Nursing Research Problem Essay
Infections are a common cause of both morbidity and mortality in premature babies ; illustrations of infections include necrotizing enterocolitis ( NEC ) and sepsis ( infection of the blood stream ) . Infections in premature babies result in drawn-out airing. drawn-out hospitalization. and higher medical costs. and can do neurodevelopment damage ( Manzoni et al. . 2009 ) . The usage of high-potency antibiotics can take to immune strains of bacteriums and potentially damage the infant’s liver and/or kidney map. Within the past decennary. research has turned from happening interventions to happening methods to cut down infections.
Breastfeeding and human milk has been good supported through research to supply unsusceptibility and positive results for preterm and full-term babies. Breastfeeding and human milk provides nutritionary. GI. immunological. developmental. and psychological benefits to preterm babies and plays an of import function on their long-run wellness and development ( Callen & A ; Pinelli. 2005 ) . The constituents of breastmilk that support unsusceptibility include lactoferrin. muramidases. interferon. and sIgA antibody ( Callen & A ; Pinelli. 2005 ) .
Specifically. lactoferrin ( LF ) is an iron-binding glycoprotein found non merely in breastmilk. but besides in spit. cryings. and other bodily secernments ; LF has biological maps which include immunomodulatory. antimicrobic. and antioxidant effects. and inhibits growing of infective bacteriums. Fungi. and viruses ( Yen et al. . 2009 ) . The described maps of LF support the protective function in unsusceptibility. The intent of this probe is to find the effects of unwritten lactoferrin supplementation on cut downing infections in preterm babies.
Nature of Problem and Importance to Nursing Practice
A nosocomial infection is described as an infection that is acquired after 48 hours of hospital admittance ( Rodriguez et al. . 2010 ) . In newborns. a late-onset infection is defined as an infection obtained after the perinatal period ( Manzoni et al. . 2009 ) . Nosocomial infections include infections of the GI piece of land ( necrotizing enterocolitis. NEC ) . blood watercourse ( sepsis ) . and lung ( pneumonia ) . The effects of an infection in a preterm baby can take to “poor growing. inauspicious long-run neurological sequelae. increased length of infirmary stay. and a significant cost to households. infirmaries. and society” ( Rodriguez et al. . 2010. p. 207 ) . The hazard of nosocomial infections increases with the diminishing birth weight and gestational age. and approximately 21 % of really low birth-weight ( VLBW ) babies will meet a late-onset infection ( Stoll et al. . 2002 ) .
The most common GI infection in premature babies is NEC. impacting 2. 6 % to 28 % of VLBW babies ( Lin et al. . 2005 ) . NEC is widely considered as a multifactorial disease. with no specific pathogenesis ; three major factors have been proposed: the presence of a infective being. the challenge of enteric eating. and altered enteral mucous membrane unity ( Lin et al. . 2005 ) . NEC is “characterized by necrotizing hurt to the bowel that requires antibiotic intervention and. in terrible instances. surgical intervention” ( Brooks et al. . 2006. p. 347 ) . Decrease of infections in preterm babies is of high precedence and active research is being performed to happen safe preventive steps. better patient results. and decrease infirmary length of stay.
Lactoferrin is an iron-binding protein found in mammalian milk and is of import in unconditioned immune host defences ( Manzoni et al. . 2009 ) . Partial digestion of LF in the tummy produces peptides called “lactoferricin” that contain more powerful antimicrobic activity ( Yen et al. . 2009 ) . Human foremilk contains more LF than breastmilk. spit. cryings. or other mucosa liners in the organic structure. Surveies have been performed to find bovine or porcine LF consequence on bar of infection in mice and rat whelps ; decisions showed a decrease in “the frequence of bacterial infections in the GI piece of land while advancing the growing of Lactobacillus and Bifidobacteria species. which are by and large believed to be good to the host” ( Yen et al. . 2009. p. 591 ) .
Bovine. porcine. and human LF molecules are similar. and bovine and porcine LF has been reported to demo higher antimicrobic activity compared to human LF ( King et al. . 2007 ) . In 2001. the US Food and Drug Administration declared bovid lactoferrin by and large recognized as safe ( CFSAN. 2001 ) . Bovine or human LF can be given as a expression additive. breastmilk linear. or given to patients by swobing of the oral cavity. either actively eating or with nil per os ( NPO ) statuses. Research surveies have now been performed on the effects of bovine or porcine LF on bar of infections in VLBW and preterm babies. and LF shows to be a promising agent of bar.
Evidence-based Practice Question
Evidence-based pattern ( EBP ) is defined as “a pattern that involves clinical decision-making based on the best available grounds. with an accent on grounds from disciplined research” ( Polit & A ; Beck. 2008. p. 753 ) . Nursing patterns are altering in the NICU to include mopping of the babies oral cavity with foremilk every six hours to help in bar of infection and better eating tolerance. The undermentioned inquiry is developed to find the results of infection bar by LF in preterm babies: Does the supplementation of LF diminish the happening of nosocomial infections in preterm babies?
