Impact of Process Optimization and Quality Improvement Measures on Neonatal Feeding Outcomes at an All‐Referral Neonatal Intensive Care Unit

Jadcherla, Sudarshan R.; Dail, James; Malkar, Manish B.; McClead, Richard E.; Kelleher, Kelly J.; Nelin, Leif D.

doi:10.1177/0148607115571667

Cited by 39 publications

(40 citation statements)

References 50 publications

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“…The feasibility of such an approach, validation of diagnostic methods and description of specific strategies has been reported earlier (17, 18, 20). In brief, neonatal nurses and nurse practitioners, neonatologists, pediatric surgeons, pediatric gastroenterologists, and parents requested referrals for evaluation of oropharyngeal dysphagia, gastroesophageal reflux disease (GERD), and for g-tube placement, and/or fundoplication.…”

Section: Methodsmentioning

confidence: 83%

“…Strategies included: a) education regarding factors that are helping or impeding feeding progress; b) monitoring nutrition and growth; and c) personalized guidance for feeding delays. (20) Feeding related education was provided to nurses, feeding therapists, and parents to ensure compliance to the directions. Each infant’s self-regulatory behaviors and tolerance to positional changes were noted and bedside providers were taught to respond to these behaviors.…”

Section: Methodsmentioning

confidence: 99%

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Feeding Methods at Discharge Predict Long-Term Feeding and Neurodevelopmental Outcomes in Preterm Infants Referred for Gastrostomy Evaluation

Jadcherla

Khot

Moore

et al. 2017

The Journal of Pediatrics

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Objective To test the hypothesis that oral (PO) feeding at first neonatal intensive care unit (NICU) discharge is associated with less neurodevelopmental impairment and better feeding milestones, as compared with discharge with a gastrostomy tube (g-tube). Study design We studied outcomes for a retrospective cohort of 194 neonates < 37 weeks gestation referred for evaluation and management of feeding difficulties between July 2006–July 2012. Discharge milestones, length of hospitalization, and Bayley Scales of Infant Development scores at 18–24 months were examined. Chi-Square, Mann-Whitney U, or t-tests and multivariable logistic regression models were used. Results 60% (n=117) of infants were discharged on PO feedings; of these, 96% remained PO-fed at 1-year. The remaining 40% (n=77) were discharged on g-tube feedings; of these, 31 (40%) remained g-tube dependent, 17 (22%) became PO-fed, and 29 (38%) were on PO and g-tube feedings at one year. Infants discharged on a g-tube had lower cognitive (p<0.01), communication (p=0.03), and motor (p<0.01) composite scores. The presence of a g-tube, younger gestation, bronchopulmonary dysplasia, or intraventricular hemorrhage was significantly associated with neurodevelopmental delay. Conclusions For infants referred for feeding concerns, g-tube evaluations and feeding management, the majority did not require a g-tube. Full PO feeding at first NICU discharge was associated with superior feeding milestones and less long-term neurodevelopmental impairment, relative to full or partial g-tube feeding. Evaluation and feeding management before and after g-tube placement may improve long-term feeding and neurodevelopmental outcomes.

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Section: Methodsmentioning

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Feeding Methods at Discharge Predict Long-Term Feeding and Neurodevelopmental Outcomes in Preterm Infants Referred for Gastrostomy Evaluation

Jadcherla

Khot

Moore

et al. 2017

The Journal of Pediatrics

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“…The ability to reach full enteral feeds and full oral feeds sooner in over 81% and 72% of the subjects respectively is noteworthy. 90 Furthermore, this standardized approach yielded positive economic outcomes in lowering the length of hospital stay as well as gastrostomy rates compared to the baseline period. Both these key outcome measures are dependent on adequacy of aerodigestive systems and overall maturation.…”

Section: ) Translational Implicationsmentioning

confidence: 99%

Advances with Neonatal Aerodigestive Science in the Pursuit of Safe Swallowing in Infants: Invited Review

