Jennifer Humphries – Feeding Practices and Necrotizing Enterocolitis

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Exploring the Essential Features of “Jennifer Humphries – Feeding Practices and Necrotizing Enterocolitis”

Speaker: Jennifer Humphries, DNP, CRNP, NNP-BC

Duration: 2 Hours 02 Minutes

Format: Audio and Video

Copyright: Nov 17, 2022

Media Type: Digital Seminar

Description

Enteral feedings is the preferred method of nutrient delivery for preterm infants with evidence supporting significant nutritional and non-nutritional benefits. Practices vary in NICUs leaving best practice abroad. Barriers for initiating and advancing enteral feeds include provider fear of Necrotizing Enterocolitis (NEC), limited evidence, and excessive growth leading to high adiposity. This recorded session will demonstrate supporting evidence that enteral feedings, especially early enteral feedings, has an impact on the overall health, growth, and development of the preterm infant.

Additionally, NEC continues to remain an indicator for high mortality rates in preterm infants, despite ongoing research and advancements in neonatal care. Here we will review the current understanding of the disease, risk factors, pathophysiology, and its epidemiology. We will discuss management and prevention of NEC in addition to new emerging research.

Speaker

Jennifer Humphries, DNP, CRNP, NNP-BC

Dr. Humphries is a Board-Certified Neonatal Nurse Practitioner (NNP). She has over 20 years of experience that includes registered nurse in the Burns and Trauma Unit and Regional Neonatal Intensive Care Unit at UAB, SICU at Walker Baptist Medical Center, and Psychiatric Unit at Montclair Baptist. She found her calling in the Neonatal Intensive Care Unit (NICU) and furthered her career as an advanced practice nurse practitioner. She currently works at DCH Northport Medical Center in the NICU. In addition, Dr. Humphries plans to expand her career to include education and leadership.

Dr. Humphries graduated from Bevill State Community College with an Associate degree in Nursing (ADN) in 2001, received her Bachelor of Science in Nursing degree (BSN) from the University of North Alabama in 2011, her Master of Science in Nursing degree (MSN) in the NNP tract at the University of Alabama of Birmingham (UAB) in 2014 and her Doctor of Nursing Practice degree (DNP) and Nursing Education Certification at UAB in 2019.

She was recently awarded the Kim Noland Spirit Award from the Florida Association of Neonatal Nurse Practitioner (FANNP). Additionally, she received two scholarships from FANNP while in graduate school. She published a literature review titled Perinatal Palliative Care in the FANNP newsletter in 2018 and a peer-reviewed article in the Alabama Nurse titled Early Placement of PICC Lines and Early Removal of UVC to Reduce CLABSIs in the NICU in 2019. She holds memberships with ASNA, FANNP, and AAP. In 2018, she served as President Elect of District 2 in the Alabama State Nurses Association (ASNA) and then President of the district in 2019-2021. Dr. Humphries currently serves as the Vice President at the state level for ASNA. Dr. Humphries is chair of the Research and Poster committee for FANNP and recently lectured on a Neonatal Pharmacology in the FANNP 2021 conference.

Speaker Disclosures:
Financial: Dr. Jennifer Humphries has employment relationships with Birmingham Vital Care, the University of Alabama at Birmingham, and Northport Medical Center DCH. She receives a speaking honorarium and recording royalties from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Dr. Jennifer Humphries is a member of the Alabama State Nurse Association, the American Nurses Association, and the Florida Association of Neonatal Nurse Practitioners.

Objectives

Determine the benefits of enteral feedings.
Formulate safe feeding practices for preterm infants.
Determine specific nutritional requirements.
Analyze the pathophysiology of necrotizing enterocolitis (NEC).
Distinguish signs and symptoms of NEC.
Differentiate medical and surgical interventions for NEC.
Assess for complications related to NEC.

Outline

Nutritional Requirements for Preterm Infants
- Human Milk Vs Formula
- Nutrient per Kg
- Growth chart
Benefits of Early Enteral Feedings
- When to start enteral feeds
- Stable infants
- High risk infants
- Colostrum as mouth care
Advancing Feeds/Full Feeds
- Trophic feeds
- Assessing Feed Tolerance
- Rate of advancement
Barriers
- Understanding best practice
- Infants with congenital abnormalities of the GI tract or following GI surgery
- Standardization of Practice across NICUs
Etiology and Pathophysiology of NEC
- Multifactorial
- Prematurity
- Bacteria Flora
- Incidences
Clinical indicators
- Subtle Indicators
  - Feeding intolerance
  - Delayed gastric emptying
  - Abdominal distention
  - Ileus
  - Hematochezia
  - Pneumatosis
- Systemic Signs
  - Apnea
  - Decreased tone
  - Shock
  - Cardiovascular response
- Laboratory Studies
  - Metabolic acidosis
  - Hyponatremia
  - Thrombocytopenia
  - Neutropenia
Differential Diagnosis
- Malrotation
- UTI
- Meningitis
- Septicemia
- Hirschsprung’s Disease
Diagnosis
- CBC, Chemistries, blood culture, blood gas
- Abdominal X-rays (AP and Lateral)
- Upper GI
- Abdominal Ultrasound
Management and Surgical indicators
- Bell Stages of NEC
- NPO
- Antibiotics
- Vasopressors
- Volume expanders
- Parenteral nutrition
- Antifungals
- Central line access
Prognosis and complications related to NEC
- Survival rate
- Long term complications
- Intestinal Strictures
- Short gut syndrome
Prevention
- Prevent asphyxia
- Antenatal steroids
- Use of Human Milk
- prevent infection risks
- monitor feed tolerance
Barriers
- Limitations of Research
- Understanding all potential risks and causative factors