Assisted Feeding Research Articles

ExTraCT - Explainable trajectory corrections for language-based human-robot interaction using textual feature descriptions.

In human-robot interaction (HRI), understanding human intent is crucial for robots to perform tasks that align with user preferences. Traditional methods that aim to modify robot trajectories based on language corrections often require extensive training to generalize across diverse objects, initial trajectories, and scenarios. This work presents ExTraCT, a modular framework designed to modify robot trajectories (and behaviour) using natural language input. Unlike traditional end-to-end learning approaches, ExTraCT separates language understanding from trajectory modification, allowing robots to adapt language corrections to new tasks-including those with complex motions like scooping-as well as various initial trajectories and object configurations without additional end-to-end training. ExTraCT leverages Large Language Models (LLMs) to semantically match language corrections to predefined trajectory modification functions, allowing the robot to make necessary adjustments to its path. This modular approach overcomes the limitations of pre-trained datasets and offers versatility across various applications. Comprehensive user studies conducted in simulation and with a physical robot arm demonstrated that ExTraCT's trajectory corrections are more accurate and preferred by users in 80% of cases compared to the baseline. ExTraCT offers a more explainable approach to understanding language corrections, which could facilitate learning human preferences. We also demonstrated the adaptability and effectiveness of ExTraCT in a complex scenarios like assistive feeding, presenting it as a versatile solution across various HRI applications.

Cognitive function in SMA patients with 2 or 3 SMN2 copies treated with SMN-modifying or gene addition therapy during the first year of life

BackgroundSpinal muscular atrophy (SMA) is a neuromuscular disease, causing progressive muscle weakness due to loss of lower motoneurons. Since 2017, three therapies, two modifying gene transcription and one adding the defective gene, have been approved with comparable efficacy on motor outcome. Data on cognitive outcomes of treated SMA type 1 patients is limited. The aim of this study was to evaluate cognitive function in symptomatic and presymptomatic SMA type 1 patients with two or three SMN2 copies who received SMN-modifying or gene-addition therapy in the first year of life. MethodsCognitive testing was performed in 20 patients, including 19 symptomatic SMA type 1 patients with up to three SMN2 copies and 1 pre-symptomatically treated patient. Children were tested using Bayley Scales of Infant Development (BSID-III) at the age of 2 or 3 years or the Wechsler Preschool and Primary Scale of Intelligence (WPSII-IV) at the of age of 5 years. Results11/20 patients showed subnormal cognitive development. Boys had significantly lower cognitive scores. Patients requiring assisted ventilation or feeding support were more likely to have cognitive deficits. Achieving more motor milestones was associated with a better cognitive outcome. ConclusionTreated patients with SMA type 1 have heterogeneous cognitive function with 55 % of patients showing deficits. Risk factors for cognitive impairment in our cohort were male gender and need for assisted ventilation or feeding support. Therefore, cognitive assessment should be included in the standard of care to allow early identification of deficits and potential therapeutic interventions.

The Pivotal Role of Oxytocin's Mechanism of Thermoregulation in Prader-Willi Syndrome, Schaaf-Yang Syndrome, and Autism Spectrum Disorder.

Oxytocin (Oxt) regulates thermogenesis, and altered thermoregulation results in Prader-Willi syndrome (PWS), Schaaf-Yang syndrome (SYS), and Autism spectrum disorder (ASD). PWS is a genetic disorder caused by the deletion of the paternal allele of 15q11-q13, the maternal uniparental disomy of chromosome 15, or defects in the imprinting center of chromosome 15. PWS is characterized by hyperphagia, obesity, low skeletal muscle tone, and autism spectrum disorder (ASD). Oxt also increases muscle tonicity and decreases proteolysis while PWS infants are hypotonic and require assisted feeding in early infancy. This evidence inspired us to merge the results of almost 20 years of studies and formulate a new hypothesis according to which the disruption of Oxt's mechanism of thermoregulation manifests in PWS, SYS, and ASD through thermosensory abnormalities and skeletal muscle tone. This review will integrate the current literature with new updates on PWS, SYS, and ASD and the recent discoveries on Oxt's regulation of thermogenesis to advance the knowledge on these diseases.

