Implementation, Process, and Outcomes of Nutrition Best Practices for Infants <1500 g

• Published in: Nutrition in clinical practice 2011-10, Vol.26 (5), p.614-624
• Main Authors: Hanson, Corrine, Sundermeier, Julie, Dugick, Laura, Lyden, Elizabeth, Anderson-Berry, Ann L.
• Format: Article
• Language: English
• Subjects: Algorithms; Body Weight; Dietary Proteins - administration & dosage; Enterocolitis, Necrotizing; Feeding Behavior; Female; Gestational Age; growth; Growth Disorders - complications; Growth Disorders - therapy; Humans; infant; Infant, Newborn; infant, premature; Infant, Premature - growth & development; Infant, Premature, Diseases - therapy; Infant, Very Low Birth Weight - growth & development; Lung Diseases - prevention & control; Male; Milk, Human; Nursing; nutrition; Nutritional Support; Practice Guidelines as Topic; Retrospective Studies
• ISSN: 0884-5336; 1941-2452
• DOI: 10.1177/0884533611418984

Background: Extrauterine growth restriction (EUGR; weight ≤10th percentile) affects many infants ≤1500 g birth weight (BW). EUGR is associated with poor neurodevelopmental outcomes. The objective of this study was to evaluate the impact of optimizing nutrition administration in infants ≤1500 g. Methods: A retrospective chart review compared infants ≤1500 g before (n = 32) and after (n = 49) implementation of nutrition practice changes designed to decrease EUGR. Changes included early aggressive parenteral nutrition (PN), early enteral feedings, trophic feedings, continuous feeding administration, protein fortification of 24-cal/oz mother’s own breast milk, and development of a “feeding intolerance” algorithm. The authors evaluated demographics, growth parameters, secondary feeding, and discharge outcomes. Differences in subgroups of infants ≤1000 g and 1000–1500 g BW were assessed. Results: Implementation of the nutrition practice changes decreased EUGR as defined by weight ≤10th percentile at discharge from 57% in the preimplementation group to 28% in the postimplementation group (P = .01). Weight percentile ranking at 36 weeks’ gestational age increased significantly in infants 1001–1500 g, from the 13th to the 27th percentile (P = .004 and P = .01, respectively). Chronic lung disease decreased significantly (P = .02). There was no increase in necrotizing enterocolitis (6% pre vs 3% post) or in blood urea nitrogen. Days of PN and central line use were decreased (P = .02 and P = .07, respectively). Conclusions: Clearly defined changes in nutrition for infants ≤1500 g significantly improved growth outcomes without increasing undesired outcomes.