No abstract

Editor-Studies investigating the impact on mortality of socioeconomic and lifestyle factors such as smoking tend to report death rates, death rate ratios, odds ratios, or the chances of smokers reaching different ages.

Breast milk is recognized as the ideal nutrition for all infants especially for infants in the neonatal intensive care unit (NICU). Breast milk diet for critically ill infants is associated with decreased septic events and length of stay and reduced risk of surgical necrotizing enterocolitis. Purpose This quality improvement project focused on the development of a breast pumping program for mothers with infants in the NICU. Methods NICU nurse breast milk champions received education on benefits of breast milk and key factors in maintaining adequate milk supply. Champions engaged mothers in conversations to provide support and used a “Coming to Volume Assessment” tool as a guide to assess pumping effectiveness. Champions were interviewed about the benefits, ease of use of assessment tool, and future directions for the pumping program. Results Daily contact with the bedside nurse had a positive effect on breast milk expression rates. Six of 14 mothers, who met with a champion greater than three times in a 2-week period, reached goal volumes. Average maximum milk produced was 836.6 ml ( SD = 228.5 ml, 95% confidence interval [596, 1076]) on infants’ eighth day of life. Champions described the program as a positive experience for the mothers and themselves and the tool as easy to use. They also endorsed continued implementation of the pumping program. Conclusions A pumping program in the NICU that incorporates staff education and use of the “Coming to Volume Assessment” tool with frequent dialogue with mothers to evaluate effectiveness of breast milk expression can aide in the promotion of breast milk expression.

Short bowel syndrome (SBS) is a condition characterized by dependence on total parenteral nutrition due to the inability of the intestines to absorb adequate nutrients, electrolytes, and water. SBS is most commonly seen in pediatric patients after extensive small bowel resection due to necrotizing enteroclolitis, intestinal atresias, gastroschisis, or volvulus (Cummings & Mercurio, 2012). The management of children with SBS focuses on maximizing enteral nutrition while mitigating the potential life-threatening complications of central venous line infections and liver failure. The process of slowly advancing enteral feedings and promoting enterocyte proliferation and villus height is termed adaptation (Warner, 2013). These changes provide an increased surface area for nutrient absorption. The promotion of adaptation is the cornerstone of pediatric intestinal rehabilitation. In the following paragraphs, a case study is presented describing the experiences of a child with ultrashort gut and her journey to independence from total parenteral nutrition at 3 years old. Key interventions that may have played a role in this child's success will be discussed.