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. 2023 Sep;43(9):1105-1112.
doi: 10.1038/s41372-023-01675-8. Epub 2023 Apr 29.

A decade of evidence: standardized feeding initiative targeting feeding milestones and predicting NICU stays in premature infants in an all-referral level IV NICU

Erika K Osborn  1 , Enas Alshaikh  1 , Leif D Nelin  2 , Sudarshan R Jadcherla  3   4   5
Affiliations

A decade of evidence: standardized feeding initiative targeting feeding milestones and predicting NICU stays in premature infants in an all-referral level IV NICU

Erika K Osborn et al. J Perinatol. 2023 Sep.

Abstract

Objective: Ten-year data from the simplified, individualized, milestone-targeted, pragmatic, longitudinal and educational (SIMPLE) feeding initiative were examined by gestational age (GA) category to characterize the feeding milestones, length of hospital stays (LOHS), annual variability and predictive models for LOHS.

Study design: Preterm infants (≤32 weeks GA, N = 434) in level-IV NICU had milestone-targeted feeding plans. Continuous data were analyzed for outcomes.

Results: Over 93% successfully attained full oral feedings. Earlier acquisition of feeding milestones correlated with earlier discharge (P < 0.05). Year-wise analysis showed sustained maintenance of milestones (P < 0.05). Milestones and outcomes (P < 0.001) were significantly correlated with different GA categories. Prediction models for LOHS were derived using GA, BPD, age at full enteral, postmenstrual age (PMA) at 1st and full oral feeds.

Conclusions: The SIMPLE feeding program minimized variability and promoted acquisition of feeding milestones consistently. LOHS is predictable using feeding milestones, co-morbidities, GA, and PMA at feeding milestones.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Feeding Milestones and Hospital Stay by Gestational Age.
Boxplots illustrate the distribution among the three gestational groups for feeding (A–D) and economic milestones (E, F). Note that the diamond (◊) represents the mean, and the solid line inside the boxplot represents the median.
Fig. 2
Fig. 2. Correlation of Feeding Milestones with PMA at Discharge.
Scatter plots show relationships between PMA at discharge and feeding milestones of DOL at first (A) and full (B) enteral feeds and PMA at first (C) and full (D) oral feeds). The line represents the regression best fit. r: Pearson correlation. A significant correlation was noted between acquisition of all feeding milestones and earlier PMA at discharge, specifically with PMA at first oral feed and PMA at full oral feed.
Fig. 3
Fig. 3. Feeding Milestones, LOHS, and PMA @ Discharge over 10 Years.
Boxplots illustrate the yearly distribution for feeding milestones (A–D) and economic outcomes (E, F); note that improvements were maintained and variability was decreased throughout the study period. The star represents the mean and the solid line the median. The discharge outliers are shown as blue dots and diamonds; (•) represent those with full oral feeding; and the diamond (◊) represents tube feeding at discharge.
See this image and copyright information in PMC

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