Baylor College of Medicine

Problem:

Improved obstetrical care, as well as management and outcome of neonatal respiratory failure, has resulted in the survival of large numbers of extremely precarious low birth weight infants requiring prolonged nutritional support. Few nutritionists or other health care professionals in the state, region, or nation have been exposed to the theory or changing nutritional management of these infants. Because neonatal nutrition management has and continues to rapidly change, update programs are needed for all health care team members.

Goals and Objectives:

The goal of this training project is to update knowledge and expertise in the nutritional management of high-risk infants in the newborn intensive care unit and in the community setting and to prepare nutritionists to become leaders in the advocacy of care for infants with special care needs. Specific objectives of the proposal: 1. Annual Neonatal Nutrition Conference for health care providers of high-risk neonates. 2. One Week Neonatal Nutrition Practicums for twelve nutritionists per year who work with high-risk infants. 3. Three Month Neonatal Nutrition Fellowships for four Registered Dietitians per year who desire to develop expertise in the nutritional management of high-risk neonates.

Methodology:

The annual nutrition conference is a three-day program. Three 45-minute lectures with topics of similar focus are placed together. Questions and answers follow each discussion to allow for clarification of issues and to further discussion. In addition, small group workshops are given. The conference dates, speakers, etc, are publicized in nutrition, pediatric and nursing journals, web sites, and list serves. The program flyers are mailed to state and regional nutrition consultants and to health care providers for high-risk infants. At the beginning of the program, each conferee receives a syllabus that includes a summary and reference list for each presentation. Continuing education credit is provided for physicians, nurses, dietitians and lactation consultants. The one-week neonatal nutrition update program is designed for nutritionists who work with high-risk infants in neonatal intensive care units or in community settings. Four nutritionists are enrolled per program to allow for individualization of the course and to facilitate participant interaction. They spend a week in daily discussions with neonatologists and neonatal nutritionists reviewing nutrition support of low birth weight and/or premature infants. Reference texts and pertinent articles are made available to each participant and practical experience in the newborn intensive care unit is an integral part of the program. Participants pay no registration fee and reasonably priced housing is available within 5 minutes walking distance from the Texas Children's Hospital. Continuing professional education units are awarded. The purpose of the three-month neonatal fellowship program is to train registered dietitians to become specialized in the nutritional management of high-risk infants both in the hospital and in the post discharge community setting. There is a core-training program for the fellowship, which presents a basic block of nutrition information to each participant regarding nutrition principles and their clinical application. The program consists of assigned readings with discussions and completion of case studies, special projects and in service education. Clinical work in the hospital, clinic and home setting is performed.

Coordination:

The Advisory Planning Committee is comprised of state, regional and national representatives. Regional and national input is represented by the Regional Nutrition Consultant, the federal level public health nutritionist with the Maternal and Child Health Bureau, Nutrition Discipline Coordinator for a State LEND program, and neonatal nutrition researchers from the University of Iowa, Medical University of South Carolina and Baylor College of Medicine. A strong link has been developed between the Baylor College of Medicine, the Texas Department of Health, and the Early Childhood Intervention Program. Nutrition consultants provide overviews on the integration of nutrition and maternal and child health services throughout the city, state and country. Training of the fellows and one-week participants is conducted at the Baylor Affiliated Hospitals.

Evaluation:

Written evaluations are submitted at the end of each training program and approximately 6 weeks after the courses are completed by participants. These evaluations identify the strengths and weaknesses, and suggest needed changes for subsequent programs, and describe how the participants are using the information presented at the training sessions in their work setting.

Experience to Date:

During this period, 2 Neonatal Nutrition Conference was held. Six hundred and seventy-one participants attended the program that was represented by 136 physicians, 81 nurses, 416 nutritionists and 38 participants of other health care professions. Thirty-seven nutritionists participated in the one-week neonatal nutrition practicums and 12 nutritionists in the Three-Month Neonatal Nutrition Fellowships.