TY - JOUR
T1 - Identifying Barriers to Initiating Minimal Enteral Feedings in Very Low-Birth-Weight Infants
T2 - A Mixed Methods Approach
AU - Malhotra, Yogangi
AU - Nzegwu, Nneka
AU - Harrington, Jamie
AU - Ehrenkranz, Richard A.
AU - Hafler, Janet P.
N1 - Funding Information:
Dr. Malhotra was supported by training grant T32-HD 07094; the study was supported in part by grants from the Hauptman Fund and Abbott Laboratories. We thank Linda Stambovsky, RN and Matthew Bizzarro, MD for their contributions throughout the study. We also thank Deepa Camenga MD and Eileen Tichy PA for their participation in data analyses.
Publisher Copyright:
Copyright © 2016 by Thieme Medical Publishers, Inc.
PY - 2015/7/14
Y1 - 2015/7/14
N2 - Objective This study aims to elicit physician and nursing perceptions about initiation of minimal enteral feedings (MEF) in very low-birth-weight (VLBW) infants. Study Design A three-phase, mixed methods study including a quantitative chart review of 37 VLBW infants, followed by 26 qualitative observations of morning rounds, 26 interviews of neonatal intensive care unit (NICU) medical team members, tailored interventions based on the identified barriers to MEF, and finally a postintervention chart audit of 50 VLBW infants. Results The main barriers to initiation of MEF were failure to appreciate the differences between the goals of MEF versus nutritive feedings, inconsistent definition of "sick" infant, indomethacin for intraventricular hemorrhage prophylaxis, awaiting mother's own milk, complicated feeding protocols/algorithms for feeding intolerance, and lack of buy-in from nurses/nurse practitioners. The compliance with early initiation of MEF per the feeding guidelines rose from 25 to 92% after our interventions. Conclusion Understanding the complex interplay of provider, system and patient-based factors that interfere with initiation of MEF may enable NICUs to develop consensus guidelines and targeted interventions and to achieve timely initiation of nonnutritive feedings.
AB - Objective This study aims to elicit physician and nursing perceptions about initiation of minimal enteral feedings (MEF) in very low-birth-weight (VLBW) infants. Study Design A three-phase, mixed methods study including a quantitative chart review of 37 VLBW infants, followed by 26 qualitative observations of morning rounds, 26 interviews of neonatal intensive care unit (NICU) medical team members, tailored interventions based on the identified barriers to MEF, and finally a postintervention chart audit of 50 VLBW infants. Results The main barriers to initiation of MEF were failure to appreciate the differences between the goals of MEF versus nutritive feedings, inconsistent definition of "sick" infant, indomethacin for intraventricular hemorrhage prophylaxis, awaiting mother's own milk, complicated feeding protocols/algorithms for feeding intolerance, and lack of buy-in from nurses/nurse practitioners. The compliance with early initiation of MEF per the feeding guidelines rose from 25 to 92% after our interventions. Conclusion Understanding the complex interplay of provider, system and patient-based factors that interfere with initiation of MEF may enable NICUs to develop consensus guidelines and targeted interventions and to achieve timely initiation of nonnutritive feedings.
KW - enteral nutrition
KW - extrauterine growth restriction
KW - feeding protocol
KW - nonnutritive feedings
KW - trophic feedings
UR - http://www.scopus.com/inward/record.url?scp=84953839257&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84953839257&partnerID=8YFLogxK
U2 - 10.1055/s-0035-1556756
DO - 10.1055/s-0035-1556756
M3 - Article
C2 - 26171596
AN - SCOPUS:84953839257
VL - 33
SP - 47
EP - 56
JO - American Journal of Perinatology
JF - American Journal of Perinatology
SN - 0735-1631
IS - 1
ER -