Jadcherla

2017

Dysphagia

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Feeding, swallowing and airway protection are three distinct entities. Feeding involves a process of sequential, neurosensory and neuromotor interactions of reflexes and behaviors facilitating ingestion. Swallowing involves anterograde bolus movement during oral-, pharyngeal- and esophageal phases of peristalsis into stomach. During these events, coordination with airway protection is vital for homeostasis in clearing any material away from airway vicinity. Neurological-airway-digestive inter-relationships are critical to the continuum of successful feeding patterns during infancy, either in health or disease. Neonatal feeding difficulties encompass a heterogeneous group of neurological, pulmonary and aerodigestive disorders that present with multiple signs posing as clinical conundrums. Significant research breakthroughs permitted understanding of vagal neural pathways and functional aerodigestive connectivity involved in regulating swallowing and aerodigestive functions either directly or indirectly by influencing the supra-nuclear regulatory centers and peripheral effector organs. These neurosensory and neuromotor pathways are influenced by pathologies during perinatal events, prematurity, inflammatory states and coexisting medical and surgical conditions. Approaches to clarify pathophysiologic mapping of aerodigestive interactions, as well as translating these discoveries into the development of personalized and simplified feeding strategies to advance child health are discussed in this review article.

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“…Our neonatology division has developed nutrition guidelines by consensus, which are implemented by the neonatal nutritionists, pharmacists, and nurses in coordination with attending neonatologists. 31 Institutional standard protocol for enteral and PN was followed on all subjects. In general, the average caloric intake goal was 110-120 kcal/kg/day, protein goals ranged from 3.5 to 4.5 g/kg/day, and feeds were advanced by 20-25 mL/kg/day.…”

Section: Nutrition Guidelinesmentioning

confidence: 99%

Unique Patterns of Body Composition and Anthropometric Measurements During Maturation in Neonatal Intensive Care Unit Neonates: Opportunities for Modifying Nutritional Therapy and Influencing Clinical Outcomes

Algotar

Shaikhkhalil

Siler-Wurst

et al. 2017

J Parenter Enteral Nutr

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BackgroundBody composition is an important predictor of long‐term outcomes in neonates and may be altered by several factors. Innovative methods like air displacement plethysmography (ADP) can safely and reliably measure body composition, potentially assisting in individualization of nutrition therapy.Objectives1) To characterize patterns of body composition change in convalescing neonates in the neonatal intensive care unit (NICU) and examine factors leading to variation. 2) To evaluate if the time interval between 2 measurements via ADP can detect significant changes.MethodsNICU infants underwent anthropometry and body composition measurements by ADP at 37.5±0.7 weeks (Time 1) and 41.0±0.7 weeks (Time 2) postmenstrual age. Nutrition data were recorded. Data were analyzed using paired t‐tests and linear regression models, presented as mean±SE, median (IQR), or %.ResultsTwenty‐two neonates (54% males, 32.2±0.9 weeks gestation) were evaluated with a median interval of 3.6 (2.9–4.0) weeks between studies. Mean weight and % body fat increased significantly. There was no significant difference between mean weight and mean % body fat compared with normal references. Abdominal girth increased and mid‐arm circumference decreased (p<0.01). Preterm group had higher mean % body fat (10.1) than term infants (6.5), p = 0.03.ConclusionLongitudinal assessment of body composition can effectively assess nutrition status of fragile NICU infants. Although, an interval of 2.9–4.0 weeks between consecutive measurements detected significant changes in body composition, more frequent measurements are needed to determine nutrition factors responsible for body composition changes.

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Impact of Process Optimization and Quality Improvement Measures on Neonatal Feeding Outcomes at an All‐Referral Neonatal Intensive Care Unit

Abstract: Process optimization and the implementation of a standardized feeding strategy minimize practice variability, accelerating the attainment of enteral and oral feeding milestones and decreasing LOS without increasing adverse morbidities.

Cited by 39 publications

References 50 publications

Feeding Methods at Discharge Predict Long-Term Feeding and Neurodevelopmental Outcomes in Preterm Infants Referred for Gastrostomy Evaluation

Feeding Methods at Discharge Predict Long-Term Feeding and Neurodevelopmental Outcomes in Preterm Infants Referred for Gastrostomy Evaluation

Advances with Neonatal Aerodigestive Science in the Pursuit of Safe Swallowing in Infants: Invited Review

Unique Patterns of Body Composition and Anthropometric Measurements During Maturation in Neonatal Intensive Care Unit Neonates: Opportunities for Modifying Nutritional Therapy and Influencing Clinical Outcomes

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