Despite a number of public health and policy-based initiatives, Ireland's national breastfeeding rates are among the lowest globally. Regionally, the Mid-West of Ireland has historically had low breastfeeding initiation rates, and parts of its major urban area such as Limerick City suffer the highest levels of economic deprivation in the country. In that context, this repeated cross-sectional study analysed breastfeeding initiation trends in the Mid-West of Ireland for two decades, from 2001 to 2020 inclusively. Statistical analysis revealed persistently low percentages of women initiating breastfeeding in the region. Time series analyses of the data demonstrated that overall breastfeeding rates are increasing, but continue to be lower than Irish national averages. From these findings and a narrative review of published research, we determined 10 plausible reasons for these consistently low breastfeeding rates. Arising from these, we propose '10 Priorities' to increase the breastfeeding initiation rates in Ireland.
UVC), umbilical arterial catheter (UAC) and Peripherally Inserted Central Catheter (PICC).The infant developed recurrent abdominal distension, associated with bilious aspirates and vomits. On examination, the abdomen appeared tense and shiny, with dilated veins. Necrotising enterocolitis (NEC) was suspected and enteral feeds were held repeatedly. Plain film abdominal x-rays revealed bowel distension. However they did not identify other radiological features of NEC or perforation, such as pneumatosis intestinalis or pneumoperitoneum.Coagulation screens were normal. On Day 36, the infant's clinical condition rapidly deteriorated. She developed a grossly distended abdomen, associated with increased oxygen requirement and desaturations. She required ventilation, inotropic support and transfer to a tertiary centre. She continued to deteriorate and further treatment was considered futile. Following discussion with her parents, palliative care was introduced and she passed away shortly afterwards.Subsequent postmortem examination revealed idiopathic superior mesenteric vein thrombosis. Discussion A differential diagnosis for neonatal abdominal distension and bilious vomiting includes necrotising enterocolitis (NEC), intestinal malrotation and volvulus. 3 Superior mesenteric vein thrombosis causes chronic, recurrent and progressive devitalisation of the small bowel wall. It is associated with pre-terminal neutropaenic sepsis and peritonitis. 4 It may be caused by an unidentified congenital thrombophilia. 5 Conclusion In refractory cases of suspected NEC, venous thromboembolism should be considered. Abdominal x-ray findings are non-specific and are unlikely to contribute to a correct diagnosis. More specific investigations include Doppler ultrasound and CT angiography. 6
Background Necrotising enterocolitis (NEC) is the commonest gastrointestinal emergency among premature infants, and accounts for significant morbidity and mortality. Breast milk (BM) is considered as the best nutritional option to prevent NEC. Traditionally cow's milk-based fortifier is added to BM to optimise growth of extremely premature infants, thus potentially increasing the risk of NEC. More recently the value of replacing the traditional cow's milk-based fortifier with human breast milk-based fortifier [resulting in the concept of an exclusive human milk (EHM) based diet] has been demonstrated to reduce NEC, improve feeding tolerance, reduce dependence on parenteral nutrition and enhance growth. We report the nursing/midwifery experience of introducing EHM for the first time in Ireland, through a qualitative study. Aims To explore nurses' and midwives' perspectives on the provision of human breast milk-based fortifier in an Irish neonatal unit for the first time.Methods Seven senior neonatal nurse/midwives, who were involved in hands-on provision of human breast-milk based fortifier in the NICU at University Maternity Hospital Limerick (UMHL), were offered a semi-structured questionnaire. Following audit committee approval, a thematic interpretive qualitative study was conducted. Results Four themes were identified based on 54 feeding episodes noted in 2017 and 2018 from the two extremely low birth weight (ELBW) infants who were offered human breast milk-based fortifier for the first time in Ireland. Key observations, experiences, expectations and barriers highlighted were analysed. Themes noted were, 1. breastfeeding improvement and culture, 2. feeding tolerance, 3. educational needs and support, and 4. confidence and concerns of nurses/midwives. Sub-themes identified were further evaluated. Conclusion Supportive environment and targeted staff education within NICU would assist in maintaining high breastfeeding rates as well as implementation of an exclusive human milk diet for ELBW infants.
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