Commentary: Can an effective end-of-life intervention for advanced dementia be viewed as moral?

We comment on Dr. Terman's considerations on the moral justification of ceasing assisted feeding and hydration for people with advanced dementia. The core idea of his paper is that an advance directive can solve future dilemmas regarding assisted feeding. We submit that this static instrument is unfit for the complex and dynamic nature of assessing how to deal with refusals to eat, in particular for people with dementia. It overvalues the past in relation to the present situation and leaves no room for the possibility of changing wishes. Moreover, the perspectives of professional caregivers and families are not addressed because the focus is entirely on individual autonomy in early dementia. Multiple perspectives should be considered in interpreting directives and the actual situation in light of the patient's view of life in order to realistically account for what is morally justifiable in care in advanced dementia.

Commentary to: "Timely dying in dementia: Use patients' judgments and broaden the concept of suffering." Timely dying, suffering in dementia, and a role for family and professional caregivers in preventing it.

Broadening the concept of suffering in dementia to five types of suffering including suffering of family caregivers as proposed by Terman etal., may help raise awareness on a need to relieve suffering when living with dementia and adopt a holistic approach. However, as objective criteria in advance care plans for severe enough suffering to stop assisted feeding or other life-sustaining treatment in people with advanced dementia, these still need interpretation in the context of, for example, available treatment, and change in coping. New is the proposal to broaden severe enough suffering to suffering of family, including "bi-directional empathic suffering." We believe this creates new dilemmas regarding responsibility and may increase feelings of guilt. Quantifying suffering by adding up moderate suffering could further complicate matters. Therefore, we argue that a health care professional should guide the process and assume responsibility over current decisions to follow a person's previous wishes.

A scoping review of the post-discharge care needs of babies requiring surgery in the first year of life.

Congenital anomalies are among the leading causes of under-5 mortality, predominantly impacting low- and middle-income countries (LMICs). A particularly vulnerable group are babies with congenital disorders requiring surgery in their first year. Addressing this is crucial to meet SDG-3, necessitating targeted efforts. Post-discharge, these infants have various care needs provided by caregivers, yet literature on these needs is scant. Our scoping review aimed to identify the complex care needs of babies post-surgery for critical congenital cardiac conditions and non-cardiac conditions. Employing the Joanna Briggs Institute's methodological framework for scoping reviews we searched Pubmed, EMBASE, CINAHL, PsychINFO, and Web of Science databases. Search terms included i) specific congenital conditions (informed by the literature and surgeons in the field), ii) post-discharge care, and iii) newborns/infants. English papers published between 2002-2022 were included. Findings were summarised using a narrative synthesis. Searches yielded a total of 10,278 papers, with 40 meeting inclusion criteria. 80% of studies were conducted in High-Income Countries (HICs). Complex care needs were shared between cardiac and non-cardiac congenital conditions. Major themes identified included 1. Monitoring, 2. Feeding, and 3. Specific care needs. Sub-themes included monitoring (oxygen, weight, oral intake), additional supervision, general feeding, assistive feeding, condition-specific practices e.g., stoma care, and general care. The post-discharge period poses a challenge for caregivers of babies requiring surgery within the first year of life. This is particularly the case for caregivers in LMICs where access to surgical care is challenging and imposes a financial burden. Parents need to be prepared to manage feeding, monitoring, and specific care needs for their infants before hospital discharge and require subsequent support in the community. Despite the burden of congenital anomalies occurring in LMICs, most of the literature is HIC-based. More research of this nature is essential to guide families caring for their infants post-surgical care.

Understanding Resistance to Honoring VSED Advance Directives in Dementia Patients: A Cross-Sectional Provider Survey

The prerogative to refuse life-sustaining and life-prolonging interventions via an advance directive is an established legal, ethical, and moral right. Controversy remains as to whether patients with dementia have an equivocal right to refuse assisted feeding at the end of life through an advance directive made when the patient had decision-making capacity.

