Variation In Feeding Practices Research Articles

Significant variations in feeding practices and choice of guidelines for the management of late preterm infants among healthcare professionals in Nigeria.

We aimed to gain insights into current nutritional management practices of late preterm infants (34-36 weeks gestational age) in Nigeria. Purposive sampling was employed to recruit 19 healthcare professionals (neonatologists, paediatricians, general practitioners and nurses) involved in the care and nutritional management of late preterm infants in Lagos and Ogun states, Nigeria. Data were collected using interviews, either individually or in small focus groups, between 15 August and 6 September 2022. Thematic analysis of interview transcripts was carried out to interpret the data. Ten distinct themes emerged across the research questions and objectives. For growth monitoring, 11, 6, 1 and 1 of our participants preferred to use the 2006 WHO growth standards, Fenton preterm growth chart, Ballard score and Intergrowth-21, respectively. Regarding the growth velocity of late preterm infants, most healthcare professionals aimed for 15 g/kg BW/day or more during hospitalisation. Breastmilk was unanimously the primary feeding option for late preterm infants. Most healthcare professionals preferred to use international guidelines over local guidelines. Our study shows that there is a wide divergence in the nutritional guidelines used in managing late preterm infants in Nigeria. Regarding growth monitoring, healthcare professionals tended to aim for a growth velocity higher than necessary for late preterm infants, which may be disadvantageous for their long-term health.

Potential for Misclassification of Infants' Usual Feeding Practices using 24-Hour Dietary Assessment Methods

Feeding patterns of 131 low income Peruvian infants were assessed by 1574 single-day studies (12-h observations plus 12-h recall) of dietary intake and by mothers' monthly reports of usual feeding practices to determine whether feeding pattern classification depends on the assessment method used. Results suggest that single-day studies produce a different view of feeding practices than do mothers' reports of usual behavior. Exclusive breast-feeding in infants younger than 4 mo was observed 25% more often than reported. Non-human milk consumption was reported 30% more often than observed. Disagreement between reported and observed practices was related by logistic regression analyses to mother's age and education, number of children younger than 5 y in the home and infant age and illness on the observation day. Most disagreement between reported and observed behavior could have been due to daily variation in feeding practices. Consumption during the past 24 h should not be used alone as the basis for classifying infant feeding practices in survey research.

When Is It Safe to Feed After Surgical Feeding Tube Placement? A Survey of EASTMembers.

Many critically ill trauma and surgical patients require nutritional support. Patients needing long-term enteral access often undergo placement of surgical feeding tubes, including percutaneous endoscopic gastrostomy tube, laparoscopic gastrostomy tube, and open gastrostomy tube. This study was performed to determine national practice patterns for feeding after feeding tube placement. A 16-question online survey was administered to members of the Eastern Association for the Surgery of Trauma via Qualtrics about feeding practices after placement of the feeding tube. Questions included demographics, training, current practice, annual procedural volume, timing to resume feeds: <2, 6, 12, or 24h, methods to advance feeds, and reasons behind management decisions. For comparison, responses were grouped into "early" (≤6h) and "late" (18-24h) groups. The chi-square test was used, and P<0.05 was significant. Five hundred sixteen Eastern Association for the Surgery of Trauma members completed the survey. Most (95%) respondents worked at a level 1 or 2 trauma center, and 68% are in academic practice. The most common feeding tube placement was percutaneous endoscopic gastrostomy (median = 25/y, interquartile range = 15-40). Responses showed variability in timing of when feeds were resumed after procedure. Early feeding was not affected by age (≤42y), trauma center designation, volume, or training programs at the respondent's hospital. Graduates of surgical critical care fellowship were less likely to feed early (P=0.043). There is wide variability in feeding practices after surgical feeding tube placement. Given the large quantity of procedures performed, a randomized controlled trial should be performed to determine the optimal timing to resume feeds in critically ill patients.

