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Best Practices in Nursing: Development of the Neonatal Microbiome

Purpose of this thesis: The purpose of this thesis is to identify best practice recommendations
for nurses and new parents to encourage optimal microbiome development in neonates through a
variety of elective influences. Education of both parties regarding elective measures that
surround childbirth may result in neonates with the most optimal microbiome. By delving into
the literature and compiling a best practice protocol for infant microbiome development, this
thesis will address an important aspect of nursing that is currently lacking.
Background: Newborn care practices immediately following delivery are dependent on the
setting, maternal decisions, prior education, and risks specific to each family. With almost four
million infants born in the United States in the last year, practices focused on proper newborn
microbiome development are especially important to foster optimal health in infants. This best
practice thesis will focus on elective postnatal choices that the parents may initiate to encourage
microbiota development. Specifically, bifidobacteria plays a dominant role in a healthy
microbiome formation, with proper colonization leading to fewer infections, fewer Clostridia
species colonized in the gut, and reduced allergic responses. Although the effects of proper
microbiome are especially important for an infant’s health, the nursing staff must also be aware
of the positive health benefits for the child’s long-term growth. Very little research has been
done on this topic and the best practice methods for patient care in this area have yet to be
implemented.
Brief description of the thesis: This research based thesis includes a literature search conducted
using PubMed, CINAHL, and Google Scholar with the following keywords: neonatal
microbiome, infant gut microbiota, delayed bathing, and vaginal seeding. Articles were narrowed
to those published from 2007 to 2017. A total of 20 articles were reviewed in this thesis, ranging
from randomized control trials to cohort studies. The proposed best practice model for postnatal
practice include vaginal birth when not medically contraindicated, exclusive breastfeeding for up
to 6 months, delayed bathing for up to 24 hours, use of skin-to-skin contact immediately
following delivery, and limiting antibiotic exposure to the infant. Through education to both the
nursing staff and the expecting families, hospitals will be able to implement these practices when
it is safe to do so for the mother-infant dyad. The aim of these proposed best practice
recommendations is to educate health care professionals and expectant families on choices that
encourage optimal microbiome development for their newborns, while minimizing adverse
effects from improper microbiome development. To educate the patients an educational
pamphlet will be developed and a theoretical implementation and evaluation will be conducted.
Educating the nurses would also be pivotal to implementing this change, as the nurses have a
responsibility to educate the expectant parents on the evidence supporting these interventions. As
more evidence becomes available recommendations can be adjusted to reflect practices that will
be most beneficial to the infant’s microbiome development.
Plan: This thesis will be completed over the course of four semesters. In the first semester, the
student began a literature review and decided on a final topic for the thesis. In the second and
third semester, the student completed chapter one to three of the thesis. In addition, the thesis
committee was finalized. During third semester, the student nurse will complete and submit an
abstract to the Western Institute of Nursing Conference. In the fourth and final semester, the
student will complete chapter four. There will also be a final committee meeting where the
student will present her final project. In addition to this presentation, the student will present her
finalized project at either the Western Institute of Nursing conference or at a college of nursing
course. In terms of meetings, the student and the advisor will meet two to three times a semester
and additionally as needed. To summarize, the committee will meet twice, once upon completion
of chapters one through three and once after the final project. The final thesis will be evaluated
based on satisfactory, scholarly completion.