Nursing Research Problem Essay

Infections be a common ca commit of both morbidness and mortality in premature infants examples of contagions embarrass necrotizing enterocolitis (necrotizing enterocolitis) and sepsis ( transmission system of the blood sprout). Infections in premature infants result in prolonged ventilation, prolonged infirmaryization, and steeper medical costs, and can cause neuro schooling impairment (Manzoni et al., 2009). The use of high-potency antibiotics can lead to resistant strains of bacteria and potentially dam mount up the infants liver and/or kidney function. Within the ago decade, research has turned from conclusion treatments to determination methods to shorten contagious diseases.Breastfeeding and gay draw has been well up supported through research to take into account immunity and positive outcomes for preterm and full-term infants. Breastfeeding and gracious milk provides nutritional, gastro enteral, immunological, developmental, and psychological benefits to preterm infants and plays an important consumption on their long-term health and development (Callen & Pinelli, 2005). The components of breastmilk that support immunity involve lactoferrin, lysozymes, interferon, and sIgA antibody (Callen & Pinelli, 2005).Specifically, lactoferrin (LF) is an iron-binding glycoprotein put not only in breastmilk, only also in saliva, tears, and opposite innate(p) secretions LF has biological functions which take immunomodulatory, antimicrobic, and antioxidant upshots, and inhibits growth of morbific bacteria, fungi, and viruses (Yen et al., 2009). The described functions of LF support the protective procedure in immunity. The purpose of this investigation is to trammel the set up of oral lactoferrin postscript on reducing contagious diseases in preterm infants.Nature of paradox and Importance to nursing PracticeA nosocomial contagion is described as an transmission that is acquired after(prenominal) 48 hours of hospital admission (Rodrig uez et al., 2010). In neonates,a late-onset transmittance is defined as an infection obtained after the perinatal period (Manzoni et al., 2009). Nosocomial infections include infections of the gastrointestinal piece of ground (necrotizing enterocolitis, NEC), blood stream (sepsis), and lung (pneumonia). The effects of an infection in a preterm infant can lead to abject growth, adverse long-term neurological sequelae, increase aloofness of hospital stay, and a genuine cost to families, hospitals, and society (Rodriguez et al., 2010, p. 207). The risk of nosocomial infections increases with the decreasing birth lading and gestational age, and roughly 21% of real down(p) birth-weight (VLBW) infants will encounter a late-onset infection (Stoll et al., 2002).The more or less common gastrointestinal infection in premature infants is NEC, affecting 2.6% to 28% of VLBW infants (Lin et al., 2005). NEC is widely considered as a multifactorial disease, with no specific pathogenesis le ad major factors stimulate been proposed the presence of a pathogenic organism, the take exception of enteral feeding, and modify enteric mucosa impartiality (Lin et al., 2005). NEC is characterized by necrotizing injury to the intestine that requires antibiotic treatment and, in severe cases, running(a) intervention (Brooks et al., 2006, p. 347). Reduction of infections in preterm infants is of high priority and active research is being performed to find safe preventative measures, rectify patient outcomes, and reduce hospital length of stay.Lactoferrin is an iron-binding protein found in mammalian milk and is important in innate insubordinate host defenses (Manzoni et al., 2009). Partial digestion of LF in the potbelly produces peptides called lactoferricin that contain to a greater extent potent anti microbial activeness (Yen et al., 2009). humanity foremilk contains more LF than breastmilk, saliva, tears, or other mucosa linings in the body. Studies have been perform ed to look out bovid or porcine LF effect on measure of infection in mice and rat pups conclusions essayed a reduction in the frequency of bacterial infections in the GI share sequence promoting the growth of Lactobacillus and Bifidobacteria species, which be by and large believed to be beneficial to the host (Yen et al., 2009, p. 591). bovid, 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 Food and medicine Administration declared bovid lactoferrin generally recognized as safe(CFSAN, 2001). Bovine or human LF can be addicted as a design additive, breastmilk additive, or disposed(p) to patients by mop up of the mouth, either actively feeding or with nil per os (NPO) statuses. look for studies have now been performed on the effects of bovine or porcine LF on saloon of infections in VLBW and preterm infants, and LF shows to be a assure agent of legal profession.Evidence-based Practice QuestionEvidence-based execute (EBP) is defined as a suffice that involves clinical decision-making based on the trounce available read, with an emphasis on evidence from disciplined research (Polit & Beck, 2008, p. 753). Nursing puts are changing in the NICU to include swabbing of the infants mouth with colostrum either half a dozen hours to assist in prevention of infection and improve feeding tolerance. The quest question is developed to determine the outcomes of infection prevention by LF in preterm infants Does the subjoining of LF pass the occurrence of nosocomial infections in preterm infants?Conceptual/Theoretical FrameworkThe studies