; 83% worked full time. Major barriers were competing demands of work, family, and school. Perseverance was a key element in overcoming barriers; most students reported being overwhelmed, and 37% considered quitting. Mechanisms for programs to consider in addressing this stress are discussed.

The effect of fluid density and volume on the accuracy of test weighing in a simulated oral feeding situation.

BACKGROUNDFor preterm infants and infants who have difficulty with oral feeding, excessive drooling during oral feedings can result in inaccurate assessment of intake. The drooled volume is typically estimated by visual and tactile assessment of the bib. Research, however, has demonstrated that visual assessment is inaccurate. PURPOSEThe purpose of this study was to determine the accuracy of a scale that was used for the test weighing of milk that was drooled during a study of oral feeding for preterm infants. Additionally, the effect of weighing solutions with different densities on the accuracy of test weights was examined. METHODDescriptive, comparative design. PROCEDURESA simulated feeding situation was performed using 3 fluids (water, Enfamil20, and Enfamil24) and 3 volume ranges (1 mL to 10 mL, 11 mL to 20 mL, and 21 mL to 30 mL). Data collection sessions were conducted for each of the 3 fluids using each range of volumes, for a total of 180 test weights. The research assistant performing the test weights was blinded to the preweight of the bib and the amount of fluid being applied to the bib. RESULTSDifferences between the actual volume applied to the bib and the volume estimated by the scale were very small, with 51% of the differences equaling 0 mL and 48% of the differences between −1 mL and 1 mL. There were significant differences in errors related to both the type of fluid (F = 25.7; df = 2; P < 0.001) and volume range (F = 12.7; df = 2; P < 0.001), as well as for the interaction between the 2 factors (F = 7.02; df = 4; P < 0.001). Water had significantly less mean error than either formula, and large volumes had significantly greater mean error than either small or medium volumes. CONCLUSIONSTest weighing is an accurate method for measuring fluids of different densities and volumes in a simulation of drooling during oral feeding. The increased error with larger volumes of higher density solutions was not clinically significant. The study supports the need to consider both the accuracy of the scale and characteristics of the fluid when test weighing is used to measure volumes of fluids.

Safe Sleep Infant Care Practices Reported by Mothers of Twins.

Background:The high prevalence of prematurity and low birth-weight places twin infants at increased risk for sudden unexpected infant death (SUID) and/or sudden infant death syndrome (SIDS). Risk for these SUID and SIDS is affected by a combination of nonmodifiable intrinsic risk factors and modifiable extrinsic stressors including infant care practices related to sleep. Although adherence to the full scope of American Academy of Pediatrics (AAP) 2011 recommendations is intended to decrease risk, these recommendations are aimed at singleton infants and may require tailoring for families with multiple infants. Purpose:The study describes infant care practices reported by mothers of twins in the first 6 months postpartum. Methods:Mothers caring for twin infants (N = 35) were surveyed online both longitudinally (at 2, 8, 16, and 24 weeks after infant hospital discharge) and cross-sectionally. AAP recommendations (2011) guided survey content. Results:The degree of adherence to AAP recommendations varied over time. For example, mothers of twins reported 100% adherence to placing twins supine for sleep initially, but many reported putting babies on their stomachs for naps as twins became older. Sharing a parents bedroom decreased over time as did frequency of crib sharing. Fewer than half of mothers offered a pacifier most or all of the time for sleep. Implications for Practice:Opportunities exist for development of an educational program geared specifically for postpartum parents of twins. Implications for Research:Barriers affecting adherence to AAP recommendations and effectiveness of educational programs addressing needs of this unique population need further exploration.

The history and state of neonatal nursing quality improvement practice and education

Quality improvement has evolved rapidly in neonatal nursing. This review outlines the history and current state of quality improvement practice and education in neonatal nursing. The future of neonatal nursing includes a stronger emphasis on quality improvement in advanced practice education that promotes doctoral projects that result in clinical improvements. A collective focus will ensure that neonatal nurses not only deliver evidence-based care, but also continually improve the care they deliver.