Prevention Of Necrotizing Enterocolitis In Premature Infants Discussion Response

Prevention Of Necrotizing Enterocolitis In Premature Infants Discussion Response

Discussion Response

It is correct that the PICOT question is the most effective way of obtaining evidence-based practices that can be applied in the clinical setting to solve clinical problems.  A strong PICOT question must address a specific population group or patient (P) as opposed to the general population, the most relevant and up-to-date intervention (I), the clinical problem affecting the indicated population group or current intervention (C), specific outcomes that can be measured (O), and specific duration (T) that the outcomes are expected to be achieved (Melnyk & Fineout-Overholt, 2018). Your PICOT question, “In premature or low birth weight infants admitted to the NICU, how does routine probiotic use compare to an exclusive human-milk diet affect the occurrence of NEC?” is relevant and includes the right interventions for the clinical problem. However, it lacks specific outcomes that the intended interventions are to achieve and a specific duration within which the expected outcomes can be realized (Melnyk & Fineout-Overholt, 2018). I suggest a PICOT question that reads: In premature or low birth weight infants admitted to the NICU, does routine probiotic use compared to an exclusive human-milk diet prevent the occurrence of NEC for a duration of eight weeks Prevention Of Necrotizing Enterocolitis In Premature Infants Discussion Response?

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Your search strategies of using Boolean operators to combine keywords and phrases, splitting the interventions in question into separate searches, and filtering search results using inclusion and exclusion criteria is a very effective way of obtaining the most relevant and up-to-date studies that address your clinical issue. However, your PICOT question compares the effectiveness of two interventions therefore, in addition to studies that evaluate the effectiveness of one intervention separately, you will also need studies that compare the effectiveness of the two interventions in a single study. You will therefore use the Boolean operators to combine the two interventions in a single search as opposed to splitting the interventions in question into separate searches. There are several studies that compare the two interventions (Sato et al., 2020; Jin et al., 2019; Thomas et al., 2017).

In replies offer suggestions to help the person who posted with their search. Also kindly make suggestions on the PICOT questions of classmates to help each other out!
This is the discussion chosen for response!
In order to implement evidence-based practice (EBP), nurses need to have both the desire to question practice in order to drive improvement and an institution that supports nurses in doing so. In order to quickly and efficiently answer a clinical question, the question should be formulated in a systematic way, allowing improved practice and optimal patient outcomes (Stillwell et al., 2010). Gallagher Ford & Melnyk (2019) suggest that a PICOT question is essentially the search strategy leading to an unbiased and effective search. PICOT questions are well written inquiries that state the key components of a clinical problem: patient population, intervention, comparison intervention or issue of interest, outcome(s), and time frame for an intervention to achieve the outcome(s) (Stillwell et al., 2010). Bermudez (2021) reinforces that including “how” or “what” in formulating a PICOT question promotes specificity and helps generate meaningful results Prevention Of Necrotizing Enterocolitis In Premature Infants Discussion Response.

The area of interest I chose to examine is the occurrence of necrotizing enterocolitis (NEC) in premature infants. NEC is a serious condition that affects the intestinal tract of babies (primarily premature and low birth weight infants), where the tissue within the intestine becomes inflamed and dies, sometimes causing a bowel perforation (U.S. Department of Health and Human Services, 2021). Having worked in multiple high level NICU’s, I’ve seen many unfortunate cases of NEC occurring in the neonatal population. Variations existed in each of the NICU’s when it came to feeding protocols. This caused me to question if there was a correlation between feeding practices and the incidence of NEC in infants admitted to the NICU. The PICOT question I formulated is: In premature or low birth weight infants admitted to the NICU, how does routine probiotic use compared to an exclusive human-milk diet affect the occurrence of NEC?

I started my search in OVID with limitations of publications 2017-present, using the keywords “ necrotizing enterocolitis ”, which yielded 436 text results. Hoping to narrow my results, I then changed my search keywords to “ necrotizing enterocolitis ” AND  prevention  AND probiotics ” OR  human milk ”, which ended up yielding 609 results, the opposite of what I was trying to accomplish. I tried splitting my search up and changing necrotizing enterocolitis to ne and searched nec AND prevention AND probiotics” (yielded 31 results), then did another search with “nec AND prevention AND human-milk” (yielded 44 results). I found it much more effective to split the interventions in question into separate searches Prevention Of Necrotizing Enterocolitis In Premature Infants Discussion Response.

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I then used the same initial terms “nec AND prevention AND probiotics OR human-milk” with limitations of publications 2017-current, and conducted a search in CINAHL plus database. My initial search yielded 4,967 results. I split the search up like I did in OVID and “nec AND prevention AND probiotics” which yielded 154 results, and “nec AND prevention AND human-milk” yielding 120 results. Again, I found it much more effective to split the interventions “probiotics” and “human-milk” into separate searches.

At first, I was not successful in narrowing down my results. The use of multiple databases and altering my search terms ultimately generated the results I needed to research my PICOT question. The use of Boolean terms helped to narrow down search results and filter out irrelevant results within each database (Walden University Library, n.d).

References

Jin, Y., Duan, Y., Deng, X., & Lin, J. (2019). Prevention of necrotizing enterocolitis in premature infants – an updated review. World Journal of Clinical Pediatrics, 8(2), 23-32. https://doi.org/10.5409/wjcp.v8.i2.23 Prevention Of Necrotizing Enterocolitis In Premature Infants Discussion Response

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia: Wolters Kluwer.

Sato, R., Malai, S., & Razmjouy, B. (2020). Necrotizing Enterocolitis reduction using an exclusive human‐milk diet and probiotic supplementation in infants with 1000–1499 Gram birth weight. Nutrition in Clinical Practice, 35(2), 331-334. https://doi.org/10.1002/ncp.10394

Thomas, J. P., Raine, T., Reddy, S., & Belteki, G. (2017). Probiotics for the prevention of necrotising enterocolitis in very low-birth-weight infants: A meta-analysis and systematic review. Acta Paediatrica, 106(11), 1729-1741. https://doi.org/10.1111/apa.13902 Prevention Of Necrotizing Enterocolitis In Premature Infants Discussion Response