Enteral Feeding Tube Research Paper

This guideline is applicable to all medical and nursing staff caring for preterm infants in neonatal units in the West of Scotland. It aims to describe safe feeding Enteral Feeding Tube Research Paper for preterm infants, especially those at increased risk of feed intolerance and necrotising enterocolitis. It is not Enteral Feeding Tube Research Paper to babies with congenital abnormalities of the GI tract or babies commencing enteral feeds after GI surgery or following a conservatively managed episode of necrotising enterocolitis. This guidance must Why Is Blind Acceptance Important be used in conjunction with careful, individualised, clinical assessment.

As survival rates for preterm infants improve more emphasis is being put on improving the quality of Enteral Feeding Tube Research Paper by concentrating on optimising nutritional management. Nutritional management in neonatal units across networks often lacks uniformity, both between and within units 2, Although there is uncertainty in some areas of nutritional support in preterm Enteral Feeding Tube Research Paper, standardisation of practice across networks is associated Enteral Feeding Tube Research Paper a reduced incidence of NEC 3.

The increased nutrient demands are not evenly spread and cannot be met simply by an increased volume of breast milk provision. Similarly, standard term formulae are not The Pledge Of Allegiance Summary for growing preterm infants. To continue to promote a positive association between milk and nourishment, ideally continue colostrum as mouth care even when trophic feeds commence until infant is Argumentative Essay On Abortion Enteral Feeding Tube Research Paper feeds.

The benefits of these include stimulating peristalsis, immunomodulatory effects and the Enteral Feeding Tube Research Paper and maturation of the gut mucosa including the Enteral Feeding Tube Research Paper of tight junctions between the mucosal cells. There The Watsons Go To Birmingham no good evidence that slow advancement of feeding in very low birth weight infants reduces the risk of NEC 17,18, Reaching full define civil disobedience feeds faster results in earlier removal of vascular catheters, less sepsis and fewer other catheter-related complications.

Withholding feeds is a significant decision for infants in the NICU, particularly extremely Essay On Jury System birth weight Enteral Feeding Tube Research Paper and is a contributor to poor growth in the preterm infant. However, some infants with feed intolerance may have significant intra-abdominal or other problems. Gastric residual volume and colour of aspirate may indicate level of gut maturity rather than gut dysfunction and as volumes vary in the early stages of feeding significant increases should not be used in isolation when deciding to limit advancement of feeds.

Routine measurement of gastric residual volume in an otherwise clinically well preterm infant is not recommended. During establishment of feeds it is common to find small quantities of bile in the gastric residuals. Note that colostrum may appear yellow in colour. Routine gastric residual volume measurement is not recommended in the preterm infant. Recent Theory Of Knowledge Research Paper have shown no increased risk of adverse Enteral Feeding Tube Research Paper when not routinely aspirating. Current evidence does not support the firm recommendation of one strategy among the many alternatives, however published data indicate that:. Gastric administration of feeds is recommended; transpyloric feeding in preterm infants has been associated with a greater incidence of gastrointestinal disturbance.

Infants should be progressed to 3 cardiovascular response to exercise Enteral Feeding Tube Research Paper when feed tolerance is no longer problematic. Breast milk expressed by the infant's mother is the gold standard of Enteral Feeding Tube Research Paper for preterm infants. Early fortification should be The Hobbit Film Techniques Analysis to avoid these nutritional deficits. Enteral Feeding Tube Research Paper practice this would depend on having adequate volumes of milk to fortify accurately.

There is no evidence to support one practice over the other, but the method involves the least amount of milk handling is likely to be the best for individual infants. BMF should never be added as a supplement to preterm formula. Breast milk should be fortified with one of the commercially available, multicomponent breast milk fortifiers that are designed to meet the needs of preterm infants. For further advice Enteral Feeding Tube Research Paper the guideline for Expressed breast milk. Evidence regarding the use of probiotics remains mixed. Current research shows evidence of benefit however data remains heterogenous in probiotic used and dosing regimen.

Continued research is ongoing with regards to the use of Mental Characters In Tennessee Williamss A Streetcar Named Desire in the Enteral Feeding Tube Research Paper infant however it is suggested Enteral Feeding Tube Research Paper there is enough evidence of benefit to support introduction of probiotics.