Assistive feeding robot for upper limb impairment—Testing and validation

A personal care robotic system has been developed that can provide feeding assistance to those suffering from upper limb impairment. The system introduces a novel approach for feeding that prioritizes two ideas: generalized functionality to encompass multiple feeding tasks and seamless user interaction. Additionally, the system leveraged novel computer vision ideas to incorporate functionality that was not reported in the literature. For the functional prototype, the system was comprised of an off-the-shelf six degrees of freedom robotic manipulator, two depth cameras, and an electric gripper. Furthermore, various tools used during the operation were designed and constructed using a 3D printer. The system’s software has three main operation phases: food identification, acquisition, and delivery. One of the novel features of this system is that instead of attempting to identify the food, the robot identifies the method required for acquiring the food. During testing and validation, it was found that the system had minimal identification errors, high success rates for acquisition and delivery, and a fast safety response time.

An Exploratory Analysis of Gastrointestinal Morbidities and Feeding Outcomes Associated with Neonatal Hypoxic-Ischemic Encephalopathy With or Without Hypothermia Therapy.

This study investigates the clinical profile and predictors of gastrointestinal/hepatic morbidities and feeding outcomes among neonates with hypoxic-ischemic encephalopathy (HIE). A single-center retrospective chart review of consecutive neonates >35 weeks of gestation admitted with a diagnosis of HIE between January 1, 2015, and December 31, 2020, and treated with therapeutic hypothermia, if met the institutional eligibility criteria. Outcomes assessed included necrotizing enterocolitis (NEC), conjugated hyperbilirubinemia, hepatic dysfunction, assisted feeding at discharge, and time to reach full enteral and oral feeds. Among 240 eligible neonates (gestational age 38.7 [1.7] weeks, birth weight 3279 [551] g), 148 (62%) received hypothermia therapy, and 7 (3%) and 5 (2%) were diagnosed with stage 1 NEC and stage 2-3 NEC, respectively. Twenty-nine (12%) were discharged home with a gastrostomy/gavage tube, conjugated hyperbilirubinemia (first week 22 [9%], at discharge 19 [8%]), and hepatic dysfunction (74 [31%]). Time to reach full oral feeds was significantly longer in hypothermic neonates compared with neonates who did not receive hypothermia (9 [7-12] days vs. 4.5 [3-9] days, p < 0.0001). Factors significantly associated with NEC were renal failure (odds ratio [OR] 9.24, 95% confidence interval [CI] 2.7-33), hepatic dysfunction (OR 5.69, 95% CI 1.6-26), and thrombocytopenia (OR 3.6, 95% CI 1.1-12), but no significant association with hypothermia, severity of brain injury, or stage of encephalopathy. Transient conjugated hyperbilirubinemia, hepatic dysfunction within first week of life, and need for assistive feeding are more common than NEC in HIE. Risk of NEC was associated with the severity of end-organ dysfunction in the first week of life, rather than severity of brain injury and hypothermia therapy per se.

Applying “Designerly Framing” to Understand Assisted Feeding as Social Aesthetic Bodily Experiences

What could it mean to take a designerly perspective of a robotic eating aid to get a more holistic understanding of meals as social and embodied experiences? In this article, we provide a new perspective of bodily experiences of assisted feeding. We apply “designerly framing” in the context of meals and Human Robot Interaction (HRI) and contribute with insights for researchers with backgrounds other than design into how “designerly framing” can foreground social and aesthetic use. The study focuses on experiences of assisted feeding of five people with impairments in their arms or hands. All of the subjects have long-term experience of meal assistance, and four also have experience of using a robotic eating aid. The data collection comprises seven interview sessions held in peoples homes, a functional analysis of the meal experience, and a workshop held at a design agency. The “designerly framing” is also supported by a theoretical framework describing different types of use to open the meal as a design space. This complements and extends existing knowledge on acceptance and abandonment of assistive technology (AT) and assistive robotics for the meal.