Daily variability in mothers' and fathers' feeding practices and associations with children's eating behaviors

The current study explores daily variability in maternal and paternal pressuring, restrictive, and structure-related feeding practices and their associations with child energy regulation and food refusal. Multilevel models were run separately for mothers and fathers to understand these associations, as well as within a dyadic framework to account for the interdependence of partners. One hundred families with at least one child between 3- to 5-years old participated by completing seven days of daily diaries. Results suggest there is daily variability in feeding practices for mothers and fathers and children's energy regulation and food refusal. Mothers' daily reports (within family variability) suggested that on days when mothers used more pressure and less structure than usual, children showed more food refusal. Fathers' daily reports suggested that on days when fathers used more pressure or less structure, children showed less energy regulation. On average across the week (between family variability), maternal pressure and restriction was related to child energy regulation. Dyadic multilevel models suggested that fathers' daily feeding behavior was associated with child eating behavior, while mothers' pressure and restrictive feeding on average across the week was a better predictor of between family variability in child eating behavior. For provision of support or structure during feeding, maternal structure was related to less father-reported energy regulation and paternal structure was related to more father-reported energy regulation. The results highlight the necessity of considering both mothers' and fathers' behaviors from day-to-day to get a more authentic picture of the family feeding relationship.

Exploring feeding practices in typically developing young children in three districts of Maharashtra: A preliminary survey

Abstract Purpose: The current study was designed to investigate and compare the feeding practices across three districts of Maharashtra and across maternal literacy levels. Materials and Methods: This study employed a cross-sectional survey. A survey tool was developed to assess the feeding practices, which included items related to the hierarchy of food types introduced to infants, their consistency, the age of introduction of various foods, utensils used, and position used to feed the infants. The survey tool was validated by experienced speech-language pathologists (SLPs). Ninety-five mothers of children in the age range of 1–3 years (30 mothers from each of the two districts—Nagpur, Sangli, and 35 participants from Mumbai) were included as participants. The participants of all the districts were also grouped based on their literacy levels. The survey tool was administered via online mode. Results: This study revealed that there were many differences in feeding practices across districts and literacy levels. Only the utensil used to provide complementary feeds, consistency of the food introduced after complementary feeds, and the position used to feed the foods of next consistency were similar across districts. Across literacy levels, only the consistency of complementary feeds, consistency of the food introduced after complementary feeds, position to feed the next consistency, utensil and position used to feed water were similar. All the other feeding practices varied across districts and literacy levels. Conclusion: It can be concluded that the geographical location of the districts across Maharashtra and maternal literacy levels influenced feeding practices. The findings of this study imply that the practicing SLPs should consider the variations in feeding practices that exist across districts during the assessment and intervention of young children with feeding issues.

Analysis of enteric methane emissions due to extreme variations in management practices of dairy-production systems

This study concerns variability in agrosystem inputs that affect greenhouse gas emissions at the farm scale, when management practices differ from average practices. Many studies of agrosystems assume average management practices. However, existence of a wide variety of farm-management practices may result in extreme variations in estimated environmental impacts. This large variation raises the need to use statistical tools to model extreme situations and their consequences on agrosystems. For instance, methane emissions generated by enteric fermentation in dairy cattle are particularly studied because they are important at a global scale. We investigated how extreme variations in feeding practices in dairy production affect predicted methane emissions, using a methane-emission model based on existing equations that is easy to apply at the farm scale. In this study, extreme variations in the time that cattle spent grazing were propagated through three different dairy-production systems. For an intensive dairy farm, predicted methane emissions decreased up to 15% (ca. 5% on average) and increased up to 11% (ca. 1% on average) under extremely long or short times spent grazing, respectively, compared to those from average variations in the time spent grazing. The range of variation in time spent grazing also reflects changes in feed rations. Farm-management practices require deep investigation to both evaluate and decrease risks of environmental impacts in dairy production.

