the infants who received milk drops would have a …...the infants who received milk drops would...
TRANSCRIPT
The infants who received milk
drops would have a shorter
length of stay than infants who did not receive milk drops.
The Neuroprotection of Oral Enjoyment by Giving Milk Drops
Blank Children’s Hospital Des Moines, IA
Lucinda Butler RN MSN, Barbara O’Rourke RN [email protected]
Table 2. Major Findings : Length of stay (LOS)
GA Subject
Infants
Mean LOS
Subjects
Control
Infants
Mean LOS
Controls
24 2 90 2 135
25 3 86 3 127.7
26 6 88.8 6 90.8
27 5 83.4 5 98.2
28 5 53 5 64.8
29 6 56.8 6 65.8
30 9 47.2 9 55.4
31 20 41.5 20 38.5
32 16 30.1 16 34.6
33 27 23.6 27 24.1
Avg LOS 43.77 Avg LOS 49.11
P = .007 paired t test with 98df
VLBW Infant ( < 1500 gm)
Survival rate: greater than 85%
Neurobehavioral disabilities: 5-15%
Cognitive, behavioral, social delays: 50-70%
Difficulty with feeding: 80%
Feeding is a major developmental issue
Major reason for increased risk: The structural differentiation of the brain is
occurring rapidly between 23 to 32 weeks
Rationale / Background
Before oral attempts are offered The 23wk infant will undergo 9-11 wks of
suctioning, tubes, oral care, & pacifiers,
during the most critical time of structural
differentiation brain.
I tasted and swallowed the amniotic fluid.
This fluid has the scent of my mother.
BEFORE
I was born
Table 1. Number or volume of milk drops given was limited
and based on corrected gestational age or status
CGA / status Milk Drops with
gavage feedings
Document
as volume
NPO See orders No
24 -26 weeks < 4 drops No
27-28 weeks < 0.1 ml No
29-30 weeks < 0.3 ml No
31-33 weeks < 0.5 ml No
34-36 weeks < 1.0 ml No
> 37 weeks < 2.0 ml No
Research Design: • Initial pilot study • Followed by quasi-experimental research design
Setting: • Level III family centered NICU • 44 bed single and multiple rooms
Time Frame: • November 2015 to November 2016
Subjects: • NICU infants born at 24 wks to 33 +6 wks gestation. • Subjects: a convenience sample of 99 premature infants who received milk drops. • Controls: a convenience sample of 99 premature infants who had been discharged and not received milk drops. • Infants matched on gender and gestational age alone.
Background: The NICU infant often receives invasive medical procedures that may have a negative impact on the oral sensory and oral motor functioning of the premature infant. The transition from gavage feedings is often challenging, with many infants staying longer in the NICU to achieve oral feeding competence.
Major Findings: Table 2 • Subject infants had significantly shorter lengths of stay • Subject infants had significantly less average adjusted costs
Estimated savings : > $663,000.00 on these 99 infants.
Implications for practice: • Simple, no expense intervention of giving milk drops • Allows premature infants enjoyable oral experiences
Milk drops
with cares or gavage feedings. Consistency = synaptic development
Setting the stage: Cares are done - now time to enjoy
On side-midline - safer- less energy
Boundaries - secure - comforting
Scent cloth = my mother
Hands to face - organize - self comfort
HUNGER + MILK DROPS = ENJOYMENT
Connecting the dots
A drop of milk
Offer
swab / pacifier
Accept or not
based on cues
You are a participant
You are in control
23 wks
32-34 wks