Weaning Methods Research Articles

Initial experience with pump controlled retrograde trial-off (PCRTO) veno-arterial extra corporeal membrane oxygenation in children.

Pump Controlled Retrograde Trial Off (PCRTO) is a relatively new technique in trialing-off Veno-Arterial Extra Corporeal Membrane Oxygenation (VA-ECMO). Literature on the use of PCRTO in children remains scarce. We describe our centre's initial experience with PCRTO in a neonate and an older child and review its potential advantages and disadvantages compared to traditional weaning methods. More research and shared best practices are required in children to facilitate wider adoption of this technique.

Impact of different weaning strategies of high-frequency ventilation (HFV) on neonatal cerebral oxygen saturation and hemodynamics: protocol for a prospective randomized controlled trial.

High-frequency ventilation (HFV) is commonly used in neonatal intensive care units to provide respiratory support for critically ill neonates. Currently, there is no standardized procedure for weaning from HFV. Two commonly used strategies are transitioning from HFV to conventional mechanical ventilation (CMV) before extubation (HFV-CMV) and extubation after decreasing mean airway pressure during HFV (HFV-HFV). The impact of these strategies on neonatal cerebral oxygenation and hemodynamics remains incompletely understood. We will conduct a prospective, single-center, randomized controlled trial to investigate the effects of two different HFV weaning strategies (HFV-CMV, HFV-HFV) on neonatal cerebral oxygenation and hemodynamics. The patients enrolled in the trial will be randomly allocated to either the HFV-CMV group or the HFV-HFV group in a 1:1 ratio. The primary outcome will be cerebral oxygen saturation (ScO2) before and after the intervention. Second outcomes are cerebral fractional tissue oxygen extraction, heart rate, blood pressure, and the incidence and severity of intraventricular hemorrhage and periventricular leukomalacia. We hypothesize that HFV-CMV results in positive impact on neonatal cerebral oxygenation compared to HFV-HFV. This study aims to identify a better weaning strategy for HFV and contribute evidence-based data to enhance its clinical application in newborns, potentially improving the care and outcomes for neonates receiving HFV. This study aims to assessing the impact of different HFV weaning strategies on neonatal cerebral oxygenation and hemodynamics, as well as the relationship between the duration of HFV under different strategies and neurological complications, to identify better weaning methods for HFV. We hope to contribute evidence-based data to enhance clinical application of HFV in newborns, potentially improving the care and outcomes for neonates receiving HFV. Chinese Clinical Trial Registry: ChiCTR2400088628. Registered on August 22, 2024, https://www.chictr.org.cn/bin/project/edit?pid=235926 .

Interventions for Managing Picky Eating in Preschool Children: Literature Review

Introduction: Picky eating in children is a widespread issue that can affect growth and development. Factors contributing to picky eating include parental influence, early feeding practices, and environmental conditions. Addressing picky eating behavior is crucial to prevent long-term negative effects on children's nutrition and health. Objective: This study aimed to evaluate the effectiveness of various interventions, such as sensory education, parent training, oral interventions, massage, and diet adjustments, in improving picky eating behavior in children. Method: A review of 15 studies published between 2013 and 2023 was conducted, focusing on intervention programs for children aged 1-6 years. The studies were selected from databases like PubMed, Science Direct, and Google Scholar. Result: Sensory education helped reduce food rejection by familiarizing children with new foods. Parent training, including cooking classes and the Baby Led Weaning (BLW) method, effectively reduced picky eating. Oral interventions, such as herbal remedies and appetite-enhancing supplements, showed positive outcomes. Massage techniques like Tui Na and tailored dietary plans also contributed to better eating habits in both underweight and overweight children. Conclusion: Interventions including sensory education, parental training, oral treatments, massage, and diet modifications can significantly improve eating behaviors in picky eater children, promoting healthier nutrition and growth.

Discontinuation of Cerebro-Spinal Fluid (CSF) Drainage in Acute Hydrocephalus: A Prospective Cohort Study and Exploratory Data Analysis.

