Elfzzani, Zenab
(2019)
Nutritional support for preterm infants: a study of current perceptions and practices of parenteral and enteral nutrition and complementary foods.
PhD thesis, University of Nottingham.
Abstract
The incidence of preterm birth is increasing globally. In the UK, approximately 7% of live born infants are born prematurely. Premature birth is one of the most important issues in perinatal medicine, leading to a considerable global burden of diseases due to high mortality and morbidity in these vulnerable infants. Suboptimal nutritional intakes during the early postnatal and post-discharge period, including inappropriate weaning practices contribute to malnutrition, suboptimal growth and poor neurodevelopment outcome among infants born preterm.
The aims of this thesis were: (1) to explore the early nutritional support of preterm infants during the first two weeks of life, (2) to investigate the current routine nutritional practice for intra-uterine growth restriction (IUGR) infants with abnormal antenatal Dopplers during their hospital stay, (3) to evaluate families’ practices and perceptions regarding the introduction of complementary feeding (CF), and (4) to critically appraise the current evidence for the provision of nutrition education to families on weaning of infants born preterm and full-term infants.
To achieve these aims, this thesis was divided into four studies. The first study (Chapter Two) utilised raw data from 59 infants admitted to the Neonatal Units at Nottingham University Hospitals to explore nutritional support for preterm infants in the first 14 days of life. To investigate how close the nutritional support for preterm infants was to published nutritional recommendations, further data were obtained for 119 preterm infants admitted to Neonatal Units within the UK Central Newborn & Trent Perinatal Networks. The study determined that overall, nutritional intakes were close to recommendations for infants in Neonatal Intensive Care Units, although the intakes were below the recommended range for infants from Special Care and Local Care Units.
The second study (Chapter Three) utilised data of 1085 IUGR infants with abnormal antenatal Doppler studies identified from a national database to account for the possible impact of the evidence on the clinical practice. I have explored change in nutritional practices between two cohorts, before and after the publication of the Abnormal Doppler Enteral Prescription Trial (ADEPT). I have also investigated the nutritional practices of those units who recruited, and those who did not recruit for the ADEPT study. The study demonstrated that there has been significantly earlier introduction of enteral and parenteral nutrition after the publication of the ADEPT study. Growth outcomes also improved for infants from the cohort after results were published from the ADEPT. However, it appears that there was no influence on the infants’ clinical outcomes.
The third study (Chapter Four) involved a survey to evaluate parents’ practice and perception of the support provided on weaning of preterm infants along with providing contextual, demographic data. A total of 100 questionnaires were completed and analysed. The survey findings revealed that the majority of parents were satisfied with the support provided on weaning although a large minority were not. This support was associated with later commencement of weaning, compliant with the few available recommendations.
The fourth study (Chapter Five) involved two Cochrane systematic reviews as a means of critically appraising published randomised controlled trials of family nutrition education interventions on weaning preterm and full-term infants. Systematic literature searching identified 1174 unduplicated records. No studies met the inclusion criteria of the review involving preterm infants, however, there was one ongoing trial. Therefore, there was no evidence to inform the potential impact of nutrition education intervention in preterm infants. The second review involved full-term infants. Nine studies were included in this review. The reviewed randomised controlled trials showed that nutrition education has an impact on infant growth outcomes. However, the available trials were of low to moderate quality, therefore, further high-quality research in this area is needed.
This programme of research concludes by highlighting the implications of a new body of research evidence for early postnatal and post-discharge nutrition support clinical practice, guidelines and future research.
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