Optimising early neonatal nutrition using translational research methodology
Denise Page1,2, Melissa Gilroy1,2, Elizabeth Hurrion2,3
1Department of Nutrition and Dietetics, Mater Health, Brisbane, Queensland, Australia.
Insights
Identifying barriers to optimal nutrition for preterm infants is crucial. This study found key challenges in roles, decision-making, evidence application, and monitoring, informing interventions for better infant care.
Area of Science:
- Neonatal critical care
- Nutritional science
- Healthcare quality improvement
Background:
- Preterm infants (<1500 g) often have minimal nutritional reserves, requiring specialized care.
- Inadequate early nutrition in preterm infants can impair growth and neurodevelopment.
- Existing guidelines for preterm infant nutrition show adherence gaps, indicating an evidence-practice divide.
Purpose of the Study:
- To identify barriers to optimal early nutrition delivery in a Neonatal Critical Care Unit.
- To inform an implementation project aimed at improving best practice in preterm infant nutrition.
Main Methods:
- Qualitative content analysis of semistructured interviews with 19 medical and nursing staff.
- Barriers to early infant feeding were categorized using the Theoretical Domains Framework (TDF).
- Interventions were identified using evidence-based strategy selection guides linked to the TDF.
Main Results:
- Four main themes emerged: roles and responsibilities, decision-making, belief-evidence disconnect, and monitoring/awareness.
- Eight barrier domains were identified via TDF, including knowledge, skills, beliefs, and environmental factors.
- Specific barriers related to memory, attention, professional identity, and social influences were noted.
Conclusions:
- A systematic analysis using the TDF and behavior change wheel identified effective interventions.
- The study provides a framework for addressing practice gaps in preterm infant nutrition.
- Ongoing audits will monitor the impact of identified interventions on care delivery.
Aim:
Preterm birth has been described as a 'nutritional emergency', with these infants often born with minimal nutrition reserves. Failure to provide adequate early nutrition jeopardises growth and neurodevelopment. Consensual nutrition guidelines exist for infants who weigh <1500 g; however, audits have identified shortfalls in their adherence, consequently highlighting an evidence-practice gap. This work aimed to identify the barriers to the delivery of early optimal nutrition in a tertiary-level Neonatal Critical Care Unit to inform an implementation project to ensure best practice care.
Methods:
A total of 19 medical and nursing staff participated in semistructured interviews. Transcripts underwent qualitative content analysis to examine barriers to early infant feeding. Barriers were categorised into domains from the Theoretical Domains Framework (TDF), and potential interventions were identified using evidence-based strategy selection guides that articulates with the TDF.
Results:
Four main themes, with associated sub-themes, emerged, including: (i) Roles and responsibilities, (ii) decision making, (iii) disconnect between beliefs and the application of evidence and (iv) monitoring and awareness. Eight barrier 'domains' were identified using TDF-Knowledge; memory, attention and decision processes; skills; professional/social role and identity; beliefs about capabilities; beliefs about consequences; environmental context and resources; and social influences.
Conclusions:
Using a systematic approach to analysing barriers to early nutrition and mapping through the TDF and behaviour change wheel, the most effective interventions to modify practice have been identified. These will be monitored in ongoing audits.
