Major deficiencies found in the way hospitals provide artificial nutrition to sick babies
A national safety watchdog found problems in three quarters of the intravenous feeding it cases examined. Complications were avoidable in half the adult patients reviewed and premature babies were not always given the sustenance they needed, and delays were rife, the report added.
The report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) looked at more than 1,000 cases of artificial - or parenteral - nutrition in England, Wales and Northern Ireland.
A catalogue of problems were uncovered while reviewing questionnaires and case notes from England, Wales and Northern Ireland, the "Mixed Bag" report found.
They included failure to ensure the catheter was inserted by a trained clinician under suitably sterile conditions, as well as lapses in monitoring and assessment.
The report noted that intravenous feeding can cause fatal problems if not properly administered - from failure to take in enough calories and vitamins to blood poisoning - although the team did not itself uncover any deaths.
But it also found that in almost a third of adult cases it was being given where other forms of feeding via the gut were possible, putting patients at risk unnecessarily.
"There's a broader lack of understanding and knowledge of how to feed patients," said Dr James Stewart, NCEPOD clinical co-ordinator.
The group is also calling for greater consensus among neonatologists about best practice for pre-term babies after uncovering a "lottery" in the way in which infants were treated.
Out of the 264 cases reviewed, there were delays in recognising the need for artificial feeding in a third of cases, and further delays in starting treatment once a decision has been taken. In nearly 40% of cases, the first feeding provided was considered inadequate for the baby's need. Complications, it found, were avoidable in a fifth of the babies treated.
Guidelines
The fact that this "mainstay" of treatment for premature babies was not being offered consistently, or at the right levels, was a cause for concern, NCEPOD said, as all the scientific evidence suggests such feeding improves growth and development.
The inquiry called for the clinical watchdog NICE to develop guidelines on nutritional support for newborns, urging that the need for artificial feeding be considered early and once decision taken, administered immediately.
Health Minister Anne Milton said it was "simply not acceptable that patients - who are already very ill - get a 'mixed bag' service from the NHS on such an important treatment".
"Clinical leaders across the health service should look carefully at the recommendations, review the service offered at their hospitals, and make improvements to patient care as a matter of urgency," she said.
Commenting on the findings, Susan Brown a top ranked medical negligence lawyer from Thames Valley law firm Boyes Turner said: “We are contacted by many parents of sick and premature babies where injury has occurred as a result of failings in the care provided in the first few weeks of the baby’s life. Let's hope that the recommendation to agree a best practice for the nutrition of premature babies is actioned so that outcomes are improved and unnecessary harm and suffering avoided.”
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