Evidence-based guidelines led to significant reduction in opioids and sedatives exposure, and in the number of infants requiring methadone for iatrogenic narcotic dependence.

Objective: To compare feeding tolerance, nutrient intake and growth in preterm infants (p32 weeks, p1750 g) fed either a standard nonhydrolyzed whey-casein (nHWC) or a partially hydrolyzed whey (pHW) preterm infant formula.Study Design: In this double-blind randomized controlled trial infants were fed either formula for at least 3 weeks. Intake was monitored daily, serum chemistries and growth weekly. Data were analyzed using analysis of covariance.Result: A total of 80 infants were enrolled, 72 completed the study. No differences were noted in demographic characteristics. No differences were detected in feeding tolerance, intakes (118 ± 21 vs 119 ± 14; nHWC vs pHW) or growth weight, 28 ± 1.5 vs 28 ± 1.6 g per day; length, 1.0 ± 0.7 vs 1.0±0.6 cm per week; head circumference, 0.9±0.4 vs 1.0±0.44 cm per week). At the end of study, blood urea nitrogen (5.2 ± 3.1 <6.7±2.3 mg per 100 ml, nHWC4.4 ± 0.5 g per 100 ml) and albumin (2.7 ± 0.3 >2.6 ± 0.4 g per 100 ml) differed. Conclusion:A pHW preterm infant formula was not associated with improved feeding tolerance, enteral intake or growth but differences in serum chemistries. These are unlikely to be clinically relevant because values were well within normal limits for preterm infants, whereas growth was identical in both groups and paralleled that 'in utero'.

OBJECTIVES: Reduce postoperative hypothermia by up to 50% over a 12-month period in children's hospital NICUs and identify specific clinical practices that impact success.

Nurse practitioner preparation and education, while evolving, still remains at a crossroads. In a recent article by Mundinger and Carter, a timeline and analysis of the number of Doctor of Nursing Practice (DNP) programs in the United States clearly demonstrated that since inception of the DNP degree, 85% of DNP programs are nonclinical. Many of the nonclinical programs in leadership and administration do not require additional clinical preparation beyond the bachelor’s or master’s degree in nursing. Thus, registered nurses and advanced practice registered nurses (APRNs) may obtain a DNP degree without additional clinical skill preparation beyond a baccalaureate or master’s degree, respectively. Several aspects of the nonclinical DNP are concerning. Among the most challenging issues that nonclinical DNPs present is confusion on the part of other health care providers and the public. The relatively low number of clinically focused DNP programs is also problematic. If we do not prepare APRNs at the clinical doctoral level, then other providers such as physician assistants will meet the health care needs of the community. The future of APRNs could be threatened, especially in primary care.