The optimal management of CSF drainage in acute hydrocephalus, in particular when to initiate drain weaning, remains uncertain. This study aimed to evaluate the impact of timing and method of drain weaning on patient outcomes. This prospective observational study in a large-volume tertiary neuroscience centre included all adult patients who required temporary CSF drainage for acute hydrocephalus of any cause between January 2020 and March 2021. Contemporaneous data collection was conducted, including patient demographics, time to clamp, weaning methods, and clinical outcomes of hospital length of stay (LOS), rate of shunt insertion, drain-related infections, and mechanical complications. Univariate and multivariate statistical analyses were performed to identify the independent associations of timing-related factors. A total of 69 patients were included (mean age = 59.4 years). A total of 59% had CSF diversion for aneurysmal subarachnoid haemorrhage, and 88% had EVD drainage. The length of drainage prior to the first clamp was significantly associated with the overall length of drainage (p < 0.0001), LOS (p = 0.004), and time to shunt (p = 0.02) following multivariate adjustment. For each day delayed in initiating the drain challenge, the overall LOS increased by an additional 1.25 days. There was no association between the weaning method and LOS, the rate of shunting, or CNS infection; however, those in the gradually weaned group had more mechanical complications, such as drain blockage or CSF leakage, than those rapidly weaned (p = 0.03) after adjustment. This study recommends challenging the drain early via a rapid wean to reduce LOS, mechanical complications, and possibly infections. The consequences of temporary CSF diversion have significant implications at financial and patient levels, but the quality of evidence regarding weaning remains poor. Further randomised multicentre studies and national databases of practice are required to allow definitive conclusions to be drawn.

Investigating Criteria for Weaning from Ventilators in Iran: A Systematic Review

Objectives: This systematic review was conducted to evaluate optimal techniques for weaning patients in Iranian intensive care units from ventilator support. Methods: Following PRISMA 2020 guidelines, studies on Iran's latest ventilator weaning methods were examined. Two researchers independently assessed the studies after transferring the studies to EndNote software and eliminating duplicates. A third collaborator resolved any disagreements and made the final decision. The evaluation encompassed primary, secondary, qualitative assessment, and data extraction stages. Results: The initial database search identified 1103 potentially relevant articles and was managed using EndNote software. After excluding 235 duplicates, screening based on title and abstract led to the exclusion of 457 articles from the remaining 868. During eligibility evaluation, 402 articles were excluded from 411 studies after thoroughly examining the complete text, aligning with inclusion and exclusion criteria. The qualitative assessment, guided by STROBE and CONSORT checklists, found all nine remaining studies satisfactory methodological quality. Consequently, these nine studies were included in the final analysis. Conclusions: Prioritizing, identifying, and implementing strategies for successful mechanical ventilation weaning is crucial for research and quality improvement. This study systematically reviewed the evidence on diverse methods to enhance ventilator weaning success in Iran. Nevertheless, additional studies are warranted to further ascertain ventilator-weaning strategies' effectiveness.

What barriers do paediatric nurses encounter when attempting to wean paediatric patients off humidified high flow nasal cannula oxygen therapy? A qualitative study

PurposeThis study aimed to explore nurse perceptions of barriers and facilitators to weaning humidified high flow nasal cannula (HHFNC) in Australian paediatric settings. Design and methodsA qualitative descriptive two phased study was conducted across Australia. Purposeful sampling and snowballing technique were used to recruit nurses with the study advertised widely on social media nursing groups. Phase One data collection was via a survey with open and closed ended questions, and Phase Two via semi-structured interviews. Data were analysed using descriptive statistics (Phase One) and thematic analysis (Phase One and Two) to identify themes and patterns in the narrative. ResultsPhase one: 36(56.25 %) participants identified their workplace had clear guidelines, 57(89.06 %) received education on HHFNC and 34(57.63 %) experienced barriers when weaning. Three themes and nine subthemes were identified i) variable clinical process for weaning HHFNC, ii) knowledge and skills and iii) clinical observation and assessment of the child. Phase two: four themes and nine subthemes were identified, i) ‘There doesn't seem to be any pattern’: no evidence to guide practice, ii) Nursing and medical led weaning, iii) Knowledge and skills and iv) Family centred approaches to weaning. ConclusionsCurrent research on HHFNC does not consider best practice for weaning. This study identified barriers as inconsistency in weaning practice and availability of guidelines and facilitators were a robust education program and confidence in weaning. Multidisciplinary team need to collaborate to determine standardised weaning practice. Practice ImplicationsFurther research is essential to determine best practice weaning methods and inform national/international guidelines.