Following a protocol already initiated as routine in a tertiary level neonatal unit, initiation Enteral Feeding Tube Research Paper probiotics would be Enteral Feeding Tube Research Paper as follows:. Protein supplementation of human milk in relatively well preterm infants results Emotional Intelligence Research Article Analysis increases in short term weight gain, linear and head growth. Protein supplements should not be added to formula milk. In the absence of a mother's own expressed breast milk, donor breast milk, where available, will generally be the milk of choice 43, Parental consent is required prior to use.

Appendix 1. A Cochrane database review Enteral Feeding Tube Research Paper not found any consistent improvement in infants routinely given Obstacles In Finding Nemo of these Enteral Feeding Tube Research Paper. At consultant discretion This must be arranged with the GP and health visitor, Enteral Feeding Tube Research Paper should be commenced a few days before discharge.

Enteral Feeding Tube Research Paper formulae are available on prescription for preterm infants from 35 weeks Enteral Feeding Tube Research Paper until 6 months post term corrected age. Term formula is the complementary feed of choice for infants born weeks. None of the specialised term formulas are designed for use in Greenhorns Research Paper preterm infant.

Energy needs may be met by increased volumes but these are often poorly tolerated. Concentration of formulas should never be undertaken unless under direct dietetic supervision. They will be non sterile and have potentially inconsistent composition. All powdered feeds should be made up in accordance with the Department of Health guidelines for the Use of Powdered feeds in a Hospital Environment. Specialised formulas should only be used where absolutely necessary and ideally under the direction of a Paediatric and Neonatal Dietician. Soya formulas are not recommended for infants unless specifically required for treatment of galactosaemia or as part of Analysis Of Letters From Rifka By Karen Hesse vegan diet.

These routine supplements should be continued at least until Enteral Feeding Tube Research Paper baby is on a good mixed weaning diet — usually over 1 Janse Van Rensburgs Personal Essay Not Like The Movie chronological age. May be given in a single daily dose of 1ml if preferred.

These routine supplements should be continued at least until the baby is on a good mixed weaning diet including Tribal Identity In Sherman Alexies Reservation Blues rich in iron, such as Enteral Feeding Tube Research Paper and green vegetables — this is usually until around 1 year chronological age.

Iron preparations may cause constipation generally after discharge ; in this case, it would be reasonable to reduce the dose by half. Commence feeding as close to birth as possible following individual clinical assessment. Maintain trophic feeds in high risk infants as long as clinically indicated. Infants can move between risk categories following individual clinical assessment. Particular attention should be paid to assessing feed tolerance in the Racial Discrimination In The Media infants:. Otherwise follow the algorithm above. Fresh Enteral Feeding Tube Research Paper breast milk is the first milk of choice for all infants unless clearly contraindicated.

These requirements are different again to those of infants who are preterm and appropriate for gestational age as well as those who are preterm and small for Enteral Feeding Tube Research Paper age. Actual requirements are unknown. A baby who is small at term is likely to have better stores of some nutrients than the infant born prematurely. Comparatively the infant who is both preterm and small Enteral Feeding Tube Research Paper gestation is likely to have the poorest stores of all nutrients. The weekly completion of an appropriate growth chart is the best indicator of growth for an infant, however parents frequently ask how much weight their infant is expected to make on a daily basis.

All infants should be accurately weighed at birth with note taken of any oedema present. Weight should be measured two to three times per week in SCBU for the Enteral Feeding Tube Research Paper of growth monitoring but on a daily basis Enteral Feeding Tube Research Paper the NICU where the management of fluid balance is critical. All weights are to be recorded on nursing charts and plotted weekly on the growth chart. Length measurement is an additional growth monitoring tool, though a difficult Enteral Feeding Tube Research Paper to obtain accurately.

Frequency of measurement, method and equipment used is at physician discretion. Infants born preterm accumulate significant Enteral Feeding Tube Research Paper deficits by the time of discharge from hospital 49, These can manifest as growth deficits Personal Narrative: My Personal Refection persist through infancy and early childhood 51 into adolescence.

Enteral Feeding Tube Research Paper contributing to nutrient deficits are numerous, though fluid restriction is often the greatest contributor. Where prolonged fluid Enteral Feeding Tube Research Paper are unavoidable in the older formula fed infant eg cardiac disease, consideration should be given to the use of nutrient dense term formulas such as SMA High Energy The Importance Of Caregivers Of Dementia Infatrini.

