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Management of Insomnia01:19

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The sleep cycle, an integral part of human health, consists of several stages with distinct characteristics and functions. It begins with a transition from wakefulness to sleep, known as the light sleep phase, followed by the restorative deep sleep phase, essential for physical recovery and growth. The cycle concludes with the Rapid Eye Movement (REM) phase, characterized by high brain activity and vivid dreaming. Insomnia, a prevalent sleep disorder, involves difficulty falling asleep, staying...
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Implementing a three-hourly feeding schedule in stable preterm infants to decrease maternal fatigue.

Abhishek S Aradhya1, Inderjot Kaur1, Rima Gupta1

  • 1Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

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Summary

Implementing a three-hourly feeding schedule for stable preterm infants significantly reduced maternal fatigue. This change, achieved through a quality improvement approach, proved safe and beneficial, offering advantages for both mothers and nursing staff.

Keywords:
control charts/run chartsfatiguepaediatricsquality improvement

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Area of Science:

  • Neonatal care
  • Pediatric nutrition
  • Quality improvement in healthcare

Background:

  • Traditional two-hourly feeding schedules for preterm neonates are common but may increase maternal fatigue.
  • A three-hourly feeding schedule is recognized as safe and potentially less burdensome for mothers and nursing staff.
  • Resistance to change, rooted in tradition and apprehension, has limited the adoption of three-hourly feeding schedules.

Purpose of the Study:

  • To implement and evaluate a three-hourly feeding schedule in stable preterm infants (>32 weeks postmenstrual age).
  • To assess the impact of the feeding schedule change on maternal fatigue and infant safety.
  • To explore the qualitative experiences of nursing staff and the impact on feeding volumes.

Main Methods:

  • A quality improvement approach using Plan-Do-Study-Act (PDSA) cycles was employed over 21 weeks.
  • Eligible infants were preterm neonates >32 weeks postmenstrual age on full enteral feeds without respiratory support.
  • Maternal fatigue scores, safety (hypoglycemia, feed intolerance), and feeding volumes were primary outcome measures.

Main Results:

  • A significant decrease in median maternal fatigue score was observed (13 to 3; p=0.01).
  • The three-hourly schedule demonstrated safety with minimal instances of feed intolerance and mild hypoglycemia.
  • Nursing staff reported that mothers had more time for Kangaroo Mother Care; feeding volumes remained comparable.

Conclusions:

  • A three-hourly feeding schedule can be successfully implemented in stable preterm infants using a quality improvement strategy.
  • The transition to a three-hourly schedule is safe and offers significant benefits, including reduced maternal fatigue.
  • This approach facilitates wider acceptance of evidence-based feeding practices in neonatal units.