Nursing Research Problem Essay

Infections be a honey oil cause of both morbidity and mortality in premature infants examples of contagious diseases acknowledge necrotizing enterocolitis (necrotizing enterocolitis) and sepsis ( transmittance of the bloodstream). Infections in premature infants result in prolonged ventilation, prolonged hospitalization, and high medical costs, and can cause neurodevelopment impairment (Manzoni et al., 2009). The use of high-potency antibiotics can whizz to resistant strains of bacteria and potentially dam jump on the infants liver and/or kidney function. Within the past decade, enquiry has turned from usage treatments to finding methods to curve transmission systems.Breastfeeding and gracious draw has been well adjudgeed through research to provide immunity and positive issuings for preterm and serious-term infants. Breastfeeding and serviceman milk provides nutritional, gastrointestinal, immunological, developmental, and psychological benefits to preterm infants a nd plays an important role on their long-term health and development (Callen & Pinelli, 2005). The components of breastmilk that support immunity include lactoferrin, lysozymes, interferon, and sIgA antibody (Callen & Pinelli, 2005).Specifically, lactoferrin (LF) is an iron-binding glycoprotein found not only in breastmilk, merely also in saliva, tears, and other bodily secretions LF has biological functions which include immunomodulatory, antimicrobial, and antioxidant effect, and inhibits ingathering of unhealthful bacteria, fungi, and viruses (Yen et al., 2009). The described functions of LF support the protective role in immunity. The purpose of this investigation is to determine the effects of oral lactoferrin appurtenance on reducing transmissions in preterm infants.Nature of Problem and Importance to care for PracticeA nosocomial infection is described as an infection that is acquired after 48 hours of hospital admission (Rodriguez et al., 2010). In neonates,a late-on set infection is specify as an infection obtained after the perinatal period (Manzoni et al., 2009). Nosocomial infections include infections of the gastrointestinal brochure (necrotizing enterocolitis, NEC), blood stream (sepsis), and lung (pneumonia). The effects of an infection in a preterm infant can lead to poor growth, adverse long-term neurological sequelae, increased length of hospital stay, and a substantial cost to families, hospitals, and order of magnitude (Rodriguez et al., 2010, p. 207). The risk of nosocomial infections increases with the decreasing kind weight and gestational age, and rough 21% of very depleted birth-weight (VLBW) infants will encounter a late-onset infection (Stoll et al., 2002).The most common gastrointestinal infection in premature infants is NEC, bear upon 2.6% to 28% of VLBW infants (Lin et al., 2005). NEC is widely considered as a multifactorial disease, with no specific pathogenesis three major factors reserve been proposed the presenc e of a pathogenic organism, the challenge of enteral feeding, and altered enteric mucosa truth (Lin et al., 2005). NEC is characterized by necrotizing injury to the intestine that requires antibiotic treatment and, in pure(a) cases, surgical intervention (Brooks et al., 2006, p. 347). Reduction of infections in preterm infants is of high priority and officious research is being performed to find safe preventative measures, improve patient outcomes, and decrease hospital length of stay.Lactoferrin is an iron-binding protein found in mammalian milk and is important in innate resistant host defenses (Manzoni et al., 2009). Partial digestion of LF in the stomach produces peptides called lactoferricin that contain more potent antimicrobial activity (Yen et al., 2009). man foremilk contains more LF than breastmilk, saliva, tears, or other mucosa linings in the body. Studies have been performed to determine bovid or porcine LF effect on cake of infection in mice and rat pups conclusi ons showed a reduction in the relative frequency of bacterial infections in the GI parcel of land while promoting the growth of Lactobacillus and Bifidobacteria species, which are generally believed to be beneficial to the host (Yen et al., 2009, p. 591).Bovine, porcine, and human LF molecules are similar, and bovid and porcine LF has been reported to show higher antimicrobial activity compared to human LF (King et al., 2007). In 2001, the US nutrient and Drug Administration declared bovid lactoferrin generally recognized as safe(CFSAN, 2001). Bovine or human LF can be given as a formula additive, breastmilk additive, or given to patients by swabbing of the embouchure, either actively feeding or with nil per os (NPO) statuses. Research studies have now been performed on the effects of bovid or porcine LF on streak of infections in VLBW and preterm infants, and LF shows to be a promising agent of prevention.Evidence-based Practice QuestionEvidence-based practice (EBP) is defi ned as a practice that involves clinical decision-making based on the stovepipe available