Variability in enteral feeding practices of preterm infants among hospitals in the SEN1500 Spanish neonatal network

Abstract Introduction Proper nutrition is one of the primary objectives in the management of preterm infants. However, lack of evidence on the best strategy to achieve this objective has led to a great variability in feeding practices. This variability may be related to the differences in the incidence of complications, such as necrotising enterocolitis (NEC). Objective The aim of this study is to assess the variability in clinical practice regarding enteral feeding in SEN-1500 Spanish network. Method An observational study was conducted using a questionnaire sent out in 2013 requesting information about feeding very low birth weight (VLBW) neonates (bank milk, start time, trophic feeding, increases, fortifiers and probiotics). Results Responses were received from 60 of the 98 hospitals. The response rate was higher in centres with more than 50 VLBW/year (30/31). Just over two-thirds (67%) have feeding protocols, and 52% refer to variability within their unit. A milk bank is available in 25% of the units. First feeding occurs fairly evenly throughout first 48 h, although it is delayed in lower gestational ages, even when there is no haemodynamic failure. In addition to haemodynamic instability there are other situations when the start is delayed (absence of breast milk, CIR, altered umbilical flow, asphyxia), while it is rarely delayed by absence of meconium or maintain an umbilical catheter. Half of those under 25 weeks begin directly with progressive increases instead of trophic feeding. Increases rarely reach 30 mL/kg/day. Almost all use fortification and vitamins. There was a significant use of probiotics at the time of the survey. Conclusions There is great variability in enteral nutrition policies in VLBW in Spain. Although some differences are justified by the lack of evidence, there are other interventions that have proven to be effective, such as evidence-based protocols or access to donor milk. Implementation in all the units could reduce the incidence of NEC and improve the nutritional status.

Variabilidad en las prácticas sobre alimentación enteral del prematuro entre hospitales españoles de la red SEN-1500

IntroductionProper nutrition is one of the primary objectives in the management of preterm infants. However, lack of evidence on the best strategy to achieve this objective has led to a great variability in feeding practices. This variability may be related to the differences in the incidence of complications, such as necrotising enterocolitis (NEC). ObjectiveThe aim of this study is to assess the variability in clinical practice regarding enteral feeding in SEN-1500 Spanish network. MethodAn observational study was conducted using a questionnaire sent out in 2013 requesting information about feeding very low birth weight (VLBW) neonates (bank milk, start time, trophic feeding, increases, fortifiers and probiotics). ResultsResponses were received from 60 of the 98 hospitals. The response rate was higher in centres with more than 50VLBW/year (30/31). Just over two-thirds (67%) have feeding protocols, and 52% refer to variability within their unit. A milk bank is available in 25% of the units. First feeding occurs fairly evenly throughout first 48hours, although it is delayed in lower gestational ages, even when there is no haemodynamic failure. In addition to hemodynamic instability there are other situations when the start is delayed (absence of breast milk, CIR, altered umbilical flow, asphyxia), while it is rarely delayed by absence of meconium or maintain an umbilical catheter.Half of those under 25 weeks begin directly with progressive increases instead of trophic feeding. Increases rarely reach 30ml/kg/day. Almost all use fortification and vitamins. There was a significant use of probiotics at the time of the survey. ConclusionsThere is great variability in enteral nutrition policies in VLBW in Spain. Although some differences are justified by the lack of evidence, there are other interventions that have proven to be effective, such as evidence-based protocols or access to donor milk. Implementation in all the units could reduce the incidence of NEC and improve the nutritional status.

Incidence and enteral feed antecedents of severe neonatal necrotising enterocolitis across neonatal networks in England, 2012–13: a whole-population surveillance study