The surveies reviewed did non advert a conceptual or theoretical model refering to the relationship of the topics investigated. A conceptual theoretical account of nursing. Levine’s Conservation Model. can be utilized in using the methods investigated to supply attention and bar of infection in preterm babies. Levine’s Conservation Model is focused in advancing version and keeping integrity utilizing the rules of preservation ( “Current Nursing. ” 2010 ) . The theoretical account guides the nurse to concentrate on the influences and responses at the organismal degree and carry through the ends of the theoretical account through the preservation of energy. construction. and personal. and societal unity ( “Current Nursing. ” 2010 ) .
Conservation of energy in preterm babies is necessary for appropriate growing. and is achieved by equal remainder and nutrition ; contending an infection in preterm babies consequences in NPO position and crossness. therefore using energy. The preservation of structural unity means to forestall physical dislocation and promote healing. and is the effect of an effectual immune system ( “Current Nursing. ” 2010 ) . The technique of LF supplementation and its possible preventive result on infection helps the patient preserve energy and structural unity.
Variables and Findingss
Manzoni et Al. ( 2009 ) performed a prospective. multicenter. double-blind. placebo-controlled. randomized test analyzing whether unwritten supplementation with bovid LF entirely or in combination with Lactobacillus rhamnosus GG ( LGG ) reduces late-onset sepsis in 472 VLBW babies. The independent variable of this survey is the supplementation of bovine LF or LGG and the dependant variable is the happening of infections in VLBW babies. The survey indiscriminately allocated babies into three groups ; groups consisted of a control group ( n = 168. babies supplemented with a placebo ) and an experimental group ( n = 153. babies given bovid LF entirely and n = 151. babies given bovid LF with LGG ) . The chief result measured the first episode of late-onset sepsis ( sepsis happening after 72 hours of birth ) ; all trials were two-tailed. and P & lt ; . 05 was considered statistically important ( Manzoni et al. . 2009 ) .
When stratifying for birth weight. Manzoni et Al. ( 2009 ) noted a important lessening in late-onset sepsis in highly low birth-weight ( ELBW. birth-weight & lt ; 1000g ) babies ( P = . 002 for bovine LF v. control and P = . 002 for bovine LF plus LGG v. control ) whereas it was non important in babies weighing 1001 to 1500 g ( P = . 34 for bovine LF v. control and P = . 07 in bovine LF plus LGG v. control ) . Overall. the consequences showed a important lessening in the happening of infection in VLBW babies in the experimental groups versus the control group ( P = . 002 for bovine LF v. control and P & lt ; . 001for bovine LF plus LGG v. control ) ( Manzoni et al. . 2010 ) .
A double-blind. placebo-controlled pilot survey examined the impact of bovine LF supplementation to bottle-fed babies ( King et al. . 2006 ) . The participants included 52 babies between the age of 0-4 hebdomads of age. ?34 hebdomads of gestational age. and ?2000 g. and who were purely bottle-fed. The babies were randomized in a double-blind manner ; the control group received a little dosage of bovine LF and the experimental group received a higher dosage of bovine LF ( King et al. . 2006 ) . The independent variable is the supplementation of the higher dosage of bovine LF and the dependant variable is the impacts observed in the first twelvemonth of life.
The results measured included diarrhoea. upper respiratory infection ( URI ) . acute otitis media ( AOM ) . and lower respiratory tract infection ( LRTI ) . The babies were examined six times throughout the twelvemonth on the measured results. The consequences showed a important lessening in the happening of LRTIs in the experimental group than in the control group ( P & lt ; 0. 05 ) ( King et al. . 2006 ) . Even though this survey did non include preterm babies & lt ; 34 hebdomads. the effects of bovine LF are still evident in the protection against infection.
Yen et Al. ( 2009 ) performed a survey to analyze the effects of porcine LF as a selective decontamination of the digestive piece of land ( SDD ) regimen in neonatal mice. Transgenic mice were generated to show porcine LF ; the neonatal mice fed from the transgenic mice and were so challenged with pathogens to measure in vivo antimicrobic activity of porcine LF ( Yen et al. . 2009 ) . The control group contained mice that were fed normal milk and the experimental group contained mice that were fed the porcine LF ( Yen et al. . 2009 ) . The independent variable is the transgenic mice with porcine LF supplementation and the dependant variable is the antimicrobic activity observed.
The result steps included the growing rate of the mice whelp. the province of the enteric piece of land mucous membrane. and the circulating cytokines ( Yen et al. . 2009 ) . Yen et Al. ( 2009 ) concluded that the experimental group of neonatal mice showed a important decrease of badness of unwellness ( P & lt ; . 01 ) . a important suppression of microbic endurance in the enteric piece of land ( P & lt ; . 01 ) . and a important lessening in the figure of bacteriums cultured ( P & lt ; . 05 ) than in the control group. The writers proposed that porcine LF is an ideal natural SDD regimen for the bar of nosocomial infections in critically sick patients ( Yen et al. . 2009 ) .
