ALGORITHM FOR HUMAN MILK ACCESS
Heather E. Smith, PhD, RN, NNP-BC, CNS
Many neonatal intensive care units (NICUs) have their own policies and procedures to provide infants with mother's breast milk (MBM) or donor breast milk (DBM). When a mother is unable to produce her own milk for her child, 2 options remain to continue feeding the infant, formula or DBM. In the case of a premature delivery, many mothers experience delayed lactogenesis, or a lag in human milk production. Separation of the mother and the infant so that the infant can be cared for in the NICU negatively works against the ability for the mother to produce her own milk. Decisions regarding her own milk production of the mother in conjunction with the infant's nutritional needs must be assessed to determine the best route for DBM. One other consideration is the idea that in some situations the use of DBM might be overused.1 To help with making the decision for the proper feeding option, a decision tree was developed.2 At a glance, the process flow may appear to be busy indicating the complexity and various variables needing consideration, but the process provides a good algorithm for methodically coming to consistent decisions while optimizing MBM instead of DBM. NICUs needing more consistent guidance for how to determine infant milk options, the Decision Tree for Donor Human Milk might be a helpful tool.
REDUCING NEUROLOGICAL RISK FOR ALL PREMATURE INFANTS
A recent study presented at the European Academy of Paediatric Society Meeting looked at 2 methods to decrease the risk of neurological problems commonly occurring in premature infants.3 The researchers enrolled 103 premature infants (born less than 37 weeks' gestation and weighing no more than 1.6 kg) to assess the use of the drug topiramate and a cooling blanket. Topiramate is an anticonvulsant used primarily in older children and adults for epilepsy and migraines that blocks glutamate receptors.4 Typically, cooling blankets are used for infants who have experienced asphyxia during the prenatal, intrapartum, or postnatal period.5 Infants were randomized into 2 groups: (1) 1 dose of topiramate per day for the first 3 days of life plus standard of care and (2) standard of care only. Five infants who received topiramate showed moderate to severe brain injury compared with 13 infants in the standard of care group. After follow-up at 2 years of age, infants who had been in the topiramate group had less cognitive and developmental delays compared with the group who did not receive topiramate. The late preterm infants (32-37 weeks' gestation) within this study received topiramate and were wrapped in a cooling blanket rather than in the conventional warm blanket. Of those 16 late preterm infants who received both therapies, only 1 infant showed developmental delays at 2 years of age. Researchers concluded that further data are needed to understand if these 2 treatments should be applied across the board for all premature infants. However, this study shows promise for 2 potential options that may reduce the risk for premature infants with neurological problems.
TELEHEALTH AND TELEMEDICINE NURSING
In the last decade or so, the idea of telemedicine has picked up as a trend to serve a healthcare need virtually. In 2010, the World Health Organization wrote a lengthy paper to provide a global assessment of the telemedicine need and status.6 With technological advances becoming more common and healthcare needs going beyond the 4 walls of a hospital or clinic, telemedicine is offering the opportunity for healthcare to reach beyond an in-person visit to a virtual consultation via phone or video. Telemedicine bridges the gap between the healthcare provider and a patient's needs when in-person access is not possible or available. Today, nursing is becoming more involved with telemedicine. Nurse practitioner programs are incorporating the use of robots to learn how to assess and care for a patient remotely.7 Much of telemedicine efforts have been aimed at populations and diseases with the least risk and effort, but telemedicine has made its way to the NICU.8 How can telemedicine help your unit? Will remote visibility to an unexpected high-risk birth help to verify that an infant can stay at a level 2 nursery or need to be transferred to a level 3? Nervous parents at 2 am in the morning could utilize telemedicine by downloading an app and videoconferencing with a nurse to make sure their child does not need to go to the hospital. There is a place and a role for nurses to provide telemedicine. How do you see yourself fitting in to remote care?
1. Meier PP, Johnson TJ, Patel AL, Rossman B. Evidence-based methods that promote human milk feeding of preterm infants: an expert review. Clin Perinatol. 2017;44(1):1–22. doi:10.1016/j.clp.2016.11.005.
2. Brandstetter S, Mansen K, DeMarchis A, Nguyen Quyhn N, Engmann C, Israel-Ballard K. A decision tree for donor human milk: an example tool to protect, promote, and support breastfeeding. Front Pediatr. 2018;6:324. doi:10.3389/fped.2018.00324.
4. Janssen Pharmaceuticals. Topamax (topiramate) tablets label. https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020844s041lbl.pdf
. Published October 2012.
5. Long M, Brandon DH. Induced hypothermia for neonates with hypoxic-ischemic encephalopathy. J Obstet Gynecol Neonatal Nurs. 2007;36(3):293–298. doi:10.1111/j.1552-6909.2007.00150.x.
6. World Health Organization. Telemedicine opportunities and developments in member states: report on the second global survey of eHealth. http://www.who.int/goe/publications/goe_telemedicine_2010.pdf
. Published 2010.
8. Fang JL, Collura CA, Johnson RV, et al. Emergency video telemedicine consultation for newborn resuscitations: the Mayo Clinic experience. Mayo Clin Proc. 2016;91(12):1735–1743. doi:10.1016/j.mayocp.2016.08.006.