PSXI-1 Evaluation of weaning methods on performance and immune response to vaccination in beef calves

Abstract The weaning process is a stressful experience for any species. Various weaning methods have been used in beef cattle to mitigate this stress and its associated consequences, such as decreased growth rate and suppression of the immune system. The objective of this study was to evaluate different weaning methods and their effect on post-weaning growth and immune function in beef calves. To accomplish this, a sample of Angus and Angus cross beef calves (n = 147) were stratified by age, sex, and sire and divided into three treatment groups: abrupt weaning (AW), fence line weaning (FL), and nose flap weaning (NF). All calves were vaccinated at weaning (d 0) and weaned according to their treatment group. Blood samples (5 mL) were collected via coccygeal venipuncture on d 0 and 14 to evaluate immune response to vaccination and quantify cortisol concentration as an indicator of stress. Individual body weights (BW) were recorded biweekly for 42 d after weaning. Data were analyzed using the PROC MIXED procedure of SAS v9.4 with main effects of treatment and sex and their interaction using ANOVA. Weaning weight, post-weaning weights, and post-weaning BW gain data were analyzed with age of calf included as a covariate. Body weights were not different among treatment groups at weaning, or at 14, 28, or 42 d post-weaning; however, the FL group had a greater (P &amp;lt; 0.05) total post-weaning BW gain than the AW group with the NF group being intermediate to the others. There was no effect of weaning method on cortisol concentration at weaning or 14 d post-weaning, but a difference in immune response was observed. Calves in the NF weaning group had a greater (P &amp;lt; 0.05) immune response to vaccination as determined by antibody titers than calves in the AW or FL weaning groups. Based on the results of this study, alternative methods of weaning may have a positive impact on calf BW gain throughout the post-weaning period and immune response to vaccination in recently weaned beef calves.

PSII-1 Weaning as prenatal stress: preliminary study on indicators of calf resiliency

Abstract Maternal stressors have been reported to alter fetal development in many species. During pregnancy beef cattle are subjected to different potential stressors, such as weaning their current offspring, as part of beef production practices. The objective of this study was to investigate the relationship between weaning method as a prenatal maternal stress and the effect on offspring resiliency. Multiparous cows were weaned of their calves in the fall of 2022 using either abrupt (A), fenceline (F), or nose-flap (N) weaning methods (n = 30 per group). Calves born from these cows the following spring (2023) were followed for birthweights, morbidity, and mortality. Mean estimated fetal age at exposure was 126 d (range 66 to 219 d) using breed averages for gestational length. Cognitive tests were performed at 2 mo of age using an outdoor arena to continuously monitor calves during 2 min of initial isolation, 2 min exposed to a novel object, and 1 min of exposure to a human in the arena. Tests were performed sequentially, and treatments were balanced across days. Prenatal exposure to A was associated with a 74.8 (2.5 to 2,237.3, P &amp;lt; 0.01) and 21.5 (1.2 to 385.7, P = 0.03) times increase in the odds of calves being stillborn or failure to thrive within 24 h of birth compared with F or N, respectively. There was no difference in morbidity or mortality during d 1 to 60. Birthweights were available on one-half of the calves from each group and showed no statistical difference; however, there was a 4.53 kg numerical difference between A and N groups. Behavioral data from a subset of 36 calves (A = 14, F = 11, and N = 11) was assessed for time spent standing, moving, exploring, duration in the open center vs. perimeter of the arena. There was a tendency for A exposed calves to spend more time in the perimeter after being confronted with a novel object compared with N exposed calves (mean difference of percent of total test time in perimeter from isolation to novel object test: A = 24.0 ± 23.9 %, N = -2.9 ± 22.1 %, P = 0.08). Fenceline exposed calves spent more time moving during initial isolation than either abrupt or nose-flap (69.3 ± 14.7 %, 50.6 ± 11.9 %, and 69.9 ± 17.8 % for A, F, N, respectively (P = 0.01 for A vs F and F vs N). These behavioral and physiological indicators support a potential divergence in survivability and coping mechanisms associated with prenatal exposure to different weaning methods. Future research will evaluate different dimensions of cognitive performance as well as increasing sample size.

Effects of weaning-related stress on the emotional health of horses-A scoping review.

