| Description |
This Doctor of Nursing Practice scholarly project consisted of developing a clinical practice guideline for neonatal nurse practitioners and neonatologists on probiotic administration in very low birth weight (VLBW) neonates. The guideline is based on a synthesis of relevant literature and consultation with professionally recognized experts in neonatology, nutrition, necrotizing enterocolitis (NEC) and probiotic use. Necrotizing enterocolitis is a gastrointestinal emergency which leads to inflammation and intestinal necrosis. It affects premature and full-term compromised neonates and may lead to prolonged hospitalization, long term serious sequelae and death. Researchers hypothesize that bacterial translocation through the mucosal layer and an interruption in blood flow to the intestine during the first days of life lead to a diminishment of the intestine's protective properties, promote the colonization of pathogenic bacteria in the gut and as a result, predispose the neonate to developing NEC. While probiotics can decrease the incidence of NEC, consistent recommendations for probiotic administration to VLBW neonates are lacking. For this project, the best available evidence is reviewed and a practice guideline for probiotic administration to VLBW neonates is described. This scholarly project included two objectives: (1) the creation of a clinical practice guideline on probiotic administration in VLBW neonates for NEC prevention and (2) the dissemination of this recommendation to the neonatal community. A systematic review was conducted using MEDLINE and EMBASE, and the strength of evidence was classified using the Center for Evidence-Based Medicine (CEBM) classification schema. The inclusion criteria were limited to systematic reviews, meta-analyses, randomized control trials (RCTs), practice guidelines, and case studies. Originally, 480 sources were obtained and assessed for relevancy to the clinical question and power of evidence. The reference lists of the systematic reviews and meta-analyses were examined for additional sources not found during the original search. Probiotics for VLBW neonates may decrease the incidence of NEC. Providers may choose to give probiotics to VLBW neonates who are at risk of acquiring NEC in facilities with a high NEC incidence. Clinicians must monitor infants for possible side effects. Contraindications for probiotic use include: extremely low birth weight (ELBW), clinical instability, abnormal abdominal exam, the presence of congenital abnormalities, post-NEC, stage III asphyxia and umbilical catheters. The project objectives were met by composing a manuscript of the guideline, receiving feedback and recommendations from content experts, obtaining approval from the project chair, submitting the final draft of the guideline manuscript to Advances in Neonatal Care and submitting an abstract for a poster presentation to the 16th Annual Neonatal Advanced Practice Nursing Forum. The development of the guideline for probiotic use provides clinicians with a concise approach regarding the use of probiotics in VLBW neonates. |
