The Association Between Human Milk and Human Milk Fortifiers and Necrotising Enterocolitis In Preterm Infants
The results of this review indicate that low birth weight, very low birth weight and extremely low birth weight infants fed with human milk fortified with human milk fortifiers are at a decreased risk for necrotising enterocolitis than those who are fed with formula milk and non-human milk fortifiers.
KEY FINDINGS: Necrotising enterocolitis continues to be one of the most devastating and unpredictable condition affecting preterm infants, leading to a high degree of morbidity and mortality. Standardised guidelines should be developed and applied in neonatal units, promoting the use of human milk with human milk fortifiers with the aim of reducing the risk of necrotising enterocolitis in preterm infants.
BACKGROUND: The purpose of this review was to determine whether breast milk fortified with human-based fortifiers decreases the incidence of necrotising enterocolitis in preterm infants.
DETAILS: A search was carried out ending July 2021. Academic Search Complete, Cochrane Central Register of Control Trials, Cochrane Database of Systematic Reviews, PubMed, CINAHL plus with full text, Environmental Complete (EBSCO), JAMA Network, MEDLINE, BioMed Central and SAGE Journals and Google Scholar were searched. Keywords included: preterm, infants, breast milk, formula milk and necrotising enterocolitis. Sixteen of the 1316 retrieved papers were included. Human milk, whether mother's own or donor milk, and human milk fortifiers decrease the risk of necrotising enterocolitis, compared to formula milk and non-human fortifiers. The initial number of studies retrieved was 1316. This number was reduced to 650 after removal of duplicates and after applying inclusion and exclusion criteria, this was further reduced to 16 studies. The final number of chosen articles included eight systematic reviews and meta-analysis, two retrospective studies, three multi-centre randomised controlled trials, one comparison cohort, one prospective cohort and one multicentre retrospective cohort. The results of this review appear to provide incontrovertible evidence on the association between human milk and human milk fortifiers and a decreased risk of necrotising enterocolitis in low birth weight, very low birth weight and extremely low birth weight infants when compared to the use of formula milk fortified with non-human fortifiers. The strength of this evidence can be qualified as medium to high.
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Copyright © Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved.
Source: Magro, S. Cini, A., Sammut, R. (2023). The Association Between Human Milk and Human Milk Fortifiers and Necrotising Enterocolitis In Preterm Infants: A Review. Journal of Neonatal Nursing. 2023; 29(1): 10-19. Published: February, 2023. DOI: 10.1016/j.jnn.2022.02.010.
Improving the Ability of Nursing Students in Neonatal Resuscitation by Using the Helping Babies Breathe Program
Resuscitation training through the use of a high-similarity simulator was significantly more effective than utilizing a low-similarity simulator when performing basic neonatal resuscitation
KEY FINDINGS: Resuscitation training through the use of a high-similarity simulator was significantly more effective than utilizing a low-similarity simulator when performing basic neonatal resuscitation
BACKGROUND: Nursing graduates must have sufficient skills to perform adequately in newborn resuscitations. New nurses should be provided with appropriate situations in order to practice the necessary skills required during a newborn resuscitation. This study aimed to improve the performance of nursing students during neonatal resuscitations through the use of a Helping Babies Breathe Program.
DETAILS: This quasi-experimental study with a control group (simulator with low similarity) and an interventional group (Helping Babies Breathe Program) was conducted on 84 eighth-semester nursing students studying at Isfahan University of Medical Sciences, Iran. A resuscitation workshop was held for a single day for 5 h with students performing standard practices for each step of the resuscitation. Knowledge and skills of students were assessed using two scenarios and a standardized checklist. The mean score of knowledge and basic neonatal resuscitation skills were significantly different between the two groups before and immediately after training, as well as Post-Internship (p < 0.05). The highest score of knowledge (17.38) belonged to the intervention group. Appropriate skills are critically important when performing bag-valve-mask ventilation. Before the intervention occurred, students in the interventional group obtained the lowest scores in resuscitation skills; however, after the intervention, all interventional group students obtained a full score and demonstrated the necessary skills required for effective newborn resuscitations.
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Source: Nazari, A., Namnabati, M., and Ajoodanian, N. (2024). Improving the Ability of Nursing Students in Neonatal Resuscitation by Using the Helping Babies Breathe Program: A Quasi-Experimental Study. Journal of Neonatal Nursing. 2024; 29(3): 453-458. Published: June, 2024. DOI: 10.1016/j.jnn.2022.06.005.