Weaning represents one of the most stressful events in the life of a horse, and may have long-term impacts on behaviour. There are a range of approaches used to wean foals from mares, including abrupt and progressive separation methods. There is currently a lack of consensus on how stress and impact are measured. To conduct a scoping review to identify and chart measures of weaning-related stress on the mare and foal. Scoping review. The scoping review was conducted using the PRISMA extension for scoping reviews. Systematic searches were conducted in three scientific databases (CAB abstracts, Medline and Embase). The title, abstract and full text of retrieved studies were reviewed against inclusion and exclusion criteria. Publications that remained after full text review were analysed. Data on study design, population characteristics, weaning method and health and behavioural outcomes were extracted and charted. A total of 366 publications were identified; 22 were retained for inclusion and charting. Eighteen studies reported behavioural measures, four only reported physiological measures and 12/22 studies used a combination of both. Fifteen studies analysed foal behaviour only (15/22), six analysed foals with their dams and one analysed the mare only. Duration of most studies (19/22) was a maximum of 12 months post weaning; three studies continued measurements until the foal age was 3-4 years old. Limited number of studies available for analysis. There is significant variation in the current evidence around weaning-related impacts in the mare and foal. This includes variation in how weaning methods and management of mares and foals are described, and very limited research evaluating long-term impacts, or the impact on the mare. This scoping review makes recommendations on how to improve the future evidence base.

The Effect of Baby-Led Weaning and Traditional Complementary Feeding Trainings on Baby Development: Study Protocol

Aim: In this study, it was aimed to evaluate the risks of self-feeding, transition to early solids and home meals, choking, anemia and obesity in 6-and 12-month-old infants who were introduced to complementary feeding with the trainings of traditional complementary feeding (TCF) and baby-led weaning (BLW) methods. Material and Method: This study is an experimental and randomized controlled study conducted to examine the effect of the trainings of the TCF and BLW methods on the transition to complementary feeding. The population of the study consisted of 73 infants aged 4 and 5 months who 62 were assigned to intervention groups by stratified randomization method. The study was conducted according to the CONSORT-2010 checklist. Five complementary feeding modular trainings with 8 sessions, appropriate for the age of the baby in months, were carried out in both intervention groups. In both groups, the trainings were maintained until the baby was 4 months to 12 months old. The outcomes consisted of height, weight gain, LAZ (Length for age z-score), WAZ (Weight for age z-score), and WLZ (Weight for length z-score) scores at 12 months, iron intake, hemoglobin, hematocrit, and ferritin levels, micronutrients, choking risk, growth retardation, transition time to solid foods, family meals and self-feeding, behaviors of transition to complementary feeding and developmental assessment parameters. Practice Implications: This study, the trainings given are expected to give an idea about the extent to which they affect the infant's body weight, growth and development, iron and micronutrient intake, obesity, choking and growth retardation risks..

A Randomized Controlled Clinical Trial Investigating the Weaning Process From Mechanical Ventilation in Elderly Patients With Dementia.

Limited data is available regarding the weaning techniques employed for mechanical ventilation (MV) in elderly patients with dementia in China. The primary objective of this study is to investigate diverse weaning methods in relation to the prognostic outcomes of elderly patients with dementia undergoing MV in the intensive care unit (ICU). Specifically, we seek to compare the prognosis, likelihood of successful withdrawal from MV, and the length of stay (LOS) in the ICU. The study was conducted as a randomized controlled trial, encompassing a group of 169 elderly patients aged ≥ 65 years with dementia who underwent MV. Three distinct weaning methods were used for MV cessation, namely, the tapering parameter, spontaneous breathing trial (SBT), and SmartCare (Dräger, Germany). In the tapering parameter group, the LOS in the ICU was notably prolonged compared to both the SBT and SmartCare groups. However, no statistically significant differences were observed among the groups with respect to demographic characteristics, such as age and sex, as well as factors including the rationale for ICU admission, cause of MV, MV mode, oxygenation index, hemoglobin levels, albumin levels, ejection fraction, sedation and analgesia practices, tracheotomy, duration of MV, successful extubation, successful weaning, incidences of ventilator-associated pneumonia, and overall prognosis. Both the SBT and SmartCare withdrawal methods demonstrated a reduction in the duration of MV and LOS in the ICU when compared to the tapering parameter method. Chinese Clinical Trial Registry: ChiCTR1900028449.