Design and Development of a Low-Cost Vision-Based 6 DoF Assistive Feeding Robot for the Aged and Specially-Abled People

Human-Robot interaction plays a vital role in the service robotics field, especially to support old age-dependent people for socio-economic reasons. In this paper, an indigenous 3D printed 6 DoF robotic arm is proposed to support specially-abled people in their independent-feeding process. The objective of the present paper is to find the combination of optimal positional controllers such as CPID, FC, FPID and FOPID, which can handle the cubic reference input signal and can produce an output signal with minimal overshoot and lesser positional error. The reduced positional error helps the robotic arm to accurately reach the destination with minimal oscillations. This would reduce the wastage of food in the middle of the trajectory as well as at the destination. The technical challenge of the paper is to synchronize machine vision, robot kinematics and trajectory planning with robot control for multiple intermediate points, subjected to the cubic input signal. The feeding robotic arm is equipped with Intel© visual depth camera, which is in synchronization with the microcontroller, servo controller, and servo actuators. Here, six intermediate points were identified in the C-space using FK, among which, fuzzy controller was selected for the first two IPs, the GA optimized FOPID was selected for IP3 to IP5 and FPID was deployed for the last IP. The GA: FOPID produced a negligible overshoot of 0.67%, whereas FC and FPID produced an overshoot of 1.4% and 0.8% respectively. The positional error gap between GA: FOPID, FC and FPID was 0.9, and 0.6 Deg/sec respectively. The selection of combination of optimal controllers helps the manipulator to successfully deliver the food without wasting it. The repeatability of the feeding process is ensured by successfully conducting user testing on 20 users for 25 cycles.

Flaws in advance directives that request withdrawing assisted feeding in late-stage dementia may cause premature or prolonged dying

BackgroundThe terminal illness of late-stage (advanced) Alzheimer’s and related dementias is progressively cruel, burdensome, and can last years if caregivers assist oral feeding and hydrating. Options to avoid prolonged dying are limited since advanced dementia patients cannot qualify for Medical Aid in Dying. Physicians and judges can insist on clear and convincing evidence that the patient wants to die—which many advance directives cannot provide. Proxies/agents’ substituted judgment may not be concordant with patients’ requests. While advance directives can be patients’ last resort to attain a peaceful and timely dying consistent with their lifelong values, success depends on their being effective and acceptable. A single flaw can provide opponents justification to refuse the directive’s requests to cease assisted feeding.AimThis article considers 24 common advance directive flaws in four categories. Process flaws focus on how patients express their end-of-life wishes. Content flaws reflect drafters’ selection of conditions and interventions, and how they are described. Inherent flaws can make advance directives unacceptable to authorities concerned about premature dying. Strategies are needed to compel physicians to write needed orders and to prevent third parties from sabotaging these orders after they are implemented. The article includes excerpts from “dementia-specific” directives or supplements that exemplify each flaw—mostly from the US and Europe. No directive critiqued here included an effective strategy to resolve this long-debated bioethical conflict: the past directive requests “Cease assisted feeding” but the incapacitated patient apparently expresses the desire to “Continue assisted feeding.” Some opponents to the controversial request, cease assisted feeding, use this conflict as a conceptual wedge to practice hard paternalism. This article proposes a protocol to prevent this conflict from emerging. These strategies may prevent authorities from requiring patients to fulfill authorities’ additional clinical criteria as a prerequisite to honor the requests in patients directives.ConclusionThis critique of flaws may serve as a guide to drafting and to selecting effective and acceptable advance directives for dementia. It also poses several bioethical and clinical questions to those in authority: Does your paternalistic refusal to honor patients’ wishes respect their self-determination? Protect vulnerable patients from harm? Force patients to endure prolonged suffering? Violate the principles of bioethics? Violate the very foundation of patient-centered care?

