Neonatal Network
November/December 2009
Vol. 27, No. 6

ABSTRACTS

Birth to Breast--A Feeding Care Map for the NICU: Helping the Extremely Low Birth Weight Infant Navigate the Course
Dorothy Dougherty, RN, IBCLC
Maureen Luther, BSc (PT), MA, IBCLC

Breast milk has been shown to contribute significantly to positive neurodevelopmental and medical outcomes in the extremely low birth weight (eLBw) infant population. It is crucial that eLBw infants receive their mother’s colostrum as a first feeding, followed by expressed breast milk for as long as possible. Evidence-based literature supports the difficult challenges both mothers and eLBw infants face if they are to succeed at breast pumping and breastfeeding. Influencing factors include the medical fragility of the infant, limited frequency and duration of kangaroo care between mother and infant, lack of an adequate volume of breast milk, as well as inconsistent or incorrect information surrounding the use of breast milk and breastfeeding. A feeding care map as described in this article can help the bedside nurse assist the mother-eLBw infant dyad in optimizing breast milk volumes, laying the groundwork for breastfeeding. Displaying supportive practices and preterm infant developmental milestones, the map categorizes infant, maternal, and dyad feeding issues along a progressive time line from admission to discharge.

Fluid and Electrolyte Management in the Premature Infant
Jean M. Chow, RN, MSN, NNP
Davina Douglas, RN, MSN, NNP

Caring for the premature infant in the NICU requires knowledge and understanding of the physiologic adaptation to extrauterine life and how prematurity affects that transition. Nurses play an integral role in managing fluid and electrolyte balance in these infants. This article addresses postnatal adaptation and all aspects of fluid and electrolyte management of the preterm infant.

Cerebellar Hemorrhage in Extremely Low Birth Weight Infants: Incidence, Risk Factors, and Impact on Long-Term Outcomes
Patricia Maddalena, RN, MHSc, NNP
Sharyn Gibbons, RN, PhD, NNP

Improvements in neuroimaging technology and techniques have contributed to the increased recognition of cerebellar hemorrhage (CBH) in the preterm infant. Studies have indicated that the extremely low birth weight (eLBw) infant (<1,000 g) is at highest risk for this injury. Associated risk factors include a constellation of antenatal, intrapartum, and neonatal factors, with immaturity, fetal distress, and cardiorespiratory instability in the early neonatal course as significant contributors. The long-term impact of CBH for the eLBw infant is not fully understood, but recent reports suggest that, in addition to motor impairments, deficits in cognitive, language, and social-behavioral function are also apparent. This article reviews the current state of knowledge of cerebellar development, risk factors for injury, and long-term developmental consequences of injury. Implications for nursing practice, education, and research are discussed.

The Relationship Between Feeding and Necrotizing Enterocolitis in Very Low Birth Weight Infants
Patti Schurr, RN, MSc
Esther M. Perkins, RN, MSN

Necrotizing enterocolitis (NeC) is the most common gastrointestinal emergency in the NICU, with often devastating consequences. The etiology of NeC is probably multifactorial, with preterm infants at the highest risk. The relationship between feeding and NeC was identified in the 1970s, leading to delayed feeding becoming standard treatment in NICUs. More recent research suggests that early feedings not only are safe, but reduce other morbidities associated with prematurity. Standardized feeding guidelines seem to confer some benefits in decreasing NeC, despite a wide variability in feeding practices within the published guidelines. A standardized approach to the management of feeding problems may be the key. This article briefly reviews the pathogenesis of NeC and examines studies of various feeding practices for their relationship to the development of NeC. It also highlights the potential benefits of breast milk in NeC prevention.