The knowledge, perceptions and practices of healthcare professionals regarding enteral feeding of premature and low birth weight infants in South Africa

Bradfield, Margot (2017-03)

Thesis (MNutr)--Stellenbosch University, 2017.

Thesis

ENGLISH SUMMARY : Background Nutrition in the premature infant is aimed at attaining similar growth and body composition to that of foetal growth and body composition. Postnatal growth will depend on the extrauterine environment, including the type, quality and quantity of feeds provided. Inadequate postnatal growth and nutrition has been linked to poor neurodevelopmental outcomes. Adequate nutrition and enteral feeding practices are necessary to prevent postnatal growth failure and poor cognitive outcomes in premature infants. Aims and objectives The study aimed to determine the knowledge, perceptions and practices of healthcare professionals regarding enteral feeding (including breastfeeding, formula feeding, breastmilk fortifier and donor breastmilk) of premature and low birth weight (LBW) infants in South Africa. Participants and methods A descriptive cross-sectional study with an analytical component was conducted from November 2015 until May 2016. The study took the form of an online survey using the web-based program, “Survey Monkey”. The study population comprised doctors and dietitians from the public and private sectors who are involved in the care of premature and low birth weight (LBW) infants. A total of 76 participants started the survey, of whom 30 (39%) completed fewer than five questions and were excluded from the data analysis. The final sample was composed of 46 participants. Results A significant difference (p = 0.025) between government and private sectors was observed for the initiation time of enteral feeds for very low birth weight (VLBW) infants. Most doctors and dietitians attempt to increase enteral feed volume daily for all birth weight categories. A significant difference was observed between doctors and dietitians (p = 0.039) with respect to the full enteral feeding volume, and a significant difference (p = 0.036) was noted between doctors and dietitians on whether nutrients are calculated in their facilities. Most doctors and dietitians chose an enteral target energy of 100–135 kcal/kg/day for all the birth weight categories. A significant difference was found between the energy prescriptions between the government and private sector for each birth weight category [< 1 000 g (p = 0.038), < 1 500 g (p = 0.027), < 2 000 g (p = 0.019), < 2 500 g (p = 0.045)]. Beliefs and perceptions were in line with current evidence and recommendations, and reflect the practices of healthcare professionals. Conclusion In this study, differences existed between certain practices between healthcare professionals as well as between hospital sectors. A significant difference was not found in the total knowledge scores between healthcare professionals and the international feeding recommendations.

AFRIKAANSE OPSOMMING : Agtergrond Voeding van die premature baba is gemik daarop om soortgelyke groei en liggaamsamestelling te behaal as die van fetale groei en liggaamsamestelling. Post-natale groei sal afhang van die ekstra-uteriene omgewing, insluitend die tipe, kwaliteit en kwantiteit van voedings wat verskaf word. Onvoldoende post-natale groei en voeding is gekoppel aan swak neuro-ontwikkeling uitkomste. Voldoende voeding en enterale voedingpraktyke word benodig om gebrekkige post-natale groei en swak kognitiewe uitkomste in premature babas te voorkom. Doelstellings en doelwitte Die doel van hierdie studie was om die kennis, persepsies en praktyke vas te stel van professionele verskaffers van gesondheidsorg aangaande enterale voeding (insluitend borsvoeding, formule voeding, borsmelk verrykers en skenker borsmelk) van premature en lae geboorte massa (LGM) babas in Suid Afrika. Deelnemers en Metodes ‘n Beskrywende deursnit studie met ‘n analitiese komponent is vanaf November 2015 tot Mei 2016 uitgevoer. Die studie is uitgevoer in die formaat van ‘n aanlynopname met gebruik “Survey Monkey”. Die studie populasie het bestaan uit dokters en dieetkundiges vanuit die openbare en die privaat sektors wat betrokke is met die versorging van premature en LGM babas. In totaal het 76 deelnemers het die opname begin, waarvan 30 (39%) minder as vyf vrae van die opname voltooi het. Hierdie deelnemers is uitgesluit uit die data analise. Die finale populasie het bestaan uit 46 deelnemers. Resultate ‘n Beduidende verskil is waargeneem in die aanvangstyd van enterale voeding vir baie lae geboorte massa (BLGM) babas tussen openbare- en privaat sektors (p = 0.025). Die meerderheid dokters en dieetkundiges poog om enterale voeding se volume op ‘n daaglikse basis te verhoog vir alle geboorte gewig kategorieë. ‘n Beduidende verskil is waargeneem tussen dokters en dieetkundiges (p = 0.039) met betrekking tot die volle enterale voedings volume en ‘n beduidende verskil is waargeneem (p = 0.036) tussen dokters en dieetkundiges rakende die berekening van nutriente in hulle fasiliteite. Die meerderheid dokters en dieetkundiges het ‘n enterale teiken energie van 100–135 kcal/kg/dag vir al die geboortegewig kategorieë verkies. ‘n Beduidende verskil is gevind tussen die energie voorskrifte van die openbare en privaatsektore vir elke geboortegewig kategorie (< 1 000 g (p = 0.038), < 1 500 g (p = 0.027), < 2 000 g (p = 0.019), < 2 500 g (p = 0.045). Oortuigings en waarnemings was in lyn met huidige gegewens en aanbevelings en weerspieël die praktyke van die gesondheidsorg verskaffers. Gevolgtrekking In hierdie studie het verskille bestaan tussen sekere praktyke en gesondheidsorg verskaffers so wel as tussen hospitaal sektore. ‘n Beduidende verskil was nie waargeneem tussen die totale kennis tellings tussen die gesondheidsorg verskaffers en die internasionale voedings aanbevelings nie.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/101387
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