Robot Arm Control System for Assisted Feeding of People With Disabilities in Their Upper Limbs

This work proposes a robot arm control system for assisted feeding of people with reduced functionality in their upper limbs. It aims at improving their quality of life by helping users recover their independence when feeding, aided by the proposed system. Previous research presents solutions that often lack functionality to meet the user's needs, such as a lack of emergency functions or the use of passive feeding techniques, due to the absence of adequate human-robot interaction. The proposed solution involves the design of an interface adapter between the robot arm and the spoon, for the correct transport and positioning of the food. Moreover, a PD-type electronic controller is implemented for the robot arm; it includes gravity compensation and trajectories defined from the detection of the user's position. Additionally, the system has two safety features: an emergency button and a proximity warning that triggers when undesired objects are too close to the robot arm. The proposed system was validated through position tests and interaction with people using rice and oatmeal. When carrying out the tests with rice, 80% success was obtained, while in the case of oatmeal, 98.9% success was achieved.

Use of feeding tubes in 112 cats in an internal medicine referral service (2015-2020).

The aims of this study were to describe diseases, complications and outcomes associated with the use of feeding tubes in a population of sick cats with appetite disturbance managed at an internal medicine referral service. Clinicopathological data from cats receiving nasoenteral (NE) or oesophagostomy (O) tubes were studied. Cats were categorised according to their underlying disease and divided into subgroups (NE or O tube). The following factors associated with survival were analysed: disease category, type of tube and return to appetite. Included in the study were 112 cats, representing 118 cases. Of the 118 cases, 98 (83%) and 20 (17%) received NE or O tubes, respectively. The most common underlying conditions were digestive (13.5%), hepatobiliary (11%) and upper urinary tract (11%) disorders. Hepatobiliary (50%) and upper respiratory tract (30%) conditions were predominant in the O tube group. Digestive (15%) and upper urinary tract (12%) diseases were more common in the NE tube group. Complications following tube placement occurred in 22/118 cases (18.6%). The global survival rate was 73% and did not differ between NE (71.4%) and O tube (80%) groups (P = 1.00) or disease categories (P = 0.61). Return of appetite before feeding tube removal occurred in 56 cases (47%), within a median of 3 days (range 1-30) and was not associated with mirtazapine administration (P = 1.00). Appetite returned earlier for cats with NE tubes (3 days, range 1-17) than for those with O tubes (33 days, range 5-60; P <0.05). Voluntary food intake was positively associated with survival (odds ratio 15.17). After discharge and feeding tube retrieval, return of appetite was observed in 67% of cases. Feeding tubes were predominantly placed for the management of appetite disturbance in cats with digestive, hepatobiliary and upper urinary tract diseases. While complications were frequent, they were mostly mild, easily managed and did not preclude feeding tube use. Return to appetite occurred in a large proportion of cats during or after assisted enteral feeding and was associated with survival.

Clinical Outcomes of Neonatal Intensive Care Unit Graduates with Bridled Nasogastric Feeding Tubes.

The aim of this study was to describe clinical outcomes of bridled nasogastric tube (NGT) program implementation for infants requiring assisted home feeding (AHF) to discharge from the neonatal intensive care unit (NICU). This was a descriptive prospective analysis of a pilot cohort of infants after implementation of a bridled NGT AHF program to facilitate discharge from level III and IV NICUs from March 2019 to October 2020. Of 29 attempts in infants, 22 infants were discharged with bridled NGTs over 18 months. Bridle placement was unsuccessful in three patients, and four bridles were removed before discharge. Bridle use ranged from 7 to 125 days, with a median duration of 37 days. Dislodgement rate was 0.69 per 100 days. Seventeen infants (77%) achieved full oral feeds, while five (23%) discharged with bridled NGTs later converted to gastrostomy tubes. Implementation of a bridled NGT program is feasible for level III and IV NICUs to facilitate discharging infants who require feeding support to transition home. · Bridled NGT use after NICU is typically 1 month.. · Infants have low bridle NGT dislodgement.. · Most bridled NGT NICU grads attain full oral feeds..

