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Standardized Nutrition Protocol for Very Low‐Birth‐Weight Infants Resulted in Less Use of Parenteral Nutrition and Associated Complications, Better Growth, and Lower Rates of Necrotizing Enterocolitis
Author(s) -
Barr Priscilla A.,
Mally Pradeep V.,
Caprio Martha C.
Publication year - 2019
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1453
Subject(s) - necrotizing enterocolitis , parenteral nutrition , medicine , low birth weight , protocol (science) , enterocolitis , pediatrics , intensive care medicine , pregnancy , biology , pathology , genetics , alternative medicine
Abstract Background We assessed the impact of a standardized nutrition initiative for very low‐birth‐weight (VLBW) infants on their nutrition and clinical outcomes. Methods This was a prospective analysis of VLBW infants born before and after the initiation of a nutrition protocol. This protocol included trophic feeds, feeding advancement, fortification guidelines, parameters on the concentration of parenteral nutrition (PN), and the discontinuation of PN and central lines. Gastric residual monitoring was discontinued. Statistical analyses were performed with Fisher's exact and Student's t ‐tests. Primary outcome measures were days receiving PN, days made nil per os (NPO) after feeding initiation, necrotizing enterocolitis, and growth parameters. Secondary outcome measures were central‐line days, sepsis, blood transfusions, cholestasis, osteopenia, chronic lung disease, and retinopathy of prematurity. Results 136 VLBW infants were analyzed, including 77 in the preprotocol group and 59 in the postprotocol group. Infants postprotocol were found to have reduced PN days (26.1 versus [vs] 18.4, P < .01), fewer days made NPO after feeding initiation (7.2 vs 4.0, P = .02), NEC (7.8% vs 0%, P = 0.038), central‐line days (26.5 vs 18.6, P < .01), cholestasis (16% vs 3%, P = .02), and blood transfusions (5.3 vs 3.1, P = .028). Growth, defined by change in z ‐score from birth to discharge, improved for weight (−1.3 vs −0.8, P < .01), length (−1.5 vs −1.0, P = .033), and head (−1.1 vs −0.6, P = .024). Conclusion Initiation of a standardized nutrition initiative for VLBW infants significantly improved growth, reduced PN use, and improved patient outcomes.