P638 Culturally sensitive neonatal care provision to infants of parents from the traveller community: a nursing and midwifery perspective

Abstract

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.