Maternal immunisation schedules are increasingly coming under the spotlight as part of the development of lifetime immunisation programmes for the role that they play in improving maternal, foetal, and neonatal health. Maternally-acquired antibodies are critical in protecting infants during the first months of their lives. Maternal immunisation was previously overlooked owing to concerns regarding vaccinations in this untested and high-risk population but is now acknowledged for its potential impact on the outcomes in many domains of foetal and neonatal health, aside from its maternal benefits. This article highlights the role that maternal immunisation may play in reducing infections in preterm and term infants. It explores the barriers to antenatal vaccinations and the optimisation of the immunisation uptake. This review also probes the part that maternal immunisation may hold in the reduction of perinatal antimicrobial resistance and the prevention of non-infectious diseases. Both healthcare providers and expectant mothers should continue to be educated on the importance and safety of the appropriate immunizations during pregnancy. Maternal vaccination merits its deserved priority in a life-course immunization approach and it is perhaps the only immunization whereby two generations benefit directly from a single input. We outline the current recommendations for antenatal vaccinations and highlight the potential advances in the field contributing to “preventive neonatology”.
A number of studies have highlighted that the amount of enteral feed delivered is significantly less than that prescribed. The majority of these studies have been undertaken in the intensive care setting (1,2). It has been demonstrated that patients on gastrostomy feeding were more likely to receive the prescribed feed when compared with nasogastric feeding (NGF) (3). In hospital patients NGF is often the first route of enteral tube feeding. Amongst medical patients limited data are available to elucidate the reasons for failure of patients on NGF to receive the prescribed amount of feed. The aim of the present baseline audit was to establish the amount of feed administered v. that prescribed and identify reasons why patients failed to receive the volume of feed prescribed. Data were collected prospectively on twenty consecutive patients who were commenced on NGF. Feed requirements were determined by a clinical dietitian. The volume of feed administered v. that prescribed was calculated from the daily fluid-balance charts. Method of feeding (pump v. bolus), medications and reasons for failure to administer prescribed feed were ascertained from medical, nursing and dietetic records and by questioning staff. Data were evaluated for thirteen male and seven female patients (mean age 66 (range 35-91) years) on gastroenterology, oncology and ear, nose and throat wards. In total 235 d of NGF were prescribed and analysed. Mean NGF delivered was 77 (SD 39) % of feed prescribed. Under-delivery of feed occurred on 70 of 235 d (30 %). No feed was administered on 39 of 235 d (17% of time period). Main reasons for not administering feed or administering less than that prescribed are illustrated in the Figure. The volume and energy deficit on days when NGF was less than that prescribed are detailed in the Table.
Gastrostomy placement is often required to help maintain and/or improve nutritional status in patients with head and neck cancer. In this hospital Trust radiologically-inserted gastrostomies (RIG) have been the preferred route for patients with head and neck cancer due to the physical problems associated with the percutaneous endoscopic gastrostomy (PEG) procedure in this patient group. Previous studies have revealed higher complication rates with RIG when compared with PEG (1,2) . The present audit aimed to evaluate complications arising from PEG or RIG placement in this patient group.Twenty-six patients with head and neck cancer who had either a PEG (n 5) or RIG (n 21) inserted between January 2006 and December 2007 were retrospectively audited. Methodology was based on a similar audit (1) . Medical, nursing and dietetic documentation were reviewed.Reasons for inserting a gastrostomy were reduced nutritional intake arising from anticipated dysphagia pre-or with treatment (65%), present severe dysphagia (15%), side effects related to treatment (8 %), not documented (12%). Reasons for inserting a RIG instead of a PEG were anticipated failure of PEG (76%), contraindication for PEG (10 %), not documented (14 %). Complications that occurred in the PEG and RIG group within the first week of placement are detailed in the Table. PEG (n 5) RIG (n 21) There were no major complications in the PEG group compared with 14 % in the RIG group. Minor complications occurred in 60 % of the PEG group and 29% in the RIG group. These data compare with the results of the earlier study that reported a major complication rate of 16 % in RIG v. 2 % in PEG (1) . The higher major complications in the RIG group may reflect the fact that in this unit RIG are inserted in those with more advanced head and neck cancer. As the 2 groups are not evenly matched and the sample size is small it is difficult to draw absolute conclusions. However, due to the major complications experienced in the RIG group, this audit has prompted the head and neck multidisciplinary team, including the Radiologists and Gastroenterologists, to review procedures for selection criteria for type of gastrostomy tube inserted in this patient group and monitor closely for complications post-placement.
A study of reasons for failure to administer prescribed volume of nasogastric enteral feeds in a district general hospital Background: A number of studies have demonstrated that the amount of enteral feed delivered is often significantly less than that prescribed (Park, 1992; Reid, 2006), which can impair nutritional status (National Institute for Health and Clinical Excellence, 2006). The aim of this survey was to establish the amount of feed administered versus that prescribed and identify the reasons for patients failing to receive the volume of feed prescribed. Methods: Data were collected prospectively on 20 consecutive patients on medical or surgical wards, who were commenced on nasogastric feeding (NGF). Feed requirements were determined by a clinical dietitian. The volume of feed administered versus that prescribed was calculated from the daily fluid balance charts. Medications and reasons for failure to administer prescribed feed were ascertained from medical, nursing and dietetic records and questioning staff. This was recorded on a data collection form. Results: Data were evaluated for 13 male and seven female patients, mean age 66 years (range 35-91 years) on gastroenterology, oncology and surgical wards. In total, 235 days of NGF were prescribed. Under-delivery of feed occurred on 70 out of 235 (30%) days. Mean (SD) NGF delivered was 77% (39%) of feed prescribed. No feed was administered on 39 out of 235 days (17%). Fifty-five percent of patients were on proton pump inhibitors (PPIs). Reasons for not administering feed or administering less than that prescribed are detailed in Fig. 1. Discussion: Inadvertent removal and inability to confirm correct positioning of nasogastric tubes (NGTs) accounted for significant interruptions to feeding resulting in under-delivery of
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