reviewed did not mention a conceptual or theoretical framework pertaining to the relationship of the subjects investigated. A conceptual manakin of nursing, Levines conservation sham, 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 maintaining lawfulness using the principles of conservation ( on-going Nursing, 2010). The mannequin guides the nurse to focus on the influences and results at the organismic level and accomplish the goals of the model through the conservation of button, structure, and personal, and social integrity (Current Nursing, 2010).Conservation of energy in preterm infants is necessary for appropriate growth, and is achieved by fair to middling rest and nutrition fighting an infection in preterm infants results in NPO status and irritability, thuslyce expending energy. The conservation of structural integrity means to prevent physical division andpromote healing, and is the consequence of an effective resistive system (Current Nursing, 2010). The technique of LF postscript and its potential preventative outcome on infection helps the patient conserve energy and structural integrity.Variables and Fi ndingsManzoni et al. (2009) performed a prospective, multicenter, double-blind, placebo- go outled, randomised exam examining whether oral supplementation with bovine LF solo or in combination with Lactobacillus rhamnosus GG (LGG) reduces late-onset sepsis in 472 VLBW infants. The in subject inconsistent of this schooling is the supplementation of bovine LF or LGG and the dependent variant is the occurrence of infections in VLBW infants. The moot arbitrarily allocated infants into three root words conferences consisted of a control assemblage (n = 168, infants supplemented with a placebo) and an experimental pigeonholing (n = 153, infants given bovine LF alone and n = 151, infants given bovine LF with LGG). The main outcome calculated the introductory episode of late-onset sepsis (sepsis occurring after 72 hours of birth) all tests were two-tailed, and P .05 was considered statistically meaning(a) (Manzoni et al., 2009).When stratifying for birth weight, Manzoni et al. (2009) noted a epoch-making 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 fundamental 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 sorts 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 pilot take aim examined the impact of bovine LF supplementation to bottle- feed 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 feed. The infants were randomized in a double-blind fashion the control groupreceived a bittie so cial disease of bovine LF and the experimental group received a higher dose of bovine LF (King et al., 2006). The independent variable is the 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, amphetamine respiratory infection (URI), acute otitis media (AOM), and raze respiratory tract 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 still apparent in the protection against infection.Yen et al. (2009) performed a study to examine the effects of porcine LF as a discriminating decontamination of the digestive tract (SDD) regimen in neonatal mice. Transgenic mice were generated to bear witness porcine LF the neonatal mice fed from the transgenic mice and were then challenged with pathogens to evaluate in vivo antimicrobial activity 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 state of the intestinal tract mucosa, and the circulating cytokines (Yen et al., 2009). Yen et al. (2009) cogitate that the experimental group of neonatal mice showed a significant reduction of severity of sickness (P .01), a significant inhibition of microbial survival in the intestinal tract (P .01), and a significant decrease in the number of bacteria cultured (P .05) than in the control group. The authors proposed that porcine L F is an ideal natural SDD regimen for the prevention of nosocomial infections in critically ill patients (Yen et al., 2009).Conclusion query has proven 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 furnish 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 day research should include a larger, neonatal population specifically targeting VLBW and/or ELBW infants and the effect of LF supplementation on prevention of NEC. but studies are needed to determine the dosing, duration, and shell of LF (bovine, porcine, or human) that will be most effective in the prevention of infection in preterm infants without causin g 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). Potential arctic 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. doi10.1111/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 kinsfolk 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 Pediatric Gastroenterology and Nutrition, 44(2), 245-251.Lin, 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, one hundred fifteen (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 kinfolk 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 safety and feasibility of oropharyngeal judicatory of own mothers colostrum to extremely low-birth-weight 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 kinsfolk 9, 2010 from http//pediatrics.aappublications.org/cgi/content/full/110/2/285US Food and Drug Administration, CFSAN/ bit 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 Review s, 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 explicit in the milk of transgenic mice protects neonates from pathogenic challenge in the gastrointestinal tract. The Journal of septic Diseases, 199, 590-598. doi10.1086/596212