Education of family members to support weaning to solids and nutrition in infants born preterm (Review) Education of family members to support weaning to solids and nutrition in infants born preterm (Review)

BackgroundWeaning refers to the period of introduction of solid food to complement breast milk or formula milk. Preterm infants are known to acquire extrauterine growth restriction by the time of discharge from neonatal units. Hence, the postdischarge and weaning period are crucial for optimal growth. Optimisation of nutrition during weaning may have long‐term impacts on outcomes in preterm infants. Family members of preterm infants may require nutrition education to promote ideal nutrition practices surrounding weaning in preterm infants who are at high risk of nutritional deficit.ObjectivesTo investigate the role of nutrition education of family members in supporting weaning in preterm infants with respect to their growth and neurodevelopment compared with conventional management.Search methodsWe used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 5), MEDLINE via PubMed (1966 to 26 June 2018), Embase (1980 to 26 June 2018), and CINAHL (1982 to 26 June 2018). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi‐RCTs.Selection criteriaRCTs and quasi‐RCTs were eligible for inclusion if they examined the effects of nutrition education of family members as compared to conventional management for weaning of preterm infants up to one year of corrected gestational age. We defined prematurity as less than 37 completed weeks of gestation.Data collection and analysisAt least two review authors independently screened potential studies for inclusion and planned to identify, extract data, and assess the quality of eligible studies. We resolved any differences in opinion through discussion with a third review author and consensus among all three review authors.Main resultsNo eligible trials looking at the impact of nutrition education of family members in weaning of preterm infants fulfilled the inclusion criteria of this systematic review. Two studies investigating the ideal timing for weaning in premature infants reported conflicting results,Authors' conclusionsWe were unable to assess the impact of nutrition education of family members in weaning of preterm infants as there were no eligible studies. This may be due to the lack of evidence to determine the ideal weaning strategies for preterm infants with regards to the time of initiating weaning and type of solids to introduce. Trials are needed to assess the many aspects of infant weaning in preterm infants. Long‐term neurodevelopment and metabolic outcomes should also be assessed in addition to growth parameters

Education of family members to support weaning to solids and nutrition in later infancy in term-born infants

Review questionWe reviewed the evidence for effects of nutrition education about appropriate feeding practices during weaning on growth and development in children born at term gestation.BackgroundAround the world, over 150 million children are undernourished and over 42 million are overweight and obese. Providing families with appropriate education about feeding practices during weaning may help to optimise nutrition while helping to protect children who are at risk of undernutrition, as well as those susceptible to being overweight and obese.Study characteristicsWe examined research published up to December 2019 and found 21 clinical trials recruiting 14,241 babies. The nutrition education provided in all included studies, whereby analysis could be pooled together, was aimed at reducing the risk of undernutrition in childhood. Five studies were undertaken in high-income countries, but the findings reported could not be included and pooled together in this review.Key resultsWe found that giving nutrition education about appropriate feeding practices during weaning to families in low- to moderate-income settings may improve weight and height at 12 months of age. We are very uncertain about the effects of nutrition education on children's development and risk of anaemia at one year of age, as only two studies reported each of these outcomes. Therefore, these results are described only in the text. We did not find any studies that assessed the effects of nutrition education on children's risk of overweight and obesity and reported outcomes that could be pooled together in this review.Certainty of evidenceThe certainty of evidence for the reduction in risk of childhood undernutrition with nutrition education is low to moderate at best due to limitations in study design and differences among the studies included in our review. The amount of improvement in growth noted is small and of unclear clinical significance. More long-term studies are needed to see if this improvement continues into later life, leading to bigger improvements. We rated the certainty of evidence for other outcomes included in this study as low due to the limited number of included studies.Further research is needed to determine whether nutrition education can reduce risks of overnutrition and obesity in children

Nutritional support for preterm infants: a study of current perceptions and practices of parenteral and enteral nutrition and complementary foods

