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Barriers to Knowledge Translation Regarding the Use of Probiotics as a Risk-Reduction Strategy for Necrotizing
1La Salle University, Philadelphia, Pennsylvania; Rutgers School of Nursing, Newark, New Jersey; and Rutgers Robert Wood Johnson Medical School, Child Health Institute of New Jersey, New Brunswick.
Insights
Despite evidence supporting probiotics for preventing necrotizing enterocolitis (NEC) in preterm infants, many providers hesitate. Lack of familiarity with probiotic literature may hinder knowledge translation into clinical practice.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Evidence-Based Practice
Background:
- Enteral probiotics are increasingly recognized as a key strategy for reducing necrotizing enterocolitis (NEC) risk in very low birth-weight and extremely low birth-weight preterm infants.
- A significant gap exists between the established evidence for probiotics and their implementation in clinical practice.
Purpose of the Study:
- To investigate the disparity between scientific evidence and clinical application of probiotics and other NEC prevention methods in New Jersey.
- To understand healthcare providers' knowledge, perceptions, and current practices regarding NEC prevention strategies.
Main Methods:
- An exploratory descriptive research design was employed.
- A multimodal, interprofessional survey was developed and administered to intensive care nursery providers.
- The survey aimed to gather data on provider knowledge, views, and current practices related to NEC prevention.
Main Results:
- Half of the surveyed providers familiar with probiotic literature rated the evidence quality as high.
- Respondents likely to recommend probiotics did not prescribe them, citing exclusive breast milk feedings as a primary reason.
- Other factors influencing probiotic use included oral colostrum care, feeding protocols, and withholding feeds during transfusions.
Conclusions:
- Some healthcare providers, particularly nurses, may lack familiarity with probiotic literature, contributing to a gap in knowledge translation.
- Future research should focus on improving knowledge dissemination, identifying barriers/facilitators to practice change, and clarifying the role of probiotics alongside other NEC risk-reduction strategies.
Background:
Increasingly, evidence supports enteral probiotics are an important risk-reduction strategy for necrotizing enterocolitis (NEC) among very low birth-weight and extremely low birth-weight preterm infants. Yet, the majority of providers remain reluctant to implement practice changes.
Purpose:
The aim of this study was to better understand the discrepancy between the available evidence and clinical practice regarding the use of probiotics and other NEC prevention strategies in New Jersey.
Methods:
Using an exploratory descriptive design, a multimodal interprofessional survey was developed and executed to elicit intensive care nursery provider knowledge, views, and current practice.
Results:
Although the sample size was small (N = 29), approximately one-half of respondents familiar with the literature rated the quality of the evidence regarding probiotics as "above average" to "excellent." These respondents were "very likely" to "extremely likely" to recommend probiotics as an NEC prevention strategy; however, none actually prescribed this intervention. The most important reason respondents did not prescribe probiotics was the focus on providing exclusive maternal and donor breast milk feedings. Other confounding factors included provision of oral colostrum care, standardized feeding protocols, and withholding feedings during blood transfusion.
Implications For Practice:
Study results suggested that some providers (primarily nurses) were not familiar with probiotic literature, which may contribute to deficits in knowledge translation to practice.
Implications For Research:
Areas for future study include identifying improved mechanisms for knowledge dissemination, recognizing and addressing barriers and facilitators to knowledge translation, and understanding how probiotics fit and/or contrast with other NEC risk-reduction strategies in the research and clinical settings.
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