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. 2020 Dec 28;6(1):e366.
doi: 10.1097/pq9.0000000000000366. eCollection 2021 Jan-Feb.

An Initiative to Reduce Preterm Infants Pre-discharge Growth Failure Through Time-specific Feeding Volume Increase

Sherman S Chu  1 , Heather O White  1 , Shannon L Rindone  1 , Susan A Tripp  1 , Lawrence M Rhein  1
Affiliations

An Initiative to Reduce Preterm Infants Pre-discharge Growth Failure Through Time-specific Feeding Volume Increase

Sherman S Chu et al. Pediatr Qual Saf. .

Abstract

Very low birth weight infants often demonstrate poor postnatal longitudinal growth, which negatively impacts survival rates and long-term health outcomes. Improving extrauterine growth restriction (EUGR) among extremely premature infants has become a significant focus of quality improvement initiatives. Prior efforts in the University of Massachusetts Memorial Medical Center neonatal intensive care unit were unsuccessful in improving the EUGR rate at discharge.

Methods: The primary aim of this initiative was to improve EUGR at discharge [defined as weight less than 10th percentile for postmenstrual age (PMA)] for infants born ≤32 0/7 weeks from a baseline of 25% to 20% by June 2019. We excluded all small for gestational age infants due to the limitation in the EUGR definition. A multidisciplinary team implemented evidence-based nutritional guideline changes using the Institute of Healthcare Improvement methods. The most notable change was the time-specific feeding volume advancement that increased the goal feeding volume between 31 0/7 and 34 0/7 weeks PMA from 150-160 to 170-180 milliliters per kilogram per day. The team monitored nutritional intake, weight, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and length of stay (LOS).

Results: The EUGR rate improved from 25% to 12% after initiation of increased time-specific, enteral feeding guidelines at 31-34 weeks PMA. NEC rate, BPD rate, and LOS remained unchanged throughout the initiative.

Conclusions: By implementing a time-specific volume increase guideline from 31 0/7 to 34 0/7 weeks PMA, the EUGR rate improved from baseline of 25% to 12% without increasing NEC rate, BPD rate, and LOS.

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Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Nutrition guideline history: how to increase the caloric content of breast milk using human milk fortifier and liquid protein. 1Similac, Abbott Laboratories, Columbus, OH; 2Abbott Nutrition, Abbott Laboratories, Columbus, OH; 3Nestle Health Science, Nestle HealthCare Nutrition, Inc, Bridgewater, NJ.
Fig. 2.
Fig. 2.
Key driver diagram to reduce EUGR at discharge for infants born less than or equal to 32 0/7 weeks. Gray indicates prior initiatives. TPN, total parenteral nutrition.
Fig. 3.
Fig. 3.
PDSA ramp cycles to establish enteral feeding guideline changes.
Fig. 4.
Fig. 4.
P chart of extrauterine growth failure rate at discharge at UMMMC for infants born less than or equal to 32 0/7 weeks GA. 1PDSA cycle timeline, please refer to Figure 2 for full list of PDSA cycles included and their initiation dates.
Fig. 5.
Fig. 5.
P chart of volume increase guideline compliance for all infants born less than or equal to 32 0/7 weeks GA.
Fig. 6.
Fig. 6.
Balancing measures for feeding volume increase. A, P chart of infants born less than or equal to 32 0/7 weeks GA diagnosed with BPD at UMMMC. B, T chart displaying duration (days) between each incidence of NEC occurring in infants born less than or equal to 32 0/7 weeks.
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References

    1. Ehrenkranz RA, Dusick AM, Vohr BR, et al. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics. 2006; 117:1253–1261 - PubMed
    1. Stephens BE, Walden RV, Gargus RA, et al. First-week protein and energy intakes are associated with 18-month developmental outcomes in extremely low birth weight infants. Pediatrics. 2009; 123:1337–1343 - PubMed
    1. Franz AR, Pohlandt F, Bode H, et al. Intrauterine, early neonatal, and postdischarge growth and neurodevelopmental outcome at 5.4 years in extremely preterm infants after intensive neonatal nutritional support. Pediatrics. 2009; 123:e101–e109 - PubMed
    1. Martin CR, Brown YF, Ehrenkranz RA, et al. ; Extremely Low Gestational Age Newborns Study Investigators. Nutritional practices and growth velocity in the first month of life in extremely premature infants. Pediatrics. 2009; 124:649–657 - PMC - PubMed
    1. Cooke RJ, Ainsworth SB, Fenton AC. Postnatal growth retardation: a universal problem in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2004; 89:F428–F430 - PMC - PubMed