Necrotizing enterocolitis is a gastrointestinal condition, where part of the bowel dies. The medical problem is common with newborns that are sick or born prematurely. The symptoms associated with necrotizing enterocolitis are bloating, poor feeding habits, vomiting of bile, bloody stool, or decreased activity. The exact cause of the health problem is not clear. However, the risk factors include premature rupture of membranes, birth asphyxia, congenital heart problem, and exchange transfusion. Necrotizing enterocolitis starts with a reduced blood flow combined with an infection in the intestines. Medical imaging is used to confirm the diagnosis. Medical officers recommend the use of probiotics and breast milk as a way of preventing the illness. Treatment is done using several methods such as intravenous fluids, intravenous antibiotics, bowel rest, and orogastric tube. When the patient has free air in the abdomen, then surgery is recommended. Various studies have been carried out to determine how necrotizing enterocolitis develops, the preventative measures recommended, and their success.
Research Article
Feinberg, Miller, Engers, Bigelow, Lewis, Brinker, and Britton (2017, p.1) conducted a study to show that necrotizing enterocolitis can be minimized with administering human milk on early stages and promoting breastfeeding. The article indicates that after delivering premature infants, it is hard for mothers to initiate and maintain lactating. Enteral nutrition is needed in the early days for gastrointestinal growth and development, and when premature children do not get enough breast milk, it increases the chances of necrotizing enterocolitis. When a mother cannot be able to provide breast milk, Bovine milk preterm formula is recommended as it offers the supplement maternal milk supplies, though the formula has high risks of necrotizing enterocolitis developing. Pediatrics at times endorse donor human milk, which is got from lactating mothers and contains all the nutrients an infant requires for intestinal growth.
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A premature child is kept in the newborn intensive care unit (NICU), where their growth is monitored. There are various interventions implemented in these units to ensure that babies get the milk they require for development purposes. The mothers are encouraged to provide breast milk to their children. There are additional interventions such as preparing milk for the infants who do not get breast milk. In milk preparation, probiotics are introduced at an early age, and hygiene is observed throughout the process. The article provides a study carried out at NICU in St. Joseph Hospital in Denver and how the unit has been handling the feeding of premature infants. The unit healthcare providers had a way in which milk was provided to the infants though the mothers were encouraged to breastfeed. For the children who received milk prepared in the hospital, it was done by bedside nurses following a non-uniform manner though sterility was maintained (Pillitteri & Silbert-Flagg, 2018, p 1276). Process change was recommended, and it would follow four objects to help improve the safety and quality of the milk the premature babies were receiving. The first objective was encouraging and offering support to mothers, so that they could breastfeed. The second was ensuring that donor human milk was available in the hospital instead of the formula milk. The third objective was ensuring that milk prepared by the nurses was supplemented with probiotics. Lastly, the introduction of milk standardization process for preparation, storage, and fortification of milk was done.
Integration of the Articles
The articles explore the necrotizing enterocolitis health problem, treatment, and prevention. Gephart, Wetzel, and Krisman (2014, p.4) introduce eNEC and GutCheck tools, which have been used in analyzing the risks of necrotizing enterocolitis. eNEC tool was used to establish the interventions that could help reduce feeding intolerance and intestinal infections, and factors responsible for feeding intolerance and development of necrotizing enterocolitis. The tool found out how essential exclusive human milk diet is for the infants, starting early trophic feeding, the advance of feeding should be careful and consistence, managing feeding intolerance and duty of nurses to communicate about the possibility of necrotizing enterocolitis developing. GutCheck tool was used in research to get evidence and to carry out analysis on how necrotizing enterocolitis develops and the risk factors. The risk factors as shown by the tool were: necrotizing enterocolitis unit rate, multiple infections, gestation age, race, with Black and Hispanic being more susceptible to the problem, use of inotropic medications and metabolic acidosis.
Rodriguez and Caplan (2015, p.81) explore how oropharyngeal administration of breast milk can be used in preventing necrotizing enterocolitis. The process is applicable in infants born with extremely low weight. Infants with extremely low-birth-weight cannot breastfeed on their own and have to be in the nursery units for long. Mothers are encouraged to express their milk, and then administration of the milk is done by placing drops onto the oral mucosa of the infant. These infants with extremely low weight are at the highest risk of their bowel not developing. Human studies have been carried out, showing that breast milk reduces bacterium, which causes abdominal infections and feeding intolerance. The premature children should receive about 25 mL/kg/d for the first twenty-eight days of life as it helps add the weight of the child and prevent the infections. “When providing this intervention, the use of fresh own mother’s milk provides optimal immune protection” ( Rodriguez and Caplan (2015, p.88) .