Mapping of critical events in disease progression through binary classification: Application to amyotrophic lateral sclerosis

BackgroundThe progression of many degenerative diseases is tracked periodically using scales evaluating functionality in daily activities. Although estimating the timing of critical events (i.e., disease tollgates) during degenerative disease progression is desirable, the necessary data may not be readily available in scale records. Further, analysis of disease progression poses data challenges, such as censoring and misclassification errors, which need to be addressed to provide meaningful research findings and inform patients. MethodsWe developed a novel binary classification approach to map scale scores into disease tollgates to describe disease progression leveraging standard/modified Kaplan-Meier analyses. The approach is demonstrated by estimating progression pathways in amyotrophic lateral sclerosis (ALS). Tollgate-based ALS Staging System (TASS) specifies the critical events (i.e., tollgates) in ALS progression. We first developed a binary classification predicting whether each TASS tollgate was passed given the itemized ALSFRS-R scores using 514 ALS patients’ data from Mayo Clinic-Rochester. Then, we utilized the binary classification to translate/map the ALSFRS-R data of 3,264 patients from the PRO-ACT database into TASS. We derived the time trajectories of ALS progression through tollgates from the augmented PRO-ACT data using Kaplan-Meier analyses. The effects of misclassification errors, condition-dependent dropouts, and censored data in trajectory estimations were evaluated with Interval Censored Kaplan Meier Analysis and Multistate Model for Panel Data. ResultsThe approach using Mayo Clinic data accurately estimated tollgate-passed states of patients given their itemized ALSFRS-R scores (AUCs > 0.90). The tollgate time trajectories derived from the augmented PRO-ACT dataset provide valuable insights; we predicted that the majority of the ALS patients would have modified arm function (67%) and require assistive devices for walking (53%) by the second year after ALS onset. By the third year, most (74%) ALS patients would occasionally use a wheelchair, while 48% of the ALS patients would be wheelchair-dependent by the fourth year. Assistive speech devices and feeding tubes were needed in 49% and 30% of the patients by the third year after ALS onset, respectively. The onset body region alters some tollgate passage time estimations by 1–2 years. ConclusionsThe estimated tollgate-based time trajectories inform patients and clinicians about prospective assistive device needs and life changes. More research is needed to personalize these estimations according to prognostic factors. Further, the approach can be leveraged in the progression of other diseases.

Large‐Size Monolayer MoSe2 Single Crystals: Ultrafast Growth of Large‐Area Uniform, Millimeter‐Size MoSe2 Single Crystals on Low‐Cost Soda‐Lime Glass (Adv. Mater. Interfaces 12/2021)

Soda-lime glass presents a smooth “liquid-phase” surface at high temperature (≈900 °C), which is helpful for the fast growth of large-size monolaye MoSe2 single crystals. The unique “beam-bridge” assisted metal-precursor feeding strategy contributes to sufficient, homogeneous release of Mo-based precursor, thereby leading to the ultrafast growth (≈50 μm s−1) of monolayer MoSe2 single crystals of millimeter-size, as presented in article number 2100415 by Xiaolong Zou, Fenghua Chen, Yanfeng Zhang, and co-workers.

The effect of assisted enteral feeding on treatment outcome in dogs with inflammatory protein-losing enteropathy.

BackgroundThe effect of assisted enteral feeding on treatment outcome in dogs with protein‐losing enteropathy (PLE) is unknown.ObjectivesTo determine if dogs with inflammatory PLE that had an enteral feeding tube placed had better outcome vs dogs with inflammatory PLE without a feeding tube.AnimalsFifty‐seven dogs with inflammatory PLE.MethodsA retrospective study at a UK referral hospital identified dogs with inflammatory PLE using a standard diagnostic criterion. Positive outcome was defined as survival greater than 6 months or death unrelated to PLE and negative outcome as death related to PLE within 6 months of diagnosis. Several variables were assessed to identify factors for positive outcome using logistic regression.ResultsThirty‐five (61%) and 22 (39%) dogs had a positive and negative outcome at 6 months, respectively. Of the 21 dogs that had a feeding tube placed within 5 days of gastrointestinal biopsy, 16 (76%) had a positive outcome and 5 (24%) had a negative outcome. Dogs treated with dietary treatment alone (P = .002) and dogs with an enteral feeding tube (P = .006) were significantly associated with a positive outcome. When stratified by treatment, assisted enteral feeding was significantly associated with a positive outcome in dogs treated with concurrent immunosuppressive treatment (P = .006), but there was insufficient data to evaluate dogs treated with dietary treatment alone.Conclusions and Clinical ImportanceAssisted enteral feeding in dogs with inflammatory PLE could be associated with improved treatment outcome, especially in those receiving immunosuppressive treatment, and should be considered in the treatment plan of these dogs.

