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Oral Care in Critically Ill Infants and the Potential Effect on Infant Health: An Integrative Review
Leslie A Parker1, Jennifer Pruitt2, Angela Monk3
1Leslie A. Parker is a professor in the University of Florida College of Nursing and a nurse practitioner in the neonatal intensive care unit, UF Health, Gainesville, Florida.
Insights
Neonatal intensive care unit oral care may reduce ventilator-associated pneumonia risk in critically ill infants. More research is needed to establish evidence-based guidelines for infant oral hygiene practices.
Area of Science:
- Neonatal intensive care
- Pediatric critical care
- Oral health in vulnerable populations
Background:
- Critically ill infants in the neonatal intensive care unit (NICU) face risks of ventilator-associated pneumonia (VAP) and abnormal oral colonization.
- Established oral care guidelines for critically ill adults improve outcomes, but similar guidelines for neonates are lacking.
- This gap may increase VAP risk and other complications in critically ill infants.
Approach:
- A systematic literature search was conducted using MEDLINE (PubMed) and CINAHL.
- Included studies were observational and randomized controlled trials.
- The search focused on the effects of oral care on oral colonization, VAP, and health outcomes in NICU infants.
Key Points:
- Limited evidence suggests neonatal oral care may promote a healthier oral and endotracheal tube aspirate microbiome.
- Oral care might reduce the incidence of VAP and shorten the length of stay in the NICU.
- Significant limitations exist due to the scarcity of research, varied procedures, and inconsistent definitions.
Conclusions:
- Oral care is potentially crucial for critically ill infants due to their immature immune systems and physiology.
- Further high-quality, adequately powered studies are essential.
- Future research should control for covariates, monitor adverse events, and use standardized VAP definitions for clinical recommendations.
Background:
Critically ill infants admitted to the neonatal intensive care unit are at risk for ventilator-associated pneumonia and abnormal oral colonization. Adherence to evidence-based guidelines for oral care in critically ill adults is associated with improved short- and long-term health outcomes. However, oral care guidelines for critically ill infants admitted to the neonatal intensive care unit have not been established, possibly increasing their risk of ventilator-associated pneumonia and other health complications.
Objective:
To describe and summarize the evidence regarding oral care for critically ill infants admitted to the neonatal intensive care unit and to identify gaps needing further investigation.
Methods:
The MEDLINE (through PubMed) and CINAHL databases were searched for observational studies and randomized controlled trials investigating the effect of oral care on oral colonization, ventilator-associated pneumonia, and health outcomes of infants in the neonatal intensive care unit.
Results:
This review of 5 studies yielded evidence that oral care may promote a more commensal oral and endotracheal tube aspirate microbiome. It may also reduce the risk of ventilator-associated pneumonia and length of stay in the neonatal intensive care unit. However, the paucity of research regarding oral care in this population and differences in oral care procedures, elements used, and timing greatly limit any possible conclusions.
Conclusions:
Oral care in critically ill infants may be especially important because of their suppressed immunity and physiological immaturity. Further appropriately powered studies that control for potential covariates, monitor for adverse events, and use recommended definitions of ventilator-associated pneumonia are needed to make clinical recommendations.
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