Bleeding Reversal With Antifibrinolytics or Cryoprecipitate Following Thrombolysis for Acute Ischemic Stroke
While limited by its small sample size, this case series demonstrates significant variability in reversal strategies for thrombolysis-associated bleeding. It also provides additional evidence for the role of antifibrinolytics in this setting.
KEY FINDINGS: While limited by its small sample size, this case series demonstrates significant variability in reversal strategies for thrombolysis-associated bleeding. It also provides additional evidence for the role of antifibrinolytics in this setting.
BACKGROUND: Patients who develop an intracerebral hemorrhage (ICH) following thrombolysis in acute ischemic stroke (AIS) have a mortality rate as high as 50%.
DETAILS: Treatment options include blood products, such as cryoprecipitate, or antifibrinolytics, such as tranexamic acid (TXA) or ε-aminocaproic acid (EACA). Current guidelines recommend cryoprecipitate first-line despite limited data to support one agent over another. In addition, compared to antifibrinolytics, cryoprecipitate is higher in cost and requires thawing before use. This case series seeks to characterize the management of thrombolytic reversal at a single institution as well as provide additional evidence for antifibrinolytics in this setting. Patients were included for a retrospective review if they met the following criteria: presented between January 2011-January 2017, were >18 years of age, were admitted for AIS, received a thrombolytic, and received TXA EACA, or cryoprecipitate. Twelve patients met the inclusion criteria. Ten (83.3%) developed an ICH, one (8.3%) experienced gastrointestinal bleeding, and one (8.3%) had bleeding at the site of knee arthroscopy. Eleven patients received cryoprecipitate (median dose: 10 units), three received TXA (median dose: 1,000 mg), and one patient received EACA (13 g). TXA was administered faster than the first blood product at a mean time of 19 min and 137 min, respectively. Hemorrhagic expansion (N = 8, 66.67%) and inhospital mortality (N = 7, 58.3%) were high.
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Source: Bailey, A. M., Baum, R., Nestor, M .,et al. (2024). Bleeding Reversal With Antifibrinolytics or Cryoprecipitate Following Thrombolysis for Acute Ischemic Stroke: A Case Series. Advanced Emergency Nursing Journal. 2024; 46(2): 101-107. Published: April/June, 2024. DOI: 10.1097/TME.0000000000000512.
Risk Predictors of Glycaemic Control in Children and Adolescents With Type 1 Diabetes
For children and adolescents with type 1 diabetes mellitus, the use of insulin pump, high-frequency sensor monitoring, prospective follow-up, good family support and reasonable diet are conducive to blood glucose control, while selective admission and DKA are not. Disease characteristics and demographic characteristics of children are closely related to subsequent blood glucose control
KEY FINDINGS: For children and adolescents with type 1 diabetes mellitus, the use of insulin pump, high-frequency sensor monitoring, prospective follow-up, good family support and reasonable diet are conducive to blood glucose control, while selective admission and DKA are not. Disease characteristics and demographic characteristics of children are closely related to subsequent blood glucose control, and the relationship between diagnosis age and blood glucose control needs to be further explored.
BACKGROUND: Aim of the study is to conduct systematic evaluation of the risk predictors of glycaemic control in children and adolescents with type 1 diabetes mellitus.
DETAILS: Cohort studies on risk predictors of glycaemic control in children and adolescents with type 1 diabetes were retrieved from CNKI, PubMed, Web of Science, Embase databases, etc. from the construction of the repository to 3 February 2023. Literature screening was conducted according to inclusion and exclusion criteria, then data extraction of region, sample size, age, follow-up time, risk predictors, outcome indicators, etc., and quality evaluation of The Newcastle-Ottawa Scale were conducted by two researchers while the third researcher makes decisions if there are disagreements. Finally, Revman5.4 and StataMP17 were used for meta-analysis. A total of 29 studies were included, and the results showed that insulin pump [Weighed mean difference (WMD) = -.48, 95% CI (-.73, -.24), p < .01], high-frequency sensor monitoring, early use of insulin pumps, prospective follow-up male, white race, large body mass index-standardised scoring, conscientiousness, agreeableness of mothers, eicosapentaenoic acid, leucine and protein (p < .05) were beneficial for reducing HbA1c levels in children and adolescents with diabetes. Ketoacidosis [WMD = .39, 95% CI (.28, .50), p < .01], selective admission, higher HbA1c level at one time (p < .01), higher glutamate decarboxylase antibody at 1 month after diagnosis, lower socio-economic status, non-living with biological parents, non-two-parent family, family disorder, family history of diabetes and high carbohydrate intake (p < .05) increased HbA1c levels in children and adolescents with diabetes.