The incidence of preterm birth is increasing globally. In the UK, approximately 7% of live born infants are born prematurely. Premature birth is one of the most important issues in perinatal medicine, leading to a considerable global burden of diseases due to high mortality and morbidity in these vulnerable infants. Suboptimal nutritional intakes during the early postnatal and post-discharge period, including inappropriate weaning practices contribute to malnutrition, suboptimal growth and poor neurodevelopment outcome among infants born preterm. The aims of this thesis were: (1) to explore the early nutritional support of preterm infants during the first two weeks of life, (2) to investigate the current routine nutritional practice for intra-uterine growth restriction (IUGR) infants with abnormal antenatal Dopplers during their hospital stay, (3) to evaluate families’ practices and perceptions regarding the introduction of complementary feeding (CF), and (4) to critically appraise the current evidence for the provision of nutrition education to families on weaning of infants born preterm and full-term infants. To achieve these aims, this thesis was divided into four studies. The first study (Chapter Two) utilised raw data from 59 infants admitted to the Neonatal Units at Nottingham University Hospitals to explore nutritional support for preterm infants in the first 14 days of life. To investigate how close the nutritional support for preterm infants was to published nutritional recommendations, further data were obtained for 119 preterm infants admitted to Neonatal Units within the UK Central Newborn & Trent Perinatal Networks. The study determined that overall, nutritional intakes were close to recommendations for infants in Neonatal Intensive Care Units, although the intakes were below the recommended range for infants from Special Care and Local Care Units. The second study (Chapter Three) utilised data of 1085 IUGR infants with abnormal antenatal Doppler studies identified from a national database to account for the possible impact of the evidence on the clinical practice. I have explored change in nutritional practices between two cohorts, before and after the publication of the Abnormal Doppler Enteral Prescription Trial (ADEPT). I have also investigated the nutritional practices of those units who recruited, and those who did not recruit for the ADEPT study. The study demonstrated that there has been significantly earlier introduction of enteral and parenteral nutrition after the publication of the ADEPT study. Growth outcomes also improved for infants from the cohort after results were published from the ADEPT. However, it appears that there was no influence on the infants’ clinical outcomes. The third study (Chapter Four) involved a survey to evaluate parents’ practice and perception of the support provided on weaning of preterm infants along with providing contextual, demographic data. A total of 100 questionnaires were completed and analysed. The survey findings revealed that the majority of parents were satisfied with the support provided on weaning although a large minority were not. This support was associated with later commencement of weaning, compliant with the few available recommendations. The fourth study (Chapter Five) involved two Cochrane systematic reviews as a means of critically appraising published randomised controlled trials of family nutrition education interventions on weaning preterm and full-term infants. Systematic literature searching identified 1174 unduplicated records. No studies met the inclusion criteria of the review involving preterm infants, however, there was one ongoing trial. Therefore, there was no evidence to inform the potential impact of nutrition education intervention in preterm infants. The second review involved full-term infants. Nine studies were included in this review. The reviewed randomised controlled trials showed that nutrition education has an impact on infant growth outcomes. However, the available trials were of low to moderate quality, therefore, further high-quality research in this area is needed. This programme of research concludes by highlighting the implications of a new body of research evidence for early postnatal and post-discharge nutrition support clinical practice, guidelines and future research

Nutritional support for preterm infants: a study of current perceptions and practices of parenteral and enteral nutrition and complementary foods

The incidence of preterm birth is increasing globally. In the UK, approximately 7% of live born infants are born prematurely. Premature birth is one of the most important issues in perinatal medicine, leading to a considerable global burden of diseases due to high mortality and morbidity in these vulnerable infants. Suboptimal nutritional intakes during the early postnatal and post-discharge period, including inappropriate weaning practices contribute to malnutrition, suboptimal growth and poor neurodevelopment outcome among infants born preterm. The aims of this thesis were: (1) to explore the early nutritional support of preterm infants during the first two weeks of life, (2) to investigate the current routine nutritional practice for intra-uterine growth restriction (IUGR) infants with abnormal antenatal Dopplers during their hospital stay, (3) to evaluate families’ practices and perceptions regarding the introduction of complementary feeding (CF), and (4) to critically appraise the current evidence for the provision of nutrition education to families on weaning of infants born preterm and full-term infants. To achieve these aims, this thesis was divided into four studies. The first study (Chapter Two) utilised raw data from 59 infants admitted to the Neonatal Units at Nottingham University Hospitals to explore nutritional support for preterm infants in the first 14 days of life. To investigate how close the nutritional support for preterm infants was to published nutritional recommendations, further data were obtained for 119 preterm infants admitted to Neonatal Units within the UK Central Newborn & Trent Perinatal Networks. The study determined that overall, nutritional intakes were close to recommendations for infants in Neonatal Intensive Care Units, although the intakes were below the recommended range for infants from Special Care and Local Care Units. The second study (Chapter Three) utilised data of 1085 IUGR infants with abnormal antenatal Doppler studies identified from a national database to account for the possible impact of the evidence on the clinical practice. I have explored change in nutritional practices between two cohorts, before and after the publication of the Abnormal Doppler Enteral Prescription Trial (ADEPT). I have also investigated the nutritional practices of those units who recruited, and those who did not recruit for the ADEPT study. The study demonstrated that there has been significantly earlier introduction of enteral and parenteral nutrition after the publication of the ADEPT study. Growth outcomes also improved for infants from the cohort after results were published from the ADEPT. However, it appears that there was no influence on the infants’ clinical outcomes. The third study (Chapter Four) involved a survey to evaluate parents’ practice and perception of the support provided on weaning of preterm infants along with providing contextual, demographic data. A total of 100 questionnaires were completed and analysed. The survey findings revealed that the majority of parents were satisfied with the support provided on weaning although a large minority were not. This support was associated with later commencement of weaning, compliant with the few available recommendations. The fourth study (Chapter Five) involved two Cochrane systematic reviews as a means of critically appraising published randomised controlled trials of family nutrition education interventions on weaning preterm and full-term infants. Systematic literature searching identified 1174 unduplicated records. No studies met the inclusion criteria of the review involving preterm infants, however, there was one ongoing trial. Therefore, there was no evidence to inform the potential impact of nutrition education intervention in preterm infants. The second review involved full-term infants. Nine studies were included in this review. The reviewed randomised controlled trials showed that nutrition education has an impact on infant growth outcomes. However, the available trials were of low to moderate quality, therefore, further high-quality research in this area is needed. This programme of research concludes by highlighting the implications of a new body of research evidence for early postnatal and post-discharge nutrition support clinical practice, guidelines and future research

Education of family members to support weaning to solids and nutrition in later infancy in infants born preterm

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of family nutrition educational interventions to improve the growth and development of infants born preterm, for weaning, compared with conventional management.</p