Necrotising enterocolitis is a neonatal gastrointestinal inflammatory disease with high mortality and severe morbidity. This disorder is growing in global relevance as birth rates and survival of babies with low gestational age improve. Population data are scant and pathogenesis is incompletely understood, but enteral feed exposures are believed to affect risk. We aimed to quantify the national incidence of severe necrotising enterocolitis, describe variation across neonatal networks, and investigate enteral feeding-related antecedents of severe necrotising enterocolitis. We undertook a 2-year national surveillance study (the UK Neonatal Collaborative Necrotising Enterocolitis [UKNC-NEC] Study) of babies born in England to quantify the burden of severe or fatal necrotising enterocolitis confirmed by laparotomy, leading to death, or both. Data on all liveborn babies admitted to neonatal units between Jan 1, 2012, and Dec 31, 2013, were obtained from the National Neonatal Research Database. In the subgroup of babies born before a gestational age of 32 weeks, we did a propensity score analysis of the effect of feeding in the first 14 postnatal days with own mother's milk, with or without human donor milk and avoidance of bovine-origin formula, or milk fortifier, on the risk of developing necrotising enterocolitis. During the study period, 118 073 babies were admitted to 163 neonatal units across 23 networks, of whom 14 678 were born before a gestational age of 32 weeks. Overall, 531 (0·4%) babies developed severe necrotising enterocolitis, of whom 247 (46·5%) died (139 after laparotomy). 462 (3·2%) of 14 678 babies born before a gestational age of 32 weeks developed severe necrotising enterocolitis, of whom 222 (48·1%) died. Among babies born before a gestational age of 32 weeks, the adjusted network incidence of necrotising enterocolitis ranged from 2·51% (95% CI 1·13-3·60) to 3·85% (2·37-5·33), with no unusual variation from the adjusted national incidence of 3·13% (2·85-3·42), despite variation in feeding practices. The absolute risk difference for babies born before a gestational age of 32 weeks who received their own mother's milk within 7 days of birth was -0·88% (95% CI -1·15 to -0·61; relative risk 0·69, 95% CI 0·60 to 0·78; number needed to treat to prevent one case of necrotising enterocolitis 114, 95% CI 87 to 136). For babies who received no compared with any bovine-origin products within 14 days of birth, the absolute risk difference was -0·65% (-1·01 to -0·29; relative risk 0·61, 0·39 to 0·83; number needed to treat 154, 99 to 345). We were unable to assess the effect of human donor milk as use was low. Early feeding of babies with their own mother's milk and avoidance of bovine-origin products might reduce the risk of necrotising enterocolitis, but the absolute reduction is small. Owing to the rarity of severe necrotising enterocolitis, international collaborations are needed for adequately powered preventive trials. National Institute for Health Research.

Infant and young child feeding practices differ by ethnicity of Vietnamese mothers.

BackgroundLimited studies have examined ethnic variation in breastfeeding and complementary feeding practices in developing countries. This study investigated ethnic variation in feeding practices in mothers with children 0–23 months old in Vietnam.MethodsWe used data on 1875 women who came from the ethnic majority, Kinh (n = 989, randomly sampled from 9875 surveyed Kinh mothers, 10 % from each province) and three ethnic minorities: E De-Mnong (n = 309), Thai-Muong (n = 229) and Tay-Nung (n = 348). Ethnic minorities were compared with the Kinh group using logistic regression model.ResultsPrevalence of breastfeeding initiation within an hour of birth was 69 % in Thai-Muong, but ~50 % in other ethnicities. In logistic regression, the prevalence of breastfeeding within one hour was lower in Tay-Nung (OR: 0.54; 95 % CI: 0.38, 0.77) than the majority Kinh. Prevalence of exclusive breastfeeding under 6 months was 18, 10, 17, and 33 % in Kinh, Thai-Muong, Tay-Nung, and E De-Mnong, respectively; compared to the majority Kinh, the prevalence was lower in Thai-Muong (OR: 0.42; 95 % CI: 0.25, 0.71) and higher in E De-Mnong (OR: 1.99; 95 % CI: 1.04, 3.82). Overall prevalence of bottle feeding in Thai-Muong and E De-Mnong (~20 %) was lower than in Kinh (~33 %): Thai-Muong (OR: 0.50; 95 % CI: 0.37, 0.68) and E De-Mnong (OR: 0.69; 95 % CI: 0.50, 0.95). Compared with Kinh (75 %), fewer ethnic minority children received minimum acceptable diets (33 % in Thai-Muong, 46 % in E De-Mnong, and 52 % in Tay-Nung; P < 0.05). Prevalence of minimum acceptable diet (met both dietary frequency and diversity) was lower in Thai-Muong (OR: 0.23; 95 % CI: 0.11, 0.46), Tay-Nung (OR: 0.52; 95 % CI: 0.39, 0.69), and E De-Mnong (OR: 0.55; 95 % CI: 0.33, 0.89) than the majority Kinh.ConclusionsBreastfeeding practices were suboptimal and differed by ethnicity, which suggests need for tailored interventions at multiple levels to address ethnic-specific challenges and norms. Complementary feeding practices were less optimal among ethnic minorities compared to Kinh, which suggests need for broad intervention including improved food availability, accessibility, and security.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0995-8) contains supplementary material, which is available to authorized users.