Electroencephalogram Background Predicts Time to Full Oral Feedings in Hypoxic-Ischemic Encephalopathy.

Infants with a history of neonatal hypoxic-ischemic encephalopathy (HIE) are at risk for oral motor dysfunction. Previous studies have associated the need for gastrostomy tube at neonatal intensive care unit discharge with brainstem injury on magnetic resonance imaging (MRI). However, the factors associated with time to full oral feeds in this population have not been previously described. This study aimed to study factors associated with time to full oral feeds in this population. This is a single-center, retrospective study that examined these factors using Cox regression. A total of 150 infants who received therapeutic hypothermia from 2011 to 2017 were included in this study. The single clinical factor significantly associated with time to full oral feeds was the severity of background abnormality on electroencephalogram in the first 24 hours of age (severe vs. mild 95% confidence interval [CI]: 0.34-0.74; moderate vs. mild 95% CI: 0.19-0.45). Brainstem injury on MRI was the factor most highly associated with need for gastrostomy tube placement (p = 0.028), though the overall incidence of need for gastrostomy tube feeds in this population was low (5%). These findings may help clinicians counsel families on what to expect in neonates with HIE and make decisions on the need for and timing to pursue gastrostomy tube in this population. · The overall incidence of the need for assisted feeding at NICU discharge is low in this population.. · MRI brainstem injury was most highly associated with need for gastrostomy tube placement.. · Worsening severity of background abnormality on EEG was associated with longer time to oral feeds..

Kangaroo mother care: EN-BIRTH multi-country validation study

BackgroundKangaroo mother care (KMC) reduces mortality among stable neonates ≤2000 g. Lack of data tracking coverage and quality of KMC in both surveys and routine information systems impedes scale-up. This paper evaluates KMC measurement as part of the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study.MethodsThe EN-BIRTH observational mixed-methods study was conducted in five hospitals in Bangladesh, Nepal and Tanzania from 2017 to 2018. Clinical observers collected time-stamped data as gold standard for mother-baby pairs in KMC wards/corners. To assess accuracy, we compared routine register-recorded and women’s exit survey-reported coverage to observed data, using different recommended denominator options (≤2000 g and ≤ 2499 g). We analysed gaps in quality of provision and experience of KMC. In the Tanzanian hospitals, we assessed daily skin-to-skin duration/dose and feeding frequency. Qualitative data were collected from health workers and data collectors regarding barriers and enablers to routine register design, filling and use.ResultsAmong 840 mother-baby pairs, compared to observed 100% coverage, both exit-survey reported (99.9%) and register-recorded coverage (92.9%) were highly valid measures with high sensitivity. KMC specific registers outperformed general registers. Enablers to register recording included perceptions of data usefulness, while barriers included duplication of data elements and overburdened health workers. Gaps in KMC quality were identified for position components including wearing a hat. In Temeke Tanzania, 10.6% of babies received daily KMC skin-to-skin duration/dose of ≥20 h and a further 75.3% received 12–19 h. Regular feeding ≥8 times/day was observed for 36.5% babies in Temeke Tanzania and 14.6% in Muhimbili Tanzania. Cup-feeding was the predominant assisted feeding method. Family support during admission was variable, grandmothers co-provided KMC more often in Bangladesh. No facility arrangements for other family members were reported by 45% of women at exit survey.ConclusionsRoutine hospital KMC register data have potential to track coverage from hospital KMC wards/corners. Women accurately reported KMC at exit survey and evaluation for population-based surveys could be considered. Measurement of content, quality and experience of KMC need consensus on definitions. Prioritising further KMC measurement research is important so that high quality data can be used to accelerate scale-up of high impact care for the most vulnerable.