Assistant Professor University of Arkansas for Medical Sciences College of Medicine North Little Rock, Arkansas, United States
Background: Inadequate nutrition early in life is a significant contributor to preterm infants' poor growth and neurodevelopmental impairment. Hospital feeding protocols have proven highly effective at improving outcomes. Protocols handle typically developing patients. The highly specific needs of patients with unique challenges require further nuance. A Nutrition Rounds paradigm was established to appropriately monitor and when necessary, deviate from protocol, nutrition decisions for patients with exceptional feeding and growth challenges. Objective: The purpose of this work was to evaluate the effectiveness of individualized nutrition plans for infants at high risk of growth failure. These rounds utilize a process by which patients with unique feeding and growth challenges are followed and the impact of care plan changes are compared to a matched peer cohort with respect to growth and discharge metrics. Design/Methods: From 8/1/2022 until 10/28/23, 90 patients were enrolled in Nutrition Rounds (NR): NR patients were born under 25 weeks GA or under the 1st %entile for weight, diagnosed with bowel perforation or presence of an ostomy, TPN induced cholestasis (PNALD, parenteral nutrition associated liver disease), or exhibiting growth challenges. A 109-patient cohort of similarly diagnosed patients admitted between 1/1/21 and 8/1/22 was created as a control group (CG). Outcomes and detailed care decisions of NR and CG were analyzed utilizing the NICUtrition™ application. Further analysis was performed on sub-cohorts of both groups that were admitted prior to their 10th day of life (n=47) and a further filtering for those that were also born under 29 weeks GA (N=26). Results: Measurable changes were observed in care, notably a marked and statistically significant increase in the use of Human Milk in the NR patients with p-value of 0.007 when measuring % of total diet comprised of human milk. Improvements in Z-Score deltas from birth to 34 weeks PMA (-0.62 vs -0.77) and 36 weeks PMA (-0.77 vs -0.86 ) were observed. Days receiving PN also improved for our earliest babies - 46.19 days vs. 52.23. Finally, overall length of stay for this youngest sub-cohort was shortened considerably from 167.48 days to 124.77 days) which is clinically important with a P-Value of 0.13 approaching statistical significance.
Conclusion(s): Implementing and executing regular rounds focused on personalized nutritional needs for our most vulnerable and challenging patients in the context of our existing protocol has resulted in additional improvements in development and critical clinical milestone achievements. .
