Katherine Carroll

An Exclusively Human Milk Diet Reduces Necrotizing Enterocolitis

OBJECTIVE This study tested the hypothesis that feeding an exclusively human milk (EHM) diet to premature infants reduces the incidence of necrotizing enterocolitis (NEC) associated with enteral feeding. STUDY DESIGN An observational study for infants born at less than 33 weeks of gestational age was performed in a single neonatal intensive care unit. An EHM diet prospectively eliminated bovine-based artificial milk, including bovine-based fortifier, through 33 weeks postmenstrual age (PMA). The clinical data from a 2.5-year interval of the EHM diet were compared with data from the previous 6.5 years for similar infants who received bovine-based milk products before 33 weeks PMA. RESULTS In the EHM diet cohort, 148 of 162 infants (91%) received EHM through 33 weeks PMA. In order to achieve an EHM diet, 140 of 162 infants (86%) received their own mothers milk, and 98 of 162 infants (60%) received donor human milk. The EHM cohort was also fed a human milk-based fortifier to truly eliminate bovine products. The distribution of NEC onset in the EHM cohort was significantly different from that in the control cohort for the day of onset (p=0.042) and the PMA at onset (p=0.011). In the control cohort, NEC onset after Day 7 of life occurred in 15 of 443 infants (3.4%), significantly more than in the EHM cohort where NEC occurred in two of 199 infants (1%) (p=0.009). CONCLUSIONS Changing to an EHM milk diet through 33 weeks PMA reduced the incidence of NEC associated with enteral feeding.

The (im)possibilities of clinical democracy

Abstract In this article, we argue that homogenising discussions of medical dominance on the meta-level of professions do not fully capture the complexity that characterises current clinical care in multidisciplinary health care teams. We illustrate this through an empirical study of a multidisciplinary team attempting to enact their work in a clinically democratic way. The challenges that arose in putting this into practice highlight the depth and complexity of enculturated medical dominance in Australian hospital practice. Our study shows that effective facilitation of clinician reflexivity has the potential to challenge and change deeply embedded structures and behaviours.

Outsider, insider, alongsider: Examining reflexivity in hospital-based video research

Abstract This research examines the power relations between the researcher, clinicians, the video camera and its footage in two innovative methodologies called ‘video ethnography’ and ‘video-reflexivity’. These methodologies have successfully facilitated clinician-learning and clinician-led practice redesign in Australian hospitals. Yet, to date, the literature has not acknowledged the power relationships that exist within these methodologies’ creative potential. This article uses a feminist framework to further theorise these methodologies as feminist video researchers have already problematised issues of power, researcher reflexivity and the collaborative use of video. Using an Australian intensive care unit (ICU) as a case study, this article unpacks the power relations involved in the use of video ethnography and video-reflexivity. It argues that researcher reflexivity and attention to power relations needs to be at the forefront of researchers’ practice to ensure that video ethnography and videoreflexivity’s careful use remains foundational to the methodology, rather than being reliant upon happenstance or individual researchers’ ethical care.

Infertile? The emotional labour of sensitive and feminist research methodologies

A researcher’s emotional labour is inextricably linked to the methodological and ethical underpinnings of ‘doing’ sensitive and some feminist research. However, a key component of the emotional labour theory does not fit with the emotional labour enacted by some researchers. This article sets out to extend the theory of emotional labour in order to make it more applicable to sensitive and feminist methodologies, and in doing so, it reveals the importance of incorporating emotion in the refinement of theory. Drawing on 20 interviews with female in vitro fertilisation patients, and extracts from a systematically recorded reflexive diary of the researcher, this article contests a key aspect of Hochschild’s theory of emotional labour in its application to sensitive and feminist qualitative researchers. Instead of estrangement from the emotional self as a result of enacting emotional labour, this article suggests that the emotional and biological selves of the researcher can be foregrounded, sometimes unwillingly. The investment of emotional labour must be acknowledged by institutions, managers and methodologists, and further theorising is required to incorporate the critical presence of emotional labour in social science research.

The Cost of Using Donor Human Milk in the NICU to Achieve Exclusively Human Milk Feeding Through 32 Weeks Postmenstrual Age

OBJECTIVES Donor human milk (DHM) is increasingly being used in neonatal intensive care units (NICUs) to achieve exclusive human milk (EHM) feedings in preterm infants. The aim of the study was to determine the cost of DHM to achieve EHM feeding for very preterm infants. The hypothesis was that the cost of DHM per infant is modulated by the availability of mothers own milk (MOM). SUBJECTS AND METHODS Preterm infants (<1,500 g at birth weight or <33 weeks in gestational age) were retrospectively evaluated for a 1-year interval. MOM, DHM, and formula feeding categories were determined. A DHM feeding log was retrospectively analyzed for feeding volumes (in milliliters) and duration (in days). Four categories were created, based on maternal ability to provide sufficient breastmilk volumes and her intention to breastfeed. The volume, duration, and cost of DHM were calculated for each category. RESULTS Forty-six of the 64 (72%) infants admitted to the NICU who were <33 weeks in gestational age received DHM. Four categories of DHM use were observed. The mean costs of DHM were

Discourse research that intervenes in the quality and safety of care practices

27 for infants of mothers who provided sufficient breastmilk through to discharge,

Body dirt or liquid gold? How the ‘safety’ of donated breastmilk is constructed for use in neonatal intensive care

154 for infants of mothers who had insufficient milk supply during admission,

Research as affect-sphere: towards spherogenics

281 for infants of mothers who went home on formula but received any volume of MOM during admission, and

From altruism to monetisation: Australian women's ideas about money, ethics and research eggs

590 for infants who received no MOM during admission. CONCLUSIONS Most NICU mothers (72%) of very preterm infants were unable to provide all of the milk necessary for an EHM diet. Few infants (15%) received exclusively DHM. The cost of DHM per NICU infant ranged from

Informed Consent and Fresh Egg Donation for Stem Cell Research

27 to