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Source: Gangqiang, G., Hua, C., and Hongyu, S., (2024). Risk Predictors of Glycaemic Control in Children and Adolescents With Type 1 Diabetes: A Systematic Review and Meta-Analysis. J Clin Nurs. 2024; 33(7): 2412-2426. Published: July, 2024. DOI: 10.1111/jocn.17110.
Reducing Procedural Pain and Avoiding Peripheral Intravenous Catheters by Implementing a Feeding Protocol for Late Preterm Infants
Administering enteral feedings on admission to stable, late preterm infants reduced the need for peripheral IV access and thus decreased pain from this procedure.
KEY FINDINGS: Administering enteral feedings on admission to stable, late preterm infants reduced the need for peripheral IV access and thus decreased pain from this procedure.
BACKGROUND: Late preterm births account for a large portion of preterm births, yet the optimal method of nutrition and enteral feeding in this population remains unclear and often involves intravenous (IV) fluids. Aim of this study is to develop and implement a late preterm feeding protocol in order to decrease the necessity of IV access, decrease the use of starter parenteral nutrition (PN), and reduce the pain endured by an infant in the neonatal intensive care unit.
DETAILS: The Plan-Do-Study-Act quality improvement model was utilized as a framework for the implementation of this quality improvement project. A literature review was conducted and subsequently, a feeding protocol was developed and included the more judicious use of starter PN. This protocol was implemented, evaluated, and adopted. A second Plan-Do-Study-Act cycle was completed with the addition of an auto-text reminder incorporated into admission notes in the electronic medical record. The implementation of the protocol significantly reduced placement of IV access and the use of starter (PN) in late preterm infants without considerable differences in balancing measures. The percentage of infants who received peripheral IV access declined considerably from 70% to 42% (P = .0017) subsequently, less pain endured by the infants. There was a decrease in the initiation of starter PN from 55% to 7% (P < .00001).
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Source: Hanford, J., McQuay, C., Vachharajani, A., et al. (2024). Reducing Procedural Pain and Avoiding Peripheral Intravenous Catheters by Implementing a Feeding Protocol for Late Preterm Infants: A Quality Improvement Project. Advances in Neonatal Care. 2024; 24(3): 219-226. Published: June, 2024. DOI: 10.1097/ANC.0000000000001125.
The Effectiveness Of Preoperative Delirium Prevention In Intermediate To High-Risk Older Surgical Patients
Despite the promising results for fascia iliaca compartment block and methylprednisolone, there is limited knowledge regarding evidence-based delirium prevention interventions.
KEY FINDINGS: Despite the promising results for fascia iliaca compartment block and methylprednisolone, there is limited knowledge regarding evidence-based delirium prevention interventions. Most studies had small sample sizes indicating that the current evidence is exploratory. There is an urgent need for the funding and conduct of trials to test preventative interventions for older surgical patients at intermediate to high risk of developing delirium.
BACKGROUND: Few reviews have addressed delirium prevention among intermediate to high-risk older surgical patients. Purpose of this study is to map preoperative delirium prevention interventions for older surgical patients at intermediate to high risk of developing delirium, assess outcomes and identify gaps in knowledge.
DETAILS: A systematic search was conducted of the literature published from 1990 to October 2022 in Medline, CINAHL and Ageline and of the grey literature in Google Scholar. Randomised controlled trials were retrieved that assessed the effectiveness of preoperative delirium prevention interventions for older surgical patients at intermediate to high risk of delirium. Data were extracted using a data extraction tool, and results were tabulated. Studies were assessed for bias using the Cochrane Collaboration Risk of Bias tool. Twenty-one studies met the selection criteria including N = 5096 participants. Two studies tested cognitive training, two studies tested fascia iliaca compartment block and one study assessed femoral nerve block. Ten studies tested prophylactic medications including methylprednisolone. Five studies investigated geriatric assessment and management. One study assessed transcutaneous electrical acupoint stimulation. In the two studies testing fascia iliaca compartment block, there was a reduction in postoperative delirium for orthopaedic patients. Methylprednisolone reduced postoperative delirium in orthopaedic patients and in those undergoing gastrointestinal surgery. Results of all other interventions on the occurrence of postoperative delirium and additional outcomes including the severity and duration of delirium were inconclusive.
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Source: Lay, N., Foley, P., and Allen, J. (2024). The Effectiveness Of Preoperative Delirium Prevention In Intermediate To High-Risk Older Surgical Patients: A Systematic Review. J Clin Nurs. 2024; 33(5): 1666-1683. Published: May, 2024. DOI: 10.1111/jocn.17020.
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