Assistant Professor of Pediatrics University of South Dakota, Sanford School of Medicine Sioux Falls, South Dakota, United States
Background: Postnatal growth failure is a common problem among preterm (PT) infants born < 30 weeks’ gestation in the neonatal intensive care unit (NICU). PT infants are particularly vulnerable population at risk for developing malnutrition due to decreased nutrient stores, immature absorption and delayed initiation of nutrition. Moderate and severe malnutrition, as defined by a decline in z scores by >1.2 standard deviations, is associated with poor neurodevelopmental outcomes. Objective: The aim of this quality improvement (QI) project was to reduce the quarterly percentage of moderate/severe malnutrition from 50% to 40% among infants born less than 30 weeks’ gestation in a level III NICU by 10/1/2022. Design/Methods: Pre-implementation data (pre-I) was obtained from 32 patients born < 30 weeks’ gestation between 10/2018 through 6/2020 to evaluate: return to birth weight (BW), z-scores for weight, length, head circumference (HC) at birth/28 days/discharge, average protein intake days 0-6 and 7-14, start of intralipids (IL), feeding guidelines, length of stay (LOS), and degree of malnutrition. Nutrition bundle interventions were implemented during parenteral or enteral nutrition periods in PDSA cycles 5-21 in the post-implementation period (post-I) (9/2020 to 04/2023). To date, 83 patients have participated in post-I cohort. Results: We demonstrated an improvement of moderate to severe malnutrition to a mean of 16.75% from a mean of 40% in eight consecutive quarters following interventions. Clinical data analyses demonstrated that infants in the post-I group returned to BW sooner, had a smaller change in z-score for weight at 0-28 days and day 0 to discharge, and were less likely to experience any malnutrition compared to infants in the pre-I group (p < 0.05).
Conclusion(s): Challenges remain in providing adequate nutritional support to preterm infants to mimic growth rates to that of intrauterine growth. We have implemented evidence-based nutritional interventions to promote normal growth patterns but acknowledge there are multiple variables that influence postnatal growth that need further study.
