Attitudes of NICU professionals regarding feeding blood-tinged colostrum or milk.

OBJECTIVE: Mothers of neonatal intensive care unit (NICU) patients sometimes bring expressed milk that is blood tinged to the NICU. In certain instances, the blood contamination appears minimal, whereas in others, the milk is quite dark pink. We have observed inconsistencies in practice regarding whether or not to feed blood-tinged colostrum or milk to NICU patients. We know of no evidence that establishes best practice in this area, and thus we sought to determine attitudes of NICU professionals on which to base a potentially best practice. STUDY DESIGN: We conducted a web-based anonymous survey of attitudes of NICU professionals at Intermountain Healthcare regarding feeding blood-tinged expressed milk to NICU patients. These professionals included neonatologists, neonatal nurse practitioners, NICU nurses, NICU dieticians and lactation consultants. RESULT: Survey results were returned from 64% (426 of 667) of those to whom it was sent. A total of 75% of respondents reported that their practice was NOT to feed the blood-tinged milk illustrated in the figure as sample 2, and nearly all respondents (98%) reported that they would NOT feed the milk illustrated as sample 3. The majority of the neonatologists (56%) and the lactation consultants (58%) recommended feeding moderately bloody milk (sample 2), whereas only 22% of the neonatal nurse practitioners (NNPs), NICU nurses and NICU dieticians recommended feeding such samples (<0.001). The most frequently selected reason for NOT feeding blood-tinged milk was that it would likely cause gastrointestinal upset and feeding intolerance (selected by 77%). The majority (87%) overestimated the amount of blood contaminating a milk sample (sample 3). CONCLUSION: As colostrum and human milk feedings can be of value to NICU patients, evidence should be assembled to document whether feeding blood-tinged samples indeed have the problems listed by the survey respondents. Such evidence is needed to enable informed decisions involving the benefits vs risks of feeding blood-tinged expressed milk to NICU patients.

Glucose metabolism in the neonate: the short and sweet of it.

Many patients the neonatal nurse cares for daily have the potential for abnormal blood glucose levels. Recognizing infants at risk can facilitate timely and appropriate interventions. The quality of the information received from tests and observation depends on decisions made by the nurse. Therefore, knowledge of glucose kinetics and monitoring techniques is essential.

Neonatal glucose determinations obtained from an umbilical artery catheter: evaluation for accuracy using an in vitro model.

Accuracy of glucose values is crucial in the management of the critically ill neonate. Sampling for these values may be obtained from an umbilical artery catheter (UAC), but dextrose solutions infused through these catheters may contaminate samples obtained for glucose determination. An in vitro study was conducted to evaluate the effect of blood withdrawal amount and normal saline irrigation on the accuracy of glucose measurements obtained from a UAC. Methods included randomization of blood withdrawal amounts and irrigation with normal saline solution prior to obtaining the blood for glucose measurement. Two hundred and eighty glucose samples were obtained. Results revealed a significant difference between measured and baseline glucose values for all withdrawal amounts and varying flush volumes. This inability to approximate the baseline glucose values could mean that a UAC sample may not reflect the neonate's actual glucose value.

Development of a program for neonatal intensive care units managed by neonatal nurse practitioners.

Because of reduced medical coverage and changing educational experiences of the pediatric residents, the Department of Nursing Practice at the University of Utah Hospital in collaboration with the Department of Patient Care Services at Primary Children's Medical Center seized the opportunity to develop a nurse-managed patient care service within two tertiary-level nurseries in the State of Utah. Collaboration with nursing administrators and practitioners in both sites yielded joint plans for a successful NNP program. Initial efforts were to fund jointly and support the College of Nursing to develop an educational program, whereas the clinical program was developed before the reduction in medical coverage. Many issues were addressed because of the multidisciplinary and multi-institutional nature of the program. Work is ongoing in the recruitment of students and NNPs, development and review of clinical practice, and endorsement and privileging considerations.