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. 2015 Jul 20;10(7):e0132584.
doi: 10.1371/journal.pone.0132584. eCollection 2015.

Quantification of EUGR as a Measure of the Quality of Nutritional Care of Premature Infants

Zhenlang Lin  1 , Robert S Green  2 , Shangqin Chen  1 , Hui Wu  3 , Tiantian Liu  3 , Jingyang Li  1 , Jia Wei  1 , Jing Lin  4
Affiliations

Quantification of EUGR as a Measure of the Quality of Nutritional Care of Premature Infants

Zhenlang Lin et al. PLoS One. .

Abstract

Objectives: To develop an index of the quality of nutritional care of premature infants based on the change in weight Z score from birth to discharge and to illustrate the use of this index in comparing the performance of different NICUs.

Methods: Retrospective data analysis was performed to compare the growth of premature infants born in three perinatal centers. Infants with gestational age ≤ 32 weeks who survived to discharge from 2006 to 2010 were included. Weight Z scores at birth and discharge were calculated by the method of Fenton. Using data from one NICU as the reference, a multivariable linear regression model of change in weight Z score from birth to discharge was developed. Employing this model, a benchmark value of change in weight Z score was calculated for each baby. The difference between this calculated benchmark value and the baby's observed change in weight Z score was defined as the performance gap for that infant. The average value of the performance gaps in a NICU serves as its quality care index.

Results: 1,714 infants were included for analysis. Change in weight Z score is influenced by birth weight Z score and completed weeks of gestation; thus the model for calculating the benchmark change in weight Z score was adjusted for these two variables. We found statistically significant differences in the average performance gaps for the three units.

Conclusions: A quality care index was developed based on change in weight Z score from birth to discharge adjusted for two initial risk factors. This objective, easily calculated index may be used as a measurement of the quality of nutritional care to rank the performance of different NICUs.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Discharge weight Z score as a function of birth weight Z score for all three NICUs.
The regression lines for the three NICUs are for Mount Sinai, y = 0.61x–0.98 (R2 = 0.36, p<0.001); for China 1, y = 0.71x–1.32 (R2 = 0.44, p<0.001); and for China 2, y = 0.65x–1.62 (R2 = 0.44, p<0.001). Thus, the y intercepts for all three NICUs are <0 and the slopes for all three NICUs are <1, reflecting EUGR.
Fig 2
Fig 2. Change in weight Z score from birth to discharge vs. birth weight Z score for the reference NICU (Mount Sinai).
Regression line: y = -0.387x-0.980, R2 = 0.192 (p<0.001).
Fig 3
Fig 3. Change in weight Z score from birth to discharge (mean ± SD) vs. completed weeks gestation at birth for reference NICU (Mount Sinai).
Regression line y = 0.066x-2.867, R2 = 0.063 (p<0.001).
Fig 4
Fig 4. Observed and benchmark values of change in weight Z score from birth to discharge for the three NICUs.
The benchmark values for the three NICUs do not differ significantly (p>0.05). The observed values for the two Chinese NICUs differ from that of Mount Sinai, from each other, and from their benchmark values (p<0.001 for all the comparisons). Per model design, the observed and benchmark values are the same for the Mount Sinai NICU.
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