Optimising early neonatal nutrition using translational research methodology

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Preterm birth has been described as a ‘nutritional emergency’, with these infants often born with minimal nutrition reserves. Failure to provide adequate early nutrition jeopardises growth and neurodevelopment. Consensual nutrition guidelines exist for infants who weigh <1500 g; however, audits have identified shortfalls in their adherence, consequently highlighting an evidence–practice gap. This work aimed to identify the barriers to the delivery of early optimal nutrition in a tertiary-level Neonatal Critical Care Unit to inform an implementation project to ensure best practice care.


A total of 19 medical and nursing staff participated in semistructured interviews. Transcripts underwent qualitative content analysis to examine barriers to early infant feeding. Barriers were categorised into domains from the Theoretical Domains Framework (TDF), and potential interventions were identified using evidence-based strategy selection guides that articulates with the TDF.


Four main themes, with associated sub-themes, emerged, including: (i) Roles and responsibilities, (ii) decision making, (iii) disconnect between beliefs and the application of evidence and (iv) monitoring and awareness. Eight barrier ‘domains’ were identified using TDF—Knowledge; memory, attention and decision processes; skills; professional/social role and identity; beliefs about capabilities; beliefs about consequences; environmental context and resources; and social influences.


Using a systematic approach to analysing barriers to early nutrition and mapping through the TDF and behaviour change wheel, the most effective interventions to modify practice have been identified. These will be monitored in ongoing audits.

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