Patterned feeding experience for preterm infants: study protocol for a randomized controlled trial

Background Neurobehavioral disabilities occur in 5–15 % of preterm infants with an estimated 50–70 % of very low birth weight preterm infants experiencing later dysfunction, including cognitive, behavioral, and social delays that often persist into adulthood. Factors implicated in poor neurobehavioral and developmental outcomes are hospitalization in the neonatal intensive care unit (NICU) and inconsistent caregiving patterns. Although much underlying brain damage occurs in utero or shortly after birth, neuroprotective strategies can stop lesions from progressing, particularly when these strategies are used during the most sensitive periods of neural plasticity occurring months before term age. The purpose of this randomized trial is to test the effect of a patterned feeding experience on preterm infants’ neurobehavioral organization and development, cognitive function, and clinical outcomes. Methods This trial uses an experimental, longitudinal, 2-group design with 120 preterm infants. Infants are enrolled within the first week of life and randomized to an experimental group receiving a patterned feeding experience from the first gavage feeding through discharge or to a control group receiving usual feeding care experience. The intervention involves a continuity of tactile experiences associated with feeding to train and build neuronal networks supportive of normal infant feeding experience. Primary outcomes are neurobehavioral organization as measured by Neurobehavioral Assessment of the Preterm Infant at 3 time points: the transition to oral feedings, NICU discharge, and 2 months corrected age. Secondary aims are cognitive function measured using the Bayley Scales of Infant and Toddler Development, Third Edition at 6 months corrected age, neurobehavioral development (sucking organization, feeding performance, and heart rate variability), and clinical outcomes (length of NICU stay and time to full oral feeding). The potential effects of demographic and biobehavioral factors (perinatal events and conditions of maternal or fetal/newborn origin and immunologic and genetic biomarkers) on the outcome variables will also be considered. Discussion Theoretically, the intervention provided at a critical time in neurologic system development and associated with a recurring event (feeding) should enhance neural connections that may be important for later development, particularly language and other cognitive and neurobehavioral organization skills

Pediatric weekend admission and increased unplanned readmission rates

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/115940/1/jhm2426.pd

Responsive versus scheduled feeding in preterm infants (Review)

Scheduled feeding of prescribed enteral volumes remains standard practice for preterm infants. However, feeding preterm infants in response to their feeding and satiation cues (responsive, cue-based, or infant led feeding) rather than at scheduled intervals might enhance parent experience and satisfaction, help in the establishment of independent oral feeding, increase nutrient intake and growth rates, and allow earlier hospital discharge. Objectives: To assess the effect of feeding preterm infants on a responsive basis versus feeding prescribed volumes at scheduled intervals on growth and duration of hospital stay.</p

The impact of hospital nursing organization on outcomes of hospitalized children

Growth of inpatient pediatric services has prompted questions about the quality of care delivered to children in the hospital setting. Prior research in adult populations has shown that the organization of hospital nurses varies across hospitals and significantly impacts patient outcomes. The purposes of this cross-sectional, observational study were threefold: to explore the relationship between hospital nursing organization and patient outcomes for children hospitalized with common conditions; to examine differences in outcomes between children\u27s and general hospitals; and to explore the joint effects of hospital nursing organization and hospital type (children\u27s versus general) on pediatric outcomes. Survey data from registered nurses collected in 2005 and 2006 by researchers at the University of Pennsylvania were merged with inpatient discharge summaries and hospital administrative data to form an analytic dataset for secondary analysis. Hospital nursing organization was empirically represented by measures of nurse staffing, nurse education, and the nurse practice environment at the hospital level. Prolonged length of stay, conditional length of stay, overall length of stay, and 21-day readmission were used as outcome measures. Logit and Cox regression models were utilized for the analysis, and robust standard errors were used to adjust for patient clustering. The most salient findings of the study relate to 21-day readmission; each one patient increase in a hospital\u27s average patient-to-nurse staffing ratio was significantly associated with a 47.8% increase in the odds of 21-day readmission among children with surgical conditions. Similarly, each one standard deviation increase in a hospital\u27s practice environment composite score was significantly associated with a 28.3% decrease in the odds of 21-day readmission in surgical patients. The results are timely given the recent emphasis within the Affordable Care Act of 2010 to reduce hospital readmission rates, and may be informative as hospitals adopt strategies to avoid financial penalties associated with readmissions. Future work should focus on replication of the study using 30-, 60-, and 90- day readmission both in pediatrics and in other patient populations. Additionally, relationships between readmission and length of stay and between hospital occupancy, hospital nursing organization, and patient outcomes merit further exploration

The impact of hospital nursing organization on outcomes of hospitalized children

Growth of inpatient pediatric services has prompted questions about the quality of care delivered to children in the hospital setting. Prior research in adult populations has shown that the organization of hospital nurses varies across hospitals and significantly impacts patient outcomes. The purposes of this cross-sectional, observational study were threefold: to explore the relationship between hospital nursing organization and patient outcomes for children hospitalized with common conditions; to examine differences in outcomes between children\u27s and general hospitals; and to explore the joint effects of hospital nursing organization and hospital type (children\u27s versus general) on pediatric outcomes. Survey data from registered nurses collected in 2005 and 2006 by researchers at the University of Pennsylvania were merged with inpatient discharge summaries and hospital administrative data to form an analytic dataset for secondary analysis. Hospital nursing organization was empirically represented by measures of nurse staffing, nurse education, and the nurse practice environment at the hospital level. Prolonged length of stay, conditional length of stay, overall length of stay, and 21-day readmission were used as outcome measures. Logit and Cox regression models were utilized for the analysis, and robust standard errors were used to adjust for patient clustering. The most salient findings of the study relate to 21-day readmission; each one patient increase in a hospital\u27s average patient-to-nurse staffing ratio was significantly associated with a 47.8% increase in the odds of 21-day readmission among children with surgical conditions. Similarly, each one standard deviation increase in a hospital\u27s practice environment composite score was significantly associated with a 28.3% decrease in the odds of 21-day readmission in surgical patients. The results are timely given the recent emphasis within the Affordable Care Act of 2010 to reduce hospital readmission rates, and may be informative as hospitals adopt strategies to avoid financial penalties associated with readmissions. Future work should focus on replication of the study using 30-, 60-, and 90- day readmission both in pediatrics and in other patient populations. Additionally, relationships between readmission and length of stay and between hospital occupancy, hospital nursing organization, and patient outcomes merit further exploration