What’s best for baby’s belly?
Nursing researcher receives $1.4 million to study nutrition in infants
By Tracy Brown Wright
Leslie Parker
A UF nursing researcher has received a $1.4 million grant from the National Institutes of Health to determine nutrition outcomes and risks in the care of very low-birth weight infants. The funding will allow researchers to study a clinical standard of care for assessing these infants’ nutritional status to determine if it is beneficial or risky to the baby.
Leslie Parker, Ph.D., A.R.N.P., a clinical assistant professor of nursing, will lead a four-year study that will examine whether the customary clinical practice of assessing the amount of residual gastric contents in an infant’s stomach actually improves care or whether it can actually cause harm. Residual gastric contents are the volume of fluid remaining in the stomach after a feeding.
“Research has never evaluated whether this widely accepted clinical practice is beneficial to these very low-birth weight infants and whether it can actually cause real harm to infants,” Parker said. “We hope this study can assess the risks and benefits of this practice and whether alternate methods can improve care.”
Approximately 63,000 very low-birth weight infants born in the United States annually are too immature to coordinate sucking, swallowing and breathing, thus requiring the use of feedings through tubes inserted orally or through the nose traveling down the esophagus into the stomach. The customary clinical practice during tube-feeding is to determine if any breast milk or formula remains in the stomach by removing residual gastric contents through a tube into a syringe prior to each feeding.
Traditionally, the presence of a large volume of fluid left in the stomach after a feeding has been thought to be due to feeding intolerance or an early symptom of necrotizing enterocolitis — a serious complication in premature infants characterized by the death of intestinal tissue.
Future nutritional decisions are based on the volume or color of the fluid removed from the stomach. If the aspiration and assessment finds a large volume of fluid, it is common to omit a feeding or not increase the amount of milk delivered to the infant and supplement with total nutrition delivered intravenously, which can be associated with serious complications.
Parker and her research team will study two groups of very low-birth weight infants in the neonatal intensive care unit at Shands at UF. One group will receive routine care. This includes assessment of residual gastric contents, monitoring for vomiting, measuring the size of the abdomen and assessing for bloody stools. The second group will not receive routine removal of residual gastric contents but will be assessed by the other routine methods of care.
Parker will evaluate the nutritional and gastrointestinal outcomes of both groups of infants to assess the risks and benefits of aspiration. All of the infants will receive breast milk from either their mothers or donors.
“It is our hope that the results of our study can have translational impact to evidence-based practice for patients,” Parker said. “I hope that my program of research can improve short- and long-term health outcomes for very low-birth weight infants by improving their nutritional status and decreasing complications due to prematurity.”