Trends and practices of weaning in infants across India: A comprehensive review.

Weaning is a critical phase in an infant's life, during which there is a transition from exclusive breastfeeding or formula feeding to consuming solid foods. Weaning is a critical step in determining a child's nutritional status, growth, and general health. India is a multiethnic and culturally diverse nation and has a variety of weaning practices that are affected by local customs, religious beliefs, and socioeconomic concerns. Malnutrition brought on by inadequate weaning methods used in infancy and early childhood may have an impact on cognitive, motor and social, development and productivity of the child, more importantly manifesting in later ages. Weaning customs in India have a long history of being ingrained in both family and cultural traditions. The variety of Indian cuisine is reflected in the meals that are offered to the infant during weaning. Homemade food commonly prepared like mashed fruits and vegetables, lentil soups, and rice porridge are the most popular. However, the inclination by parents toward professionally produced infant foods and formulas has increased because of urbanization and globalization; there have been observable changes in weaning practices over the past few decades because of changing lifestyles and easier access. These foods are frequently thought of as more convenient but may not be as nutrient-dense as homemade alternatives. Not following the medically recommended mandate of an exclusive diet of mother's breast milk to the infant, many parents often begin introducing complementary foods as early as four months. Still most concerningly also the timing of weaning commencement varies significantly across areas and communities. Overall, this review offers valuable insights into the current trends and practices of weaning in infants across India, underscoring the importance of culturally sensitive and informed strategies to ensure the well-being of the nation's youngest population.

Early feeding practices and eating behaviour in preschool children: The CORALS cohort

AbstractThis study aimed to investigate if the duration of breastfeeding and the method at initiation of complementary feeding affect eating behaviour in children aged 3−6 years. This is a cross‐sectional analysis from the Childhood Obesity Risk Assessment Longitudinal Study project, an ongoing longitudinal cohort study that aims to identify childhood obesity risk factors in Spanish children. A total of 1215 children aged 3−6 years were included. Breastfeeding duration and the method of initiation of complementary feeding [baby‐led weaning (BLW), traditional/spoon or mixed method] were evaluated. Eating behaviour at 3−6 years was assessed with the Child Eating Behaviour Questionnaire. Generalized linear models were fitted to assess the association between the aforementioned exposures and eating behaviour.Children breastfed for ≥4 months were less likely to be fussy eaters at 3−6 years compared to those breastfed for &lt;1 month (OR: 0.86 95% CI: 0.76−0.98; p = 0.031). Compared to those children using the traditional/spoon‐feeding method, those initiating complementary feeding through BLW or through a mixed approach were more likely to have higher scores on the enjoyment of food (EF) (OR, 95% CI: 1.33, 1.13−1.57; p = 0.001 and 1.17, 1.05−1.30; p = 0.002, respectively) and lower scores on food fussiness (FF) at 3−6 years (0.76, 0.62−0.91; p = 0.004 and 0.87, 0.78−0.98; p = 0.033, respectively). Breastfeeding for ≥4 months and initiation of complementary feeding with the BLW and a mixed approach were associated with greater EF and lower FF, which should endure practice.

The Impact of Abrupt and Fenceline-Weaning Methods on Cattle Stress Response, Live Weight Gain, and Behaviour.

The impact of abrupt (AB) and fenceline (FL) weaning methods on cattle stress response, live weight gain, and behaviour were determined across 14 days. Thirty-two cow-calf pairs were fitted with ear tag sensors (to continuously record behaviour) and allocated to two weaning treatments. After separation, FL calves were maintained in a pen adjacent to the FL cow paddock. The AB calves were transported to a pen removing all contact with the cows. After 7 d, FL cows were transported away from all calf pens. Body weights and salivary samples were collected for all animals on experimental days 0, 7, and 14. Fenceline-weaned calves had a greater duration of rest and rumination with reduced high activity across the first 3 days after separation as compared to abruptly weaned calves in line with the greater occurrences of pacing observed for AB calves. Fenceline-separated cows had greater levels of rest across the first 7 days but similar levels of rumination compared to abruptly separated cows. Fenceline-separated cow activity levels tended to be greater and eating levels were similar across the first three days. Body weight (BW) and cortisol concentrations were similar for AB and FL cattle, but FL cows had lower overall weight gain than the abrupt cows likely due to reduced eating time on days four to seven. Together, these results suggest that calves be fenceline-weaned for three days followed by total separation.