Research has proven the high incidence of a nosocomial infection and its inauspicious results in a preterm baby. The attempts of research have changed to happening a method to cut down or forestall nosocomial infections in preterm babies. Human foremilk is best in providing the baby with LF to contend infection. but other methods of providing LF are being studied. Research has late proven that the supplementation of bovine LF has decreased the happening of infections in VLBW and preterm babies.
Future research should include a larger. neonatal population specifically aiming VLBW and/or ELBW babies and the consequence of LF supplementation on bar of NEC. Further surveies are needed to find the dosing. continuance. and type of LF ( bovine. porcine. or human ) that will be most effectual in the bar of infection in preterm babies without doing inauspicious effects or intolerance ( Venkatesh & A ; Abrams. 2010 ) .
Brooks. H. J. L. . McConnell. M. A. . Corbett. J. . Buchan. G. S. . Fitzpatrick. C. E. . & A ; Broadbent. R. S. ( 2006 ) . Potential contraceptive value of bovine foremilk in necrotizing enterocolitis in newborns: an in vitro survey on bacterial fond regard. antibody degrees. and cytokine production. FEMS Immunology and Medical Microbiology. 48. 347-354. doi:10. 1111/j. 1574-695X. 2006. 00151. ten
Callen. J. & A ; Pinelli. J. ( 2005 ) . A reappraisal of the literature analyzing the benefits and challenges. incidence and continuance. and barriers to suckling in preterm babies. Progresss in Neonatal Care. 5 ( 2 ) . 72-88. doi:10. 1016/j. adnc. 2004. 12. 003
Current Nursing. ( 2010 ) . Levine’s four preservation rules. Retrieved on September 23. 2010 from hypertext transfer protocol: //currentnursing. com/nursing_theory/Levine_four_conservation_princples. hypertext markup language
King. J. C. . Cummings. G. E. . Guo. N. . Trivedi. L. Readmond. B. X. . Keane. V. . … de Waard. R. ( 2007 ) . A double-blind. placebo-controlled. pilot survey of bovine lactoferrin supplementation in bottle-fed babies. Journal of Pediatric Gastroenterology and Nutrition. 44 ( 2 ) . 245-251.
Lin. H. . Su. B. . Chen. A. . Lin. T. . Tsai. C. . Yeh. T. . & A ; Oh. W. ( 2005 ) . Oral probiotics cut down the incidence and badness of necrotizing enterocolitis in really low birth weight babies. Pediatrics. 115 ( 1 ) . 1-4. doi:10. 1542/peds. 2004-1463
Manzoni. P. . Rinaldi. M. . Cattani. S. . Pugni. L. . Romeo. M. G. . Messner. H. . … Farina. D. ( 2009 ) . Bovine lactoferrin supplementation for bar of late-onset sepsis in really low birth-weight newborns. The Journal of the American Medical Association. 302 ( 13 ) . 1421-1428. Retrieved on September 4. 2010 from hypertext transfer protocol: //jama. ama-assn. org/cgi/content/full/302/13/1421
Polit. D. E. . & A ; Beck. C. T. ( 2008 ) . Nursing research generating and measuring grounds for nursing pattern ( 8th ed. ) . Philadelphia: Lippincott Williams & A ; Wilkins.
Rodriguez. N. A. . Meier. P. P. . Groer. M. W. . Zeller. J. M. . Engstrom. J. L. . & A ; Fogg. L. ( 2010 ) . A pilot survey to find the safety and feasibleness of oropharyngeal disposal of ain mother’s foremilk to highly low-birth-weight babies. Progresss in Neonatal Care. 10 ( 4 ) . 206-212.
Stoll. B. J. . Hansen. N. . Fanaroff. A. A. . Wright. L. L. . Carlo. W. A. . Ehrenkranz. R. A. . … Poole. W. K. ( 2002 ) . Late-onset sepsis in really low birth weight newborns: the experience of the NICHD neonatal research web. Pediatrics. 110 ( 2 ) . 285-291. Retrieved September 9. 2010 from hypertext transfer protocol: //pediatrics. aappublications. org/cgi/content/full/110/2/285
US Food and Drug Administration. CFSAN/Office of Food Additive Safety. ( 2001 ) . Agency response missive: GRAS notice ( No. GRN 000077 ) . Retrieved on September 23. 2010 from hypertext transfer protocol: //www. Food and Drug Administration. gov/Food/FoodIngredientsPackaging/GenerallyRecognizedAsSafeGRAs/GRASListings/ucm154188. htm
Venkatesh. M. P. . & A ; Abrams. S. A. ( 2010 ) . Oral lactoferrin for the bar of sepsis and necrotizing enterocolitis in preterm babies. Cochrane
Database of Systematic Reviews. Art. No. : CD007137 ( 5 ) . doi:10. 1002/14651858. CD007137. pub2
Hankering. C. . Lin. C. . Chong. K. . Tsai. T. . Shen. C. . Lin. M. . … Chen. C. ( 2009 ) . Lactoferrin as a natural regimen for selective decontamination of the digestive piece of land: recombinant porcine lactoferrin expressed in the milk of transgenic mice protects neonates from infective challenge in the GI piece of land. The Journal of Infectious Diseases. 199. 590-598. doi:10. 1086/596212