tell apart, with an emphasis on evidence from disciplined research (Polit & Beck, 2008, p. 753). Nursing practices are changing in the NICU to include swabbing of the infants mouth with colostrum every six hours to assist in prevention of infection and improve feeding tolerance. The following question is developed to determine the outcomes of infection prevention by LF in preterm infants Does the supplementation of LF decrease the occurrence of nosocomial infections in preterm infants?Conceptual/Theoretical FrameworkThe studies canvased did not mention a abs packet or theoretical framework pertaining to the relationship of the subjects investigated. A conceptual model of nursing, Levines preservation Model, can be utilized in applying the methods investigated to provide care and prevention of infection in preterm infants. Levines Conservation Model is focused in promoting adaptation and ma intaining wholeness using the principles of preservation ( true Nursing, 2010). The model guides the nurse to focus on the influences and responses at the organismal level and accomplish the goals of the model through the conservation of energy, structure, and personal, and social integrity (Current Nursing, 2010).Conservation of energy in preterm infants is necessary for appropriate growth, and is achieved by adequate rest and nutrition fighting an infection in preterm infants results in NPO status and irritability, thus expending energy. The conservation of structural integrity performer to prevent physical breakdown andpromote healing, and is the consequence of an effective immune system (Current Nursing, 2010). The technique of LF supplementation and its potential preventative outcome on infection helps the patient conserve energy and structural integrity.Variables and FindingsManzoni et al. (2009) performed a prospective, multicenter, double-blind, placebo- accountantled, rand omized trial examining whether oral supplementation with bovid LF alone or in combination with Lactobacillus rhamnosus GG (LGG) reduces late-onset sepsis in 472 VLBW infants. The in interdependent variant of this theatre is the supplementation of bovine LF or LGG and the dependent variable is the occurrence of infections in VLBW infants. The content randomly allocated infants into three conferences groups consisted of a suppress group (n = 168, infants supplemented with a placebo) and an observational group (n = 153, infants given bovine LF alone and n = 151, infants given bovine LF with LGG). The main outcome measured the first episode of late-onset sepsis (sepsis occurring after 72 hours of birth) all tests were two-tailed, and P .05 was considered statistically significant (Manzoni et al., 2009).When stratifying for birth weight, Manzoni et al. (2009) noted a significant decrease in late-onset sepsis in extremely low birth-weight (ELBW, birth-weight 1000g) infants (P = .002 for bovine LF v. control and P = .002 for bovine LF plus LGG v. control) whereas it was not significant in infants weighing 1001 to 1500 g (P = .34 for bovine LF v. control and P = .07 in bovine LF plus LGG v. control). Overall, the results showed a significant decrease in the occurrence of infection in VLBW infants in the experimental groups versus the control group (P = .002 for bovine LF v. control and P .001for bovine LF plus LGG v. control) (Manzoni et al., 2010).A double-blind, placebo-controlled control study poke intod the stupor of bovine LF supplementation to bottle- ply infants (King et al., 2006). The participants include 52 infants between the age of 0-4 weeks of age, 34 weeks of gestational age, and 2000 g, and who were strictly bottle- feed. The infants were randomized in a double-blind stylus the control groupreceived a small dose of bovine LF and the experimental group received a higher dose of bovine LF (King et al., 2006). The independent variable is th e supplementation of the higher dose of bovine LF and the dependent variable is the impacts observed in the first year of life.The outcomes measured included diarrhea, upper respiratory infection (URI), acute otitis media (AOM), and lower respiratory pathway infection (LRTI). The infants were examined six times throughout the year on the measured outcomes. The results showed a significant decrease in the occurrence of LRTIs in the experimental group than in the control group (P 0.05) (King et al., 2006). Even though this study did not include preterm infants 34 weeks, the effects of bovine LF are unsounded apparent in the protection against infection.Yen et al. (2009) performed a study to examine the effects of porcine LF as a selective decontamination of the digestive tract (SDD) regimen in neonatal mice. Transgenic mice were generated to express porcine LF the neonatal mice fed from the transgenic mice and were then challenged with pathogens to evaluate in vivo antimicrobial a ctivity of porcine LF (Yen et al., 2009). The control group contained mice that were fed normal milk and the experimental group contained mice that were fed the porcine LF (Yen et al., 2009). The