Wednesday, December 21, 2011

Evidence Based Practice

This week at work has been incredibly quiet. By quiet I mean boring.  I’ve only had one client and was caught up on my charting and all my work at the end of last week so I didn’t really leave myself much to do this week.  I’ve been passing the time reading journal articles and catching up on the most current nutrition research.  I’m sure this time next month I’ll be wishing for an afternoon to read and catch up so I’m trying to take advantage of the office being slow while I can.

Despite the quiet, I did have one cool project this week!  We have a mom of a premature baby who is in the process of switching from breast milk with added human milk fortifier to formula and wanted to know how long she should keep her baby on specialized formula for preemies.  There are a ton of different formula products out there formulated specifically for different conditions and stages of infancy.  The formulas designed for premature babies are higher in calories (22-24 kcal/fl oz versus 20 kcal/fl oz for full term formulas) and are higher in protein, vitamins and minerals. I didn’t know the answer to this question off hand; my initial assumption was to keep the baby on preemie formula while tracking growth very regularly and once the baby has achieved healthy growth patterns they could be switched to regular formula.  However, I didn’t really want to give a recommendation without knowing exactly what the research and official recommendations were.  As Registered Dietitians we use Evidenced Based Practice, which means we use the latest research to make recommendations to clients and to develop all of our interventions. We had an Evidence Based Practice course at UPEI where our project was to pick a random nutrition related question and answer it in a paper using evidence from our own research.  The point of the class was to learn how to evaluate research papers to determine if the research itself was strong enough to base recommendations off.  Anyways, it was time consuming and a huge pain, especially considering the paper took all semester to write and was only a max of 4 pages.  But I did learn a lot from that class. I really liked going through research articles and finding the limitations to the studies and flaws in their methods and having to decide if it was applicable to the population of my question.

Since I had a lot of free time this week for reading, I decided to tackle the question of the preemie baby formula in the same way.  I didn’t realize I was doing it until I was perusing through the Cochrane Library via the UPEI library website and had a flash back of 4th year university.  It made me happy that I was actually using skills and methods I learned in University to solve real life Dietitian problems.  There were a lot of classes in University that I have never once used and that I am fairly confident I will never ever use in either my practice or my real life.  I loved UPEI and am so glad I chose to do my undergrad there and using this process made me realize just how awesome my program was and how lucky I was to have gone through a University program that actually prepared me to join the work force.  There are not a ton of programs that do that anymore.

Based on the research, there is no strong evidence that giving a premature baby specialized premature formula after hospital discharge impacts growth or development.  Babies are smart, and the evidence shows that preemies who aren’t on specialized formulas simply take in more of the regular formula to make up the different in the calories, vitamins and minerals. There is some evidence that these formulas can result in greater growth if provided for at least 6 months, but this was only evident in very small birth weight infants weighing < 1000-1250 g, which the baby in question is not.  So long story short is that this baby is following a normal growth curve and is currently doing well.  While providing him with specialized formula will likely do no harm, it hasn’t been shown to provide benefit either.  This answer seems really fluffy…it doesn’t actually contain a concrete recommendation for what mom should do, but based on the evidence it’s all I can really tell her.  I used to be really frustrated by the fact that often the evidence isn’t available for us to make definite recommendations and felt like we weren’t really answering the questions asked of us as Dietitians.  However, I am glad that we can tell people what the most current research is saying and allow them to make their own decisions based on fact.

Today is my last day of work until the new year! I’m getting antsy to get home. I’ve never travelled this close to Christmas though and am slightly terrified of what the airports are going to be like on the 23rd of December.

1 comment:

  1. Is this mother breastfeeding as well? I thought that breastfeeding is always the best. the mother's body will supply what the baby needs.