Since premature children have to be held in the newborn intensive care unit, the involved pediatrics and nurses have to ensure that high levels of hygiene are maintained. The premature children are vulnerable and ingesting low-quality milk from the mother, or formula milk increases the chances of necrotizing enterocolitis. There are various interventions that hospitals with newborn intensive care units should implement to ensure quality maintenance (Feinberg, Miller, Engers, Bigelow, Lewis, Brinker, & Britton, 2017, p.2). Once the risk factors are determined, such as the gestation period, the determination of the amount of milk the child requires and the administration approach such as oropharyngeal are used.
Nurses should have knowledge about necrotizing enterocolitis condition to help them advocate for maternal and child healthcare. The results of the study will help the nurses to determine safety measures they need when preparing formula milk for premature children. Such include following the standardized process of preparing, storing, and fortifying milk. In that way, the quality of the milk will not be compromised and will not expose the child to any infections. Nurses will use information such as risk factors of necrotizing enterocolitis to educate lactating mothers on the importance of healthy eating and regular check-up when pregnant to avoid giving birth to premature babies. Most women are not aware that their eating or health behaviors risk premature children, but through guidance by nurses, pregnant women can reduce the cases of low-birth-weight children. The information will help nurses to create educative programs. The women will be educated about exclusive breastfeeding for the first six months after birth (Pillitteri & Silbert-Flagg, 2018, p.1277). The working mothers will learn about how they can express breast milk and safe storage methods to ensure that their children get the required supplements.
The research provides knowledge nurses can use, especially in the newborn intensive care units to address some challenges they face. The challenge of feeding infants with extremely low weight can be addressed through the use of oropharyngeal administration. Nurses will learn how to feed premature babies through the oral mucosa and ensuring that such children do not shock. The studies provide various interventions the nurses can use when dealing with nursing mothers and premature infants. Formula milk preparation intervention, for instance, which follows a standardization process to ensure that all supplements needed are included and quality improvement, is achieved. “ At the unit level of policy change, revisiting a standardized approach to encouraging the feeding of human milk and using a standardized feeding protocol is warranted” ( Gephart, Wetzel, & Krisman, 2014, p.8). The information will be used in general nursing care to guide pregnant women from the initial state of pregnancy, birth, and lactating period. Childcare, mainly premature children, will be supported by information from the research.
Summary
Premature infants are exposed to lots of health problems necrotizing enterocolitis being one of them. The health problem is progressive, but it can be prevented and treated when determined immediately after birth. Women are encouraged to breastfeed children shortly after birth. Breast milk contains lots of advantages and supplements required for the child to grow. Therefore, necrotizing enterocolitis can be prevented by ensuring that premature children are getting enough breast milk. However, in case of the absence of milk from the mother, donor human milk is recommended. In the newborn intensive care units, the nurses are responsible for preparing formula milk for premature children, though the milk leads to feeding intolerant, thus less recommended. Quality improvement is recommended when the milk is being prepared to ensure that it is safe and contains the required supplements. Intravenous antibiotics and probiotics are used in treating the health problem.
References
Feinberg, M., Miller, L., Engers, B., Bigelow, K., Lewis, A., Brinker, S., ... & Britton, J. R. (2017). Reduced necrotizing enterocolitis after an initiative to promote breastfeeding and early human milk administration. Pediatric quality & safety , 2 (2), 5.
Gephart, S. M., Wetzel, C., & Krisman, B. (2014). Prevention and early recognition of necrotizing enterocolitis, a tale of two tools: eNEC and GutCheckNEC. Advances in neonatal care: official journal of the National Association of Neonatal Nurses , 14 (3), 18.
Pillitteri, A. & Silbert-Flagg, J. (2018). Maternal & child health nursing: care of the childbearing & childrearing family ( 8 th ed) . Philadelphia: Wolters Kluwer
Rodriguez, N. A., & Caplan, M. S. (2015). Oropharyngeal Administration of Mother's Milk to Prevent Necrotizing Enterocolitis in Extremely Low-Birth-Weight Infants. The Journal of perinatal & neonatal nursing , 29 (1), 81-90.