Improved lung recruitment and diaphragm mobility with an in-line speaking valve in tracheostomised mechanically ventilated patients – An observational study

Introduction: Critically ill children are at an increased risk of malnutrition. Variability in feeding practices has been highlighted as a barrier to optimising nutrition during Paediatric Intensive Care Unit (PICU) admission. Introduction of a feeding algorithmhas been shown to improve nutritional outcomes in this population. Studyobjective: To develop and implement a feeding algorithm for patients in a tertiary 22 bed PICU. Methods: The study was performed in three phases: Phase 1: A survey of nursing attitudes and perceived practices to enteral feeding. Phase 2: A three week prospective nutrition audit to evaluate the adequacy of energy and protein intake compared to estimated requirements. Phase 3: A multidisciplinary working group formed to devise, pilot and implement a feeding algorithm. Results: Phase 1: Demonstrated considerable variability and specific barriers to feeding. These included delayed medical approval to initiate feeds and multiple fasting for procedures and possible extubations. Phase 2: The mean time to feed initiation was 22h (range 0–92h). Within 72h of admission, patients achieved 66% of estimated energy requirements (EER); and 36% of estimated protein requirements (EPR), with only 4 (15%) reaching their EER; none reached EPR. Phase 3: A multidisciplinary team (dietetics, medical and nursing) reviewed the results of phases 1 and 2 and developed a single page algorithm. This was piloted in April 2014 and the final algorithm initiated in May 2014. Conclusion:Barriers to nutrition in a tertiary children’s hospital PICUwere identified by survey and audit tools. A feeding algorithm was developed by a multidisciplinary team utilising these results. A one page feeding algorithm was initiated in May 2014.

Development and implementation of a feeding algorithm to optimise nutrition in Paediatric Intensive Care

Introduction: Critically ill children are at an increased risk of malnutrition. Variability in feeding practices has been highlighted as a barrier to optimising nutrition during Paediatric Intensive Care Unit (PICU) admission. Introduction of a feeding algorithm has been shown to improve nutritional outcomes in this population.

Improving preterm infant outcomes: implementing an evidence-based oral feeding advancement protocol in the neonatal intensive care unit.

The ability of a preterm infant to exclusively oral feed is a necessary standard for discharge readiness from the neonatal intensive care unit (NICU). Many of the interventions related to oral feeding advancement currently employed for preterm infants in the NICU are based on individual nursing observations and judgment. Studies involving standardized feeding protocols for oral feeding advancement have been shown to decrease variability in feeding practices, facilitate shortened transition times from gavage to oral feedings, improve bottle feeding performance, and significantly decrease the length of stay (LOS) in the NICU. This project critically evaluated the implementation of an oral feeding advancement protocol in a 74-bed level III NICU in an attempt to standardize the process of advancing oral feedings in medically stable preterm infants. A comprehensive review of the literature identified key features for successful oral feeding in preterm infants. Strong levels of evidence suggested an association between both nonnutritive sucking (NNS) opportunities and standardized feeding advancement protocols with successful oral feeding in preterm infants. These findings prompted a pilot practice change using a feeding advancement protocol and consisted of NNS and standardized oral feeding advancement opportunities. Time to exclusive oral feedings and LOS were compared pre- and postprotocol implementation during more than a 2-month evaluation period. Infants using NNS and the standardized oral feeding advancement protocol had an observed reduction in time to exclusive oral feedings and LOS, although statistical significance was not achieved.