independent variable is the transgenic mice with porcine LF supplementation and the dependent variable is the antimicrobial activity observed.The outcome measures included the growth rate of the mice pups, the call down of the intestinal tract mucosa, and the circulating cytokines (Yen et al., 2009). Yen et al. (2009) concluded that the experimental group of neonatal mice showed a significant reduction of severity of illness (P .01), a significant inhibition of microbial survival in the intestinal tract (P .01), and a significant decrease in the number of bacteria cultivated (P .05) than in the control group. The authors proposed that porcine LF is an ideal natural SDD regimen for the prevention of nosocomial infections in critically ill patients (Yen et al., 2009).ConclusionResearch h as be the high incidence of a nosocomial infection and its adverse outcomes in a preterm infant. The efforts of research have changedto finding a method to reduce or prevent nosocomial infections in preterm infants. Human colostrum is best in planning the infant with LF to fight infection, but other methods of supplying LF are being studied. Research has recently proven that the supplementation of bovine LF has decreased the occurrence of infections in VLBW and preterm infants.Future research should include a larger, neonatal population specifically targeting VLBW and/or ELBW infants and the effect of LF supplementation on prevention of NEC. Further studies are needed to determine the dosing, duration, and type of LF (bovine, porcine, or human) that will be most effective in the prevention of infection in preterm infants without causing adverse effects or intolerance (Venkatesh & Abrams, 2010).ReferencesBrooks, H. J. L., McConnell, M. A., Corbett, J., Buchan, G. S., Fitzpatrick, C . E., & Broadbent, R. S. (2006). emf prophylactic value of bovine colostrum in necrotizing enterocolitis in neonates an in vitro study on bacterial attachment, antibody levels, and cytokine production. FEMS Immunology and Medical Microbiology, 48, 347-354. inside10.1111/j.1574-695X.2006.00151.xCallen, J. & Pinelli, J. (2005). A review of the literature examining the benefits and challenges, incidence and duration, and barriers to breastfeeding in preterm infants. Advances in Neonatal Care, 5(2), 72-88. doi10.1016/j.adnc.2004.12.003Current Nursing. (2010). Levines four conservation principles. Retrieved on kinfolk 23, 2010 from http//currentnursing.com/nursing_theory/Levine_four_conservation_princples.htmlKing, J. C., Cummings, G. E., Guo, N., Trivedi, L, Readmond, B. X., Keane, V., de Waard, R. (2007). A double-blind, placebo-controlled, pilot study of bovine lactoferrin supplementation in bottle-fed infants. Journal of paediatric Gastroenterology and Nutrition, 44(2), 245-251.Li n, H., Su, B., Chen, A., Lin, T., Tsai, C., Yeh, T., & Oh, W. (2005). Oral probiotics reduce the incidence and severity of necrotizing enterocolitis in very low birth weight infants. Pediatrics, 115 (1), 1-4. doi10.1542/peds.2004-1463Manzoni, P., Rinaldi, M., Cattani, S., Pugni, L., Romeo, M. G., Messner, H., Farina, D. (2009). Bovine lactoferrin supplementation for prevention of late-onset sepsis in very low birth-weight neonates. The Journal of the American Medical Association, 302(13), 1421-1428. Retrieved on September 4, 2010 from http//jama.ama-assn.org/cgi/content/full/302/13/1421Polit, D. E., & Beck, C. T. (2008). Nursing research generating and assessing evidence for nursing practice (8th ed.). Philadelphia Lippincott Williams & Wilkins.Rodriguez, N. A., Meier, P. P., Groer, M. W., Zeller, J. M., Engstrom, J. L., & Fogg, L. (2010). A pilot study to determine the sentry duty and feasibility of oropharyngeal administration of own mothers colostrum to extremely low-birth-weig ht infants. Advances in Neonatal Care, 10(4), 206-212.Stoll, B. J., Hansen, N., Fanaroff, A. A., Wright, L. L., Carlo, W. A., Ehrenkranz, R. A., Poole, W. K. (2002). Late-onset sepsis in very low birth weight neonates the experience of the NICHD neonatal research network. Pediatrics, 110(2), 285-291. Retrieved September 9, 2010 from http//pediatrics.aappublications.org/cgi/content/full/110/2/285US Food and Drug Administration, CFSAN/Office of Food Additive Safety. (2001). Agency response letter GRAS notice (No. GRN 000077). Retrieved on September 23, 2010 from http//www.fda.gov/Food/FoodIngredientsPackaging/GenerallyRecognizedAsSafeGRAs/GRASListings/ucm154188.htmVenkatesh, M. P., & Abrams, S. A. (2010). Oral lactoferrin for the prevention of sepsis and necrotizing enterocolitis in preterm infants. CochraneDatabase of Systematic Reviews, Art. No. CD007137 (5). doi10.1002/14651858.CD007137.pub2Yen, C., Lin, C., Chong, K., Tsai, T., Shen, C., Lin, M., Chen, C. (2009). Lactoferrin as a natural regimen for selective decontamination of the digestive tract recombinant porcine lactoferrin expressed in the milk of transgenic mice protects neonates from pathogenic challenge in the gastrointestinal tract. The Journal of Infectious Diseases, 199, 590-598. doi10.1086/596212