PENGARUH METODE BABY LED WEANING TERHADAP KETERAMPILAN ORAL MOTOR PADA BAYI (6-12 BULAN) DI KLINIK PRATAMA TANJUNG KECAMATAN DELI TUA

The Baby Led Weaning method is a method of eating activities that introduces healthy family foods that are often consumed by families in the form of finger food and gives children the opportunity to eat on their own since the beginning of the process of introducing complementary foods to breast milk. Breast milk only meets the nutritional needs of infants as much as 60% in infants aged 6-12 months. The rest must be met with other foods that are sufficient in number and good in nutrition. Therefore, at the age of 6 months and over, babies need additional nutrition from complementary foods, but the MP-ASI given must also be of high quality. Objective: To determine the effect of the Baby Led Weaning Method on Oral Motor Skills in Infants (6 – 12 months). Methods: This type of research is pre-experimental with a One Group Prestest-Posttest design. This sampling uses a total sampling and obtained 15 infants 6-12 months. Conclusion: This study uses the Wilcoxon test. Based on the results of bivariate analysis using the Wilcoxon test, p-value of 0.001 &lt; 0.05 means that Ho is rejected and Ha is accepted, which means that it can be said that there is an effect of giving the baby lad weaning method on oral motor skills in infants. -12 months at Tanjung Pratama Clinic.

Comparison of Conventional Methods with Pump-Controlled Retrograde Trial off for Weaning Adults with Cardiogenic Shock from Veno-Arterial Extracorporeal Membrane Oxygenation.

Pump-controlled retrograde trial off (PCRTO) is a safe, simple, and reversible method for weaning patients from veno-arterial extracorporeal membrane oxygenation (VA-ECMO). However, few studies have compared PCRTO to conventional weaning methods. This retrospective study aimed to compare PCRTO to non-PCRTO methods. This study included patients who were weaned from VA-ECMO from January 2016 to December 2022 at our medical center. Demographic data, ECMO management, ECMO complications, survival to discharge, and cardiogenic shock after VA-ECMO weaning were compared between the 2 groups. Seventy patients who were weaned from VA-ECMO using PCRTO and 85 patients who were weaned with conventional methods were compared. Patient characteristics were not significantly different between the 2 groups. The rate of survival to discharge was significantly higher in the PCRTO group than in the non-PCRTO group (90% vs. 72%, p=0.01). The rates of freedom from all-cause mortality at 10, 30, and 50 days after weaning from ECMO were 75%, 55%, and 35% in the non-PCRTO group and 62%, 60%, and 58% in the PCRTO group, respectively (p=0.1). The incidence of cardiogenic shock after weaning from VA-ECMO was significantly higher in the non-PCRTO group (16% vs. 5%, p=0.04). In logistic regression analysis, PCRTO was a significant factor for survival to discharge (odds ratio, 2.42; 95% confidence interval, 1.29-5.28; p=0.02). Compared to conventional methods, PCRTO is a feasible and reversible method, and it serves as a useful predictor of successful VA-ECMO weaning through a preload stress test.

Challenges in Selecting the Right Oxygen Delivery Devices in Neonatal Intensive Care Unit in Developing Countries

Abstract Oxygen is a life-saving drug but it may be dangerous if not used properly. Preterm babies are more susceptible to oxygen-induced free radical damage due to their organ immaturity. When supplementing oxygen in newborns, we must evaluate the equipment’s effectiveness, acceptability, tolerance, nasal injuries, and cost-effectiveness. The two most common time-trusted equipment used in neonatal intensive care units (NICUs) are nasal prongs and oxygen hood. The developed countries are using servo-controlled devices and are continuously monitoring the FiO2 and oxygen levels by the analyzer, but it is impractical in developing countries due to the unavailability of the equipment and financial constraints. We are lacking such sophisticated equipment which can monitor all parameters and are servo mode, especially the oxygen hood. Both equipment has got own merits and demerits, and there are no clear-cut guidelines that which one is better. The proper guidelines regarding the use, indications, methods, and monitoring of oxygen therapy in newborn babies are not clear. Many of the staff working in NICU are the ignorant about the nature of complications and side effects and the need for follow-up. This article highlights the rationale of oxygen therapy and saturation policy, methods of weaning, comparison of the efficacy, merits, and demerits, and implications of oxygen delivery devices in the care of newborns in NICU mostly in developing countries.

