Neonatology Fellow University of California, Irvine, School of Medicine Anaheim, California, United States
Background: Preterm infants are at increased risk for hypertriglyceridemia (HTG) due to their physiologic immaturity and reliance on intravenous lipid emulsions (ILE) as a source for essential fatty acids and calories when receiving parental nutrition. In particular, infants with birth weights (BW) less than 1000g and gestational age less than 28 weeks are at the highest risk of developing HTG. Across institutions and within our own institution there are inconsistencies in triglyceride (TG) monitoring and a lack of consensus about who and when to screen for HTG. Review of baseline data at our institution suggests that we are over-screening for HTG. Objective: The aim of our quality improvement project is to reduce the number of blood tests drawn for TG monitoring by 20% over 12 months. Design/Methods: After performing a retrospective chart review of all 189 preterm infants born at less than or equal to 1500g admitted to our NICU from 2020-2022, we found that the incidence of HTG (>300 mg/dL) was 13.6%. Of those infants with HTG, less than 10% had BW of over 1000g, and the overall incidence of HTG in infants with BW over 1000g was less than 2%. Additional analysis revealed inconsistencies in the ILE dose (in g/kg) at which the first TG level was checked as ILE doses were escalated. From this, we created and implemented new TG screening guidelines recommending only checking TG levels in infants born at less than or equal to 1000g unless medically indicated (septic shock, hypoxic ischemic encephalopathy, persistent hyperglycemia, etc.) and standardizing the first TG level to be checked at an ILE dose of 2g/kg. The primary outcome measure is the number of TG level tests per 1000 patient days. Process measures include guideline compliance via electronic medical record audits. Balancing measures include incidence of severe HTG > 500 mg/dL. Statistical process control charts will be used to track outcome measures over the 12 months after the creation and implementation of our new guidelines and future interventions with each PDSA cycle.