Enteral feeding practices in very preterm infants: an international survey

ObjectiveTo evaluate enteral feeding practices in neonatal units in different countries and on different continents.DesignA web-based survey of 127 tertiary neonatal intensive care units in Australia, Canada, Denmark, Ireland, New...

The Relationship Between Feeding and Necrotizing Enterocolitis in Very Low Birth Weight Infants

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in the NICU, with often devastating consequences. The etiology of NEC is probably multifactorial, with preterm infants at the highest risk. The relationship between feeding and NEC was identified in the 1970s, leading to delayed feeding becoming standard treatment in NICUs. More recent research suggests that early feedings not only are safe, but reduce other morbidities associated with prematurity. Standardized feeding guidelines seem to confer some benefits in decreasing NEC, despite a wide variability in feeding practices within the published guidelines. A standardized approach to the management of feeding problems may be the key. This article briefly reviews the pathogenesis of NEC and examines studies of various feeding practices for their relationship to the development of NEC. It also highlights the potential benefits of breast milk in NEC prevention.

Early management of race-bred weanlings and yearlings on farms

A total of 58 Thoroughbred and Quarter Horse farms that managed 1,987 weanlings and yearlings responded to a survey designed to better characterize early management of racing prospects. Average age at weaning was 5.5 months and over half of all farms kept almost three-fourths of all weanlings to be placed in pre-race training. Variation in feeding practices was evident and while well over half of all farms provided balanced nutrient supply to young horses, 20% to 40% likely fed unbalanced diets. An obvious preference existed for semi-confinement in young horses with plenty of free exercise. The majority of farms reported that young prospects were fed and managed for a moderate rate of growth. Forced exercise occurred to a much larger extent with yearlings than weanlings and 40% of farms described the footing as soft, but not deep. Response to the prevalence of developmental orthopedic diseases appeared somewhat guarded, and average injury rate was low on farms that attributed much of injury to horses playing too hard. Technological advancements such as photoperiod manipulation in broodmares were widely used, while valuable tools such as body condition scoring were utilized to a lesser extent.

Review of equine feeding and stable management practices in the UK concentrating on the last decade of the 20th century.

Equine feeding and stable management practices for horses kept in the UK vary greatly and it is probable that almost any permutation of regimen could be found somewhere. Unfortunately, there is uncertainty about the number of horses in the UK and very limited data are available on the ways horses are being fed and managed. This paper reviews some of the information that is available and provides an outline of some of the factors influencing the practices used. To a certain extent, the way UK horses are fed and managed primarily reflects the purpose for which they are kept (e.g. racing Thoroughbred vs. native breeding pony) as well as their location (urban vs. rural); the time of year; their breed/age as well as the owner's financial situation. In very general terms, the various ways that horses can be kept and managed fall between 2 extremes: the professional riders/owners/trainers who tend to keep horses and ponies either in large barns/stable yards managed by themselves or a head stable person and the more amateur competitor/leisure riders who tend to keep their horses at a livery yard or at their own or a friend's home. Many of these animals are kept under either part or full do-it-yourself (DIY) conditions. Common feeding practices range from feeding traditional home cereal-based mixes to feeding coarse mixes/pelleted compound manufactured feeds. Very few people, however, feed just a simple single grain or compound feed plus roughage diet. Many add other separate feeding stuffs and supplements including soaked sugar beet or straight molasses, primarily as palatability enhancers. Other common additions include cod liver oil, various types of vegetable oil, carrots, one or more vitamin/mineral mixes, herbal mixes and certain agents with ergogenic/performance-enhancing claims. Especially for horses used for competition purposes, provision of supplementary salt is common either by means of a salt block or lick or as an addition to the feed. The soaking of hay, for a variable time period, is another common practice. Although the type and amount of feed fed fundamentally varies according to the work load of the horse there tends to be marked seasonal variations in feeding practices due to the weather and the availability of pasture.