Neonatal Network
July/August 2005
Vol. 24, No. 4

ABSTRACTS

Early Enteral Feeding for the Very Low Birth Weight Infant:
The Development and Impact of a Research-Based Guideline
Joan Renaud Smith, RNC, MSN, NNP

Providing optimal nutrition for the very low birth weight (VLBW) infant is critical during the neonatal period. Evidence-based practice guidelines are essential in managing these fragile infants. Putting scientific research into daily clinical practice may be arduous at times, however. A multidisciplinary team of health care providers successfully established a practical feeding guideline for a 52-bed, teaching-affiliated, Level III neonatal intensive care unit in St. Louis. This guideline identifies human milk as the recommended source of nutrition for the VLBW infant, a suggestion that has significantly affected lactation services in the unit. This article describes the process of developing, implementing, and evaluating a feeding guideline based on current research and describes the impact on lactation rates of having such a guideline in place within the unit.

Implementation and Evaluation of a Home Gavage Program for Preterm Infants
Lynn D. Sturm, RN, BSN

Purpose: To describe the implementation and evaluation of a home gavage program for preterm infants.
Design: Retrospective chart reviews were used to assess physiologic progress of infants, and retrospective written questionnaires were administered by mail to families participating in home gavage to assess their experience and solicit advice.
Sample: One hundred forty-three infants born at <37 weeks gestational age with a primary diagnosis of prematurity who met criteria for home gavage, of whom 52 were given home gavage and 91 attained full oral feedings in intensive care before discharge.
Main Outcome Variables: The safety of home gavage was evaluated by weight change and hospital readmission. Parental satisfaction was assessed by the mailed survey. Cost savings also were evaluated.
Results: Infants gained an average of 31 gm/day while receiving home gavage. No hospital readmissions were related to home gavage. Parents expressed satisfaction with the home gavage program. There was an average savings of $12,428 per infant related to shorter hospital stays.

Identifying, Understanding, and Working with Grieving Parents in the NICU,
Part II: Strategies
Kristi A. Dyer, MD, MS

Supporting parents in coping with stress and loss improves the health and development of their child. This article looks at the need for monitoring the health and well-being of parents of infants in the NICU, including practical matters for the health care professionals providing follow-up care. It is important to increase public and professional awareness of the grief response. Practical suggestions for coping with the NICU experience, many of them from professionals who are also parents of NICU patients, are offered for grieving parents and family members.

Haddad Syndrome: A Case Study
Lisa Shuman, MSN, APRN, BC-FNP
Diane Youmans, RNC, MSN

Hirschsprung's disease (HD), also known as congenital aganglionic megacolon, is a relatively common cause of congenital obstruction of the colon. Congenital central hypoventilation syndrome (CCHS), also known as Ondine's curse, is a rare condition involving failed autonomic respiration in the absence of cardiorespiratory disease resulting in inadequate alveolar ventilation. Both conditions typically present in the newborn period and belong to a group of disorders referred to as neurocristopathies.

HD and CCHS most commonly exist as discrete entities, but the coexistence of them is now called Haddad syndrome. Although few documented cases of Haddad syndrome exists in the literature. the association of CCHS and HD suggests a common etiology involving neural crest development.