Australasian neonatal intensive care enteral nutrition survey: Implications for practice

Abstract

Enteral nutrition was initiated earlier than in the past. Great variation remains in clinical practices. Nutritional implications are discussed. Standardisation of feeding guidelines and enteral nutrition policy based on current evidence and international consensus nutrition recommendations may be beneficial and should be encouraged.

Neonatal dietitian resourcing and roles in New Zealand and Australia: A survey of current practice

“…In 2009, the majority of Australasian neonatal units did not have a written enteral feeding/nutrition policy. 9 This was also the case in the 2007 British survey. 16 Our 2018 survey indicates that along with greater access to a neonatal dietitian there has also been a huge improvement in the area of written enteral feeding policy and also that many units now have other important written nutrition-related policies.…”

“…Where appropriate, responses were compared with a 2013 survey of Australasian neonatologists. 9 The British Association of Perinatal Medicine (BAPM) Service Standards for Hospitals Providing Neonatal Services 12 dietetic section workforce figures recommended by the British Dietetic Association, 13 Table 1, were used to calculate the recommended dietitian full time equivalent (FTE) using the following formula: Recommended dietitian FTE = SUM(Level 3 cots × 0.05) + (Level 2 × 0.025) + (Level 1 × 0.017). The lower recommendation of the range in Table 1 was used for all calculations and comparisons.…”

“…[5][6][7] However, surveys of neonatal nutrition practice in the United States, Britain, Europe, New Zealand and Australia demonstrate most neonatal units do not achieve the recommended nutrient intakes for preterm babies. 8,9 There are two likely causes for this. One is a lack of confidence that the guidelines are evidence-based.…”

“…Many neonatal units did not have access to a neonatal dietitian. 9 The aim of this survey of neonatal dietitians was to investigate and report on neonatal dietitian resourcing and roles in Australasian neonatal units a decade later, and to compare this with published evidence, neonatal dietitian workforce recommendations and previously reported data.…”

Patient blood management, what does this actually mean for neonates and infants?

“…International and national organisations recommend routine administration of 2-3 mg kg −1 day −1 supplemental oral iron to preterm and small-for-gestational age infants because of the evidence that it can prevent IDA due to prematurity (Lundstrom et al, 1977;Long et al, 2012). However, further evidence is needed to define the optimal dose, timing and duration of iron supplementation (Long et al, 2012;Mills & Davies, 2012) and there is variability in clinical practice (Ahmed et al, 2013;Cormack et al, 2013). No studies have looked at the role of oral or intravenous (IV) iron in neonates or infants in the perioperative setting (Long et al, 2012;Mills & Davies, 2012;NBA, 2016).…”