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Evaluation of Key Factors Impacting Feeding Safety in the Neonatal Intensive Care Unit

A Systematic Review

Matus, Bethany A., MS, RD; Bridges, Kayla M., MS, RD-AP, CNSC, FAND; Logomarsino, John V., PhD, RD, LD/N

Section Editor(s): Harris-Haman, Pamela A. DNP, CRNP, NNP-BC; ; Zukowsky, Ksenia PhD, APRN, NNP-BC;

doi: 10.1097/ANC.0000000000000516
Oral Feeding Strategies: Special Series

Background: Individualized feeding care plans and safe handling of milk (human or formula) are critical in promoting growth, immune function, and neurodevelopment in the preterm infant. Feeding errors and disruptions or limitations to feeding processes in the neonatal intensive care unit (NICU) are associated with negative safety events. Feeding errors include contamination of milk and delivery of incorrect or expired milk and may result in adverse gastrointestinal illnesses.

Purpose: The purpose of this review was to evaluate the effect(s) of centralized milk preparation, use of trained technicians, use of bar code-scanning software, and collaboration between registered dietitians and registered nurses on feeding safety in the NICU.

Methods/Search Strategy: A systematic review of the literature was completed, and 12 articles were selected as relevant to search criteria. Study quality was evaluated using the Downs and Black scoring tool.

Findings/Results: An evaluation of human studies indicated that the use of centralized milk preparation, trained technicians, bar code-scanning software, and possible registered dietitian involvement decreased feeding-associated error in the NICU.

Implications for Practice: A state-of-the-art NICU includes a centralized milk preparation area staffed by trained technicians, care supported by bar code-scanning software, and utilization of a registered dietitian to improve patient safety. These resources will provide nurses more time to focus on nursing-specific neonatal care.

Implications for Research: Further research is needed to evaluate the impact of factors related to feeding safety in the NICU as well as potential financial benefits of these quality improvement opportunities.

Nutrition and Dietetics Program, Department of Human Environmental Studies, Central Michigan University, Mount Pleasant (Ms Matus and Dr Logomarsino); Food and Nutrition Services, Beaumont Hospital—Royal Oak, Royal Oak, Michigan (Mss Matus and Bridges); and Department of Nutritional Sciences, School of Health Professions, Rutgers, The State University of New Jersey, Newark (Ms Bridges).

Correspondence: Bethany A. Matus, MS, RD, Food and Nutrition Services, Beaumont Hospital—Royal Oak, Royal Oak, MI, 48073.(

This study was conducted at Central Michigan University, Mount Pleasant, Michigan.

Coauthors Matus and Logomarsino declare no conflicts of interest. Coauthor Bridges has received financial compensation as a speaker for Mead Johnson Nutrition and Abbott Nutrition. Coauthor Bridges is recipient of a Children's Miracle Network grant and Mead Johnson Nutrition length board grant. However, the content of this paper has no ties, nor has been influenced by coauthor Bridges' affiliations. She receives no compensation for this work.

© 2019 by The National Association of Neonatal Nurses