Inpatient education reduces length of outpatient oxygen therapy in bronchopulmonary dysplasia: A quality improvement project.

Patients discharged on home oxygen therapy (HOT) for bronchopulmonary dysplasia (BPD) often receive months of this therapy. A previous trial comparing two methods of HOT weaning showed that increased parent involvement in HOT weaning decreased HOT duration. Our outpatient team uses a standard protocol for outpatient HOT weaning, starting at the first clinic visit 4-6 weeks after discharge. To shorten HOT duration by teaching parents the outpatient HOT weaning process before neonatal intensive care unit(NICU) discharge. We launched a quality improvement program in April 2021 for preterm infants with BPD without significant comorbidities who were stable on ≤0.5 L nasal cannula. Eligible infants started the outpatient HOT weaning protocol while inpatient, with education for parents and nurses. The outcome measure was the duration of HOT after discharge. Process measures focused on protocol adherence. Balancing measures included NICU length of stay and appropriateness of parent-directed HOT weaning. During the study period, there were a total of 133 eligible patients discharged on home oxygen, with 75 in the baseline group and 58 in the intervention group. Forty-five (78%) participated in the HOT weaning protocol while inpatient. HOT was reduced from an average of 27 to 12 weeks after May 2021. We observed no change in NICU length of stay or inappropriate HOT weaning. Early introduction of HOT weaning with a focus on caregiver education is associated with a decreased duration of HOT.

Comparison of Two Methods for Weaning from Nasal Continuous Positive Airway Pressure via the Cyclic Use of High-Flow Nasal Cannula or Room Air in Preterm Infants.

Nasal continuous positive airway pressure (NCPAP) is extensively used for preterm infants experiencing respiratory distress syndrome (RDS). Weaning from NCPAP includes direct weaning or gradually extending room air exposure. However, a high-flow nasal cannula (HFNC) is an alternative weaning method. Therefore, this study evaluated the clinical outcomes of HFNC and progressively increasing room air duration as weaning strategies. This study enrolled 46 preterm infants with RDS receiving NCPAP support who underwent the cyclic use of NCPAP and HFNC weaning protocol as the HFNC group; a retrospective analysis included 87 preterm infants weaned from NCPAP by gradually extending room air duration as the room air group. Differences in clinical conditions, complications, and short-term outcomes between the weaning methods were compared. The mean post-menstrual age at initiating NCPAP weaning was lower in the room air group than in the HFNC group (mean ± SD, 35.2 ± 2.3 weeks vs. 33.2 ± 2.5 weeks, p < 0.001). Hospital stay duration and total respiratory therapy days were longer in the HFNC group (96 ± 38 days and 80 ± 37 days, respectively) than in the room air group (78 ± 28 days and 56 ± 25 days, respectively), with p-values of 0.006 and <0.001. In conclusion, employing HFNC for weaning from NCPAP resulted in longer hospital admissions and respiratory therapy days than the room air method. However, further studies with a larger sample size are warranted for a more comprehensive evaluation, given the limited number of enrolled patients.

Effect of complementary feeding using the baby-led weaning method on development in toddlers: a narrative review

Background: The baby-led weaning (BLW) approach can introduce complementary food to six-month-old infants. This method offers large pieces of solid foods such as vegetables, meat, and fruit. BLW can encourage children's development, especially motor skills such as chewing and speaking. This literature review aimed to determine the definition and technique of the BLW in giving complementary feeding and identify the effect of using the BLW method on toddler development. Methods: The type of research was a literature review based on the review process of research articles that discuss the effect of BLW on toddler development. The search for articles was done from the Google Scholar and PubMed databases. Results: The author found infants were introduced to complementary feeding late from standard weaning. Initially, the baby is offered finger food and allowed to eat alone. BLW significantly affects children's development, especially in helping to form independence, preventing picky eater behaviour, stimulating children's fine motor skills, and improving oral motor skills. Conclusion: The mother offered late complementary feeding with different types of food and techniques from the standard method. The BLW could significantly influence toddler development.