A standardized nutrition approach for very low birth weight neonates improves outcomes, reduces cost and is not associated with increased rates of necrotizing enterocolitis, sepsis or mortality

Butler, Thomas J.; Szekely, L J; Grow, Jennifer L.

doi:10.1038/jp.2013.66

Cited by 36 publications

(43 citation statements)

References 25 publications

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“…Basing feeding decisions on gastric residuals in the neonate is challenging, as there is considerable overlap in residual characteristics among those with and without pathology 12 . ‐ 14 Regardless, feeding protocols that detail both evaluation of and suggested clinical response to gastric residuals can still allow for improved feeding outcomes in neonatal populations 15 …”

Section: Question 3: What Clinical Factors Should Be Assessed To Detementioning

confidence: 99%

“…Nutrition protocols have been effective quality improvement interventions, reducing the time to achieve nutrition goals, including transitioning off PN to full EN, while also lowering costs 24 , 25 . In a large tertiary pediatric institution, the development and implementation of PN guidelines resulted in a marked reduction in PN courses that lasted less than 5 days, a cutoff that the authors used as an indicator of inappropriate PN use 21 .…”

Section: Question 14: How Should Healthcare Organizations Track/monitmentioning

confidence: 99%

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When Is Parenteral Nutrition Appropriate?

Worthington

Balint

Bechtold

et al. 2017

J Parenter Enteral Nutr

180

202

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Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur. In an effort to provide clinical guidance regarding PN therapy, the Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) convened a task force to develop consensus recommendations regarding appropriate PN use. The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy. These consensus recommendations build on previous ASPEN clinical guidelines and consensus recommendations for PN safety. They are intended to guide evidence-based decisions regarding appropriate PN use for organizations and individual professionals, including physicians, nurses, dietitians, pharmacists, and other clinicians involved in providing PN. They not only support decisions related to initiating and managing PN but also serve as a guide for developing quality monitoring tools for PN and for identifying areas for further research. Finally, the recommendations contained within the document are also designed to inform decisions made by additional stakeholders, such as policy makers and third-party payers, by providing current perspectives regarding the use of PN in a variety of healthcare settings. (JPEN J Parenter Enteral Nutr. 2017;41:324-377) The etiology-based nutrition diagnoses in adults in clinical practice settings are as follows: Starvation-related malnutrition: Chronic starvation without inflammation (eg, anorexia nervosa). Chronic disease-related malnutrition: Inflammation is chronicand of mild to moderate degree (eg, organ failure, pancreatic cancer, rheumatoid arthritis, sarcopenic obesity). Acute disease or injury-related malnutrition:Inflammation is acute and of severe degree (eg, major infection burns, trauma, closed head injury). 2,3Malnutrition, pediatric: An imbalance between nutrient requirement and intake, resulting in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes. It is recommended that growth charts based on a standard deviation z score system be used to track and assess nutrition status in children. 4,5Nutritionally-at-risk: Consider the individual nutritionally-atrisk if any of the following is present. Nutritionally-At-Risk Adult Summary of RecommendationsThese consensus recommendations are designed to identify best practices, guide day-to-day clinical decisions, reduce variations in practice, and enhance patient safety. They are not intended to supersede the judgment of the healthcare professional based on the circumstances of the individual patient.

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Section: Question 3: What Clinical Factors Should Be Assessed To Detementioning

confidence: 99%

Section: Question 14: How Should Healthcare Organizations Track/monitmentioning

confidence: 99%

When Is Parenteral Nutrition Appropriate?

Worthington

Balint

Bechtold

et al. 2017

J Parenter Enteral Nutr

180

202

View full text Add to dashboard Cite

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“…Studies have shown that the use of preterm feeding protocols in the NICU can improve feeding tolerance and decrease the risk for NEC . They have also shown reduced PN use and days to full feeds, reduced late‐onset sepsis, fewer line days, and improved growth . The focus of our study was to measure the neonatal outcomes from use of a nutrition protocol during the NICU stay.…”

Section: Introductionmentioning

confidence: 99%

“…[17][18][19] They have also shown reduced PN use and days to full feeds, reduced late-onset sepsis, fewer line days, and improved growth. [18][19][20][21] The focus of our study was to measure the neonatal outcomes from use of a nutrition protocol during the NICU stay. Our primary outcome measures were to see if a nutrition protocol made a difference in growth outcomes (weight, length, and head circumference), the number of days made nil per os (NPO) after feeding initiation, PN days, and NEC.…”

Section: Introductionmentioning

confidence: 99%

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

Barr

Mally

Caprio

2018

J Parenter Enteral Nutr

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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.

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“…In one study, a NICU feeding protocol decreased PN duration by approximately 5 days, in turn leading to a significant reduction in cost: approximately $385,000 in hospital savings in 1 year. 75 …”

Section: Cost Of Pn Complicationsmentioning

confidence: 99%

Complications Associated with Parenteral Nutrition in the Neonate

Calkins

Venick

Devaskar

2014

Clinics in Perinatology

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Parenteral nutrition (PN) is essential to the practice of neonatology. While PN is life-sustaining, it associated with a host of complications including parenteral nutrition-associated liver disease (PNALD) and central line-associated bloodstream infections (CLASBIs), which carry a high morbidity and mortality and pose a burden to the healthcare system. Evidence has emerged that the dose and composition of intravenous lipid products can alter the incidence of PNALD and CLASBIs. However, other patient- and PN-related factors, such as prematurity, birth weight, and gastrointestinal anatomy and function, must not be ignored. In order improve neonatal care, future research is still needed to optimize the content of PN and decrease the incidence PNALD and CLASBIs.

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A standardized nutrition approach for very low birth weight neonates improves outcomes, reduces cost and is not associated with increased rates of necrotizing enterocolitis, sepsis or mortality

Cited by 36 publications

References 25 publications

When Is Parenteral Nutrition Appropriate?

When Is Parenteral Nutrition Appropriate?

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

Complications Associated with Parenteral Nutrition in the Neonate

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