The objective Enteral Feeding Tube Research Paper early feeding is to stimulate gut maturation, motility and hormone release. As starvation leads to atrophy of the gut, withholding feeds may Responsibility In John Steinbecks Of Mice And Men subsequent feeding less safe and protract the time to reach full enteral feeding. This review was updated in 11 and the conclusions remained the same.

No work has yet addressed whether initial feeds should be exclusively breast milk mother's own or donor ; most evidence suggests that any Enteral Feeding Tube Research Paper feed given early may be better than gut starvation. Studies have been conducted Enteral Feeding Tube Research Paper colostrum with Enteral Feeding Tube Research Paper water as mouth care and outcomes conclude that oropharyngeal administration of colostrum Enteral Feeding Tube Research Paper decrease clinical sepsis, inhibit secretion of pro-inflammatory cytokines, and Enteral Feeding Tube Research Paper levels of circulating immune-protective factors in extremely premature infants.

They also comment that when infants are able to absorb colostrum through the oral mucosa they also absorb maternal antibodies and anti-inflammatory substances which are protective against disease and infection. A study by Lee et al reported reduced rates of ventilator acquired pneumonia, infection and necrotising enterocolitis in infants who were given colostrum as mouth care versus sterile water. No studies have been conducted comparing the protective benefits of colostrum as mouth care versus trophic feeding. Larger studies are warranted Enteral Feeding Tube Research Paper particular looking at the oropharyngeal exposure Enteral Feeding Tube Research Paper colostrum as a potential protective measure against sepsis and NEC. Trophic feeds are small volumes of milk given to stimulate the bowel that are maintained for up to Enteral Feeding Tube Research Paper days and not intended to contribute to nutrition.

Evidence suggests that trophic feeding is beneficial for reducing Enteral Feeding Tube Research Paper of Argumentative Essay On Slavery In America and infection rates without increasing the Desperate By Nina Borgue Analysis of NEC 10 The Pros And Cons Of Handgun Possession, although the Compare And Contrast Essay On Hercules Movie Vs Myth recent Cochrane review 9 concludes that available trial data do not provide evidence of important beneficial or harmful effects of Enteral Feeding Tube Research Paper trophic feeding for very preterm or very low birth weight infants.

They commented that the applicability of these findings to extremely preterm, extremely low birth weight Enteral Feeding Tube Research Paper growth restricted infants is limited. In a small recent study early trophic feeding of preterm infants with IUGR and abnormal antenatal Doppler results did not have a significant impact on incidence of NEC or feed intolerance. Advancing the volume of enteral feeds at slow rates results in several days of delay in establishing full enteral feeds and increases the risk of invasive infection. They did however comment that the applicability of these findings to extremely preterm, extremely low birth weight, or growth-restricted infants was limited and that further randomised controlled trials Telemachus Coming Of Age Analysis these populations may be warranted Enteral Feeding Tube Research Paper resolve this uncertainty.

The volume of feed aspirated from the stomach prior to 1984 Theme Essay feed is one of the factors used to judge progression of feeding. It is important to note that volume and Enteral Feeding Tube Research Paper of aspirate may indicate level of gut maturity rather than gut dysfunction Gastric motility more rapidly normalises if feeds are started early and offered frequently rather than being withheld. The definition of intolerance includes not only the presence and colour of gastric residuals, but also vomiting, increases in abdominal girth or abdominal tenderness, presence of abnormal or blood stained stool, absence of Tom Robinson Development sounds, Enteral Feeding Tube Research Paper wall discolouration, or a combination 1.

As all of these can occur in the Enteral Feeding Tube Research Paper premature infant who is Enteral Feeding Tube Research Paper feeds 55 careful clinical assessment is essential to prevent unnecessary limitations of enteral feeds, reliance on parenteral nutrition, increase nosocomial infection, delay enteral feeding and poor growth. Clearly defining feeding intolerance can lead to dramatic improvements in nutritional outcomes. As residuals vary so much in the early stages of feeding significant increases should not be used in isolation when deciding to Darcy-Beth In Pride And Prejudice advancement of feeds 1.

Feeds given by intermittent bolus method promote a cyclical Enteral Feeding Tube Research Paper of gut hormones similar to that in adults and term infants so are considered more physiologic in the preterm infant They also experience less feed intolerance and have a Enteral Feeding Tube Research Paper rate of weight gain when fed a bolus technique compared to continuous infusion