Oropharyngeal Colostrum Exposure-An Underutilized and Neglected Intervention Among Preterm Infants

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Oropharyngeal Colostrum Exposure-An Underutilized and Neglected Intervention Among Preterm Infants Lindsey Jensen, BSN, RNC-NIC , DNP Student Julieanne Schefeilbein, DNP, MAPPSC, MA, CNM, NNP-BC, CPNP, NPT-C and Jessica Davidson, MD Key Findings: Oral immune therapy is a feasible, safe, well-tolerated, and cost effective intervention that provides additional opportunity for parent/infant bonding. Background • Amniotic fluid contains protective biofactors that stimulate the fetal immune system when they come in contact with the fetus’ oropharynx Results • The matched survey data consisting of mostly Likert scale responses was analyzed using the Wilcoxon Signed Rank Test • Preterm birth results in immediate cessation of exposure to amniotic fluid and its biofactors • Due to clinical instability and physiologic immaturity, preterm infants require tube feedings, which bypass the oropharynx, resulting in a delay in oropharyngeal exposure to biofactors until oral feedings are begun ~32 weeks • The results showed post-survey results were higher than presurvey results on the following questions: • I can verbalize the difference between oral care and oral immune therapy. (z= -4.08, p< .001) • Do you feel the administration of oral immune therapy is safe? (z= -3.86, p< .001) • Do you feel the administration of oral immune therapy is beneficial? (z= -3.85, p< .001) • This delay in oropharyngeal exposure to protective biofactors, may contribute to prematurity-associated infectious morbidities and mortality • A chart review was performed and of the 16 infants that qualified for OIT, according to the guideline, 14 (88%) had it ordered by a provider • Colostrum/breast milk contains high concentrations of biofactors and if placed onto the oral mucosa may serve as a natural alternative to amniotic fluid and provide immune stimulation and protection • Oropharyngeal immune therapy administration did not result in any reported adverse events Methods Conclusions • QI Project to create a guideline for oral immune therapy (OIT) administration in a level III NICU at an academic medical center in the urban Salt Lake Region • Results will be disseminated to the OIT team at an upcoming meeting and to the nursing staff and providers through email • A multidisciplinary team was formed to create the OIT guideline • Educational materials on OIT were developed and were distributed to nurses, providers, and parents. Lactation therapy provided education to labor and delivery staff on the importance of early manual expression of colostrum • OIT is a feasible, safe, well-tolerated, and cost-effective intervention. It was well received by the nurses and providers and will continue as an intervention for infants admitted to the NICU • • Nursing pre and post-education surveys were given to 27 out of 129 RNs (21%) to assess attitudes on oral colostrum/breast milk administration among preterm infants OIT guideline implementation went into effect in February 2021 • Future implications include updating the EPIC admission order set to include OIT so that it easier for providers to order, and to involve the milk lab in the preparation and labeling of OIT doses for administration • Further studies with larger sample sizes, over a longer time period, are needed in order to determine significance of OIT on patient outcomes COLLEGE OF NURSING