Implications of continuity of care on infant caloric intake in the neonatal intensive care unit

Machut, Kerri Z.; Robinson, Daniel T.; Murthy, Karna; Falciglia, Gustave H.

doi:10.1038/s41372-020-0636-y

Cited by 3 publications

(9 citation statements)

References 19 publications

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“…Lastly, there is evidence to suggest the use of standardized feeding guidelines for the advancement of feeds in the NICU (35). Continuity of care in the NICU may increase growth velocity (36); neonatologists in the NICU associated with this current study generally rotated on a weekly basis.…”

Section: Discussionmentioning

confidence: 94%

“…The advantage of using a set of feeding guidelines to schedule fortification and advance feed volumes is demonstrated in this retrospective study (34). The use of feeding guidelines further implements standardized practice and continuity between multiple healthcare professionals caring for PTNBs, while also providing a tracking method for analyzing feeding intolerances and growth issues (35,36).…”

Section: Introductionmentioning

confidence: 99%

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Examining weight gain: A retrospective study on preterm newborn growth on a diet exclusively of fortified donor breast milk

2021

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Preterm newborns born at <32 weeks gestational age are at an increased risk of developing multiple comorbidities. When a mother's own milk is unavailable as a source of nutrition, pasteurized donor breast milk may be used as a substitute. Recent studies using fortified donor breast milk have demonstrated that post-natal growth may be achieved comparable to a mother's own milk. Using data from our milk laboratory charts of preterm newborns exclusively fed fortified donor breast milk, the present study focused on weight gain in relation to the volume of feeds received. The micro-preemie group averaged feeds at the goal volume of 140-170 ml/kg/day for 34% of the time, with the weight gain goal of 15-20 g/kg/day met 30% of the time on average. The extremely low birth weight group averaged feeds at the goal volume of 140-170 ml/kg/day for 70% of the time, with the weight gain goal of 15-20 g/kg/day met 34% of the time on average. The very low birth weight group averaged feeds at the goal volume of 140-170 ml/kg/day for 56% of the time and achieved the weight gain goal of 15-20 g/kg/day 21% of the time, on average. On the whole, the findings of the present study indicate that standard growth goals may be realized with fortified donor breast milk fed at a goal volume.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Examining weight gain: A retrospective study on preterm newborn growth on a diet exclusively of fortified donor breast milk

2021

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“…[11][12][13][14] Evaluations, applications, and recognized benefits of COC are diverse and, in some instances, limited in scope. Studies examining patient outcomes related to continuity of attending physicians (defined as the same physician over time) in intensive care units (ICUs) show reduced central venous line utilization and increased nutritional delivery, 15,16 but show mixed results for length of stay (LOS), readmission, and mortality. [17][18][19][20] Few studies have focused on COC from neonatologists (hereafter referred to as neonatologist COC) of infants in NICUs.…”

mentioning

confidence: 99%

“…[17][18][19][20] Few studies have focused on COC from neonatologists (hereafter referred to as neonatologist COC) of infants in NICUs. 15,16 As these infants often have complex clinical needs, prolonged LOS (often many months), and multiple transitions of providers, 15,[21][22][23] neonatologist COC may be especially critical. Incoming providers may contribute new ideas to the care of infants, but also may introduce gaps in longitudinal assessments, plans, The impact of neonatologist COC on families is also plausible, but dedicated, formal study is lacking.…”

mentioning

confidence: 99%

“…Studies examining patient outcomes related to continuity of attending physicians (defined as the same physician over time) in intensive care units (ICUs) show reduced central venous line utilization and increased nutritional delivery,15,16 but show mixed results for length of stay (LOS), readmission, and mortality 17–20. Few studies have focused on COC from neonatologists (hereafter referred to as neonatologist COC) of infants in NICUs 15,16. As these infants often have complex clinical needs, prolonged LOS (often many months), and multiple transitions of providers,15,21–23 neonatologist COC may be especially critical.…”

mentioning

confidence: 99%

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Parental Perspectives on Neonatologist Continuity of Care

Machut¹,

Gilbart²,

Murthy³

et al. 2021

Advances in Neonatal Care

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Background: Continuity of care (COC) is highly regarded; however, data about benefits are mixed. Little is known about components, parental views, or the value COC may provide to neonatal intensive care unit (NICU) infants and families. Purpose: To describe parents' perspectives on definitions, reasons they value, and suggested improvements regarding COC provided by neonatologists. Methods: We performed a qualitative study of in-person, semistructured interviews with parents of NICU infants hospitalized for 28 days or more. We analyzed interview transcripts using content analysis, identifying codes of parental experiences, expressed value, and improvement ideas related to neonatologist COC, and categorizing emerging themes. Results: Fifteen families (15 mothers and 2 fathers) described 4 themes about COC: (1) longitudinal neonatologists: gaining experience with infants and building relationships with parents over time; (2) background knowledge: knowing infants' clinical history and current condition; (3) care plans: establishing patient-centered goals and management plans; and (4) communication: demonstrating consistent communication and messaging. Parents described benefits of COC as decreasing knowledge gaps, advancing clinical progress, and decreasing parental stress. Suggested improvement strategies included optimizing staffing and sign-out/transition processes, utilizing clinical guidelines, and enhancing communication. Using parent input and existing literature, we developed a definition and conceptual framework of COC. Implications for Practice: NICUs should promote practices that enhance COC. Parental suggestions can help direct improvement efforts. Implications for Research: Our COC definition and conceptual framework can guide development of research and quality improvement projects. Future studies should investigate nursing perspectives on NICU COC and the impact of COC on infant and family outcomes.

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A Qualitative Study of Nurses' Perspectives on Neonatologist Continuity of Care

Machut¹,

Gilbart²,

Murthy³

et al. 2023

Advances in Neonatal Care

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Background: Families and staff in neonatal intensive care units (NICUs) value continuity of care (COC), though definitions, delivery, and impacts of COC are incompletely described. Previously, we used parental perspectives to define and build a conceptual model of COC provided by neonatologists. Nursing perspectives about COC remain unclear. Purpose: To describe nursing perspectives on neonatologist COC and revise our conceptual model with neonatal nurse input. Methods: This was a qualitative study interviewing NICU nurses. The investigators analyzed transcripts with directed content analysis guided by an existing framework of neonatologist COC. Codes were categorized according to previously described COC components, impact on infants and families, and improvements for neonatologist COC. New codes were identified, including impact on nurses, and codes were classified into themes. Results: From 15 nurses, 5 themes emerged: (1) nurses validated parental definitions and benefits of COC; (2) communication is nurses' most valued component of COC; (3) neonatologist COC impact on nurses; (4) factors that modulate the delivery of and need for COC; (5) conflict between the need for COC and the need for change. Suggested improvement strategies included optimizing staffing and transition processes, utilizing clinical guidelines, and enhancing communication at all levels. Our adapted conceptual model describes variables associated with COC. Implications for Practice and Research: Interdisciplinary NICU teams need to develop systematic strategies tailored to their unit's and patients' needs that promote COC, focused to improve parent–clinician communication and among clinicians. Our conceptual model can help future investigators develop targeted interventions to improve COC.

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Implications of continuity of care on infant caloric intake in the neonatal intensive care unit

Cited by 3 publications

References 19 publications

Examining weight gain: A retrospective study on preterm newborn growth on a diet exclusively of fortified donor breast milk

Examining weight gain: A retrospective study on preterm newborn growth on a diet exclusively of fortified donor breast milk

Parental Perspectives on Neonatologist Continuity of Care

A Qualitative Study of Nurses' Perspectives on Neonatologist Continuity of Care

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