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

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.

Does prefeed gastric residual evaluation impair enteral nutrition intake in very preterm infants?

“…Overall, despite limitations, the study design is appropriate. Results are consistent with other literature suggesting that omitting prefeed gastric residual evaluation improves nutritional outcomes without increasing complications . Given the importance of infant nutrition, it would seem reasonable to omit prefeed gastric residuals in clinical practice for the population studied here.…”

“…Results are consistent with other literature suggesting that omitting prefeed gastric residual evaluation improves nutritional outcomes 2-5,9 without increasing complications. 2,4,5,9 Given the importance of infant nutrition, it would seem reasonable to omit prefeed gastric residuals in clinical practice for the population studied here. Gastric residuals would only be evaluated if infants had gastro-intestinal symptoms.…”

Çok Düşük Doğum Ağırlıklı İnfantlarda Tam Enteral Beslenmeye Geçiş Süresine Etki Eden Faktörler

“…Prevention of preterm births, prevention of RDS and preeclampsia facilitate the transition to full enteral nutrition. (6,7,18). Çalışmamızda NEK açısından iki grup arasında fark saptanmamıştır.…”

“…Çok düşük doğum ağırlıklı, özellikle de aşırı düşük doğum ağırlıklı preterm bebeklerde beslenme intoleransının sık görülmesi ve bu bebeklerde ciddi bir mortalite ve morbidite nedeni olan NEK riski istenilen beslenme hedeflerine ulaşılmasını engellemektedir (5)(6)(7). Bu nedenle enteral beslenmenin optimum başlangıç zamanı ve artış hızları bu bebekler için halen belirsizdir (8).…”

Examining weight gain: A retrospective study on preterm newborn growth on a diet exclusively of fortified donor breast milk

“…The NICU registered dietitian (RD) and attending physicians used current practices and available evidence-based guidelines to develop the UAMS guidelines. Feeding guidelines can be used to provide a systematic method for advancing feeds volume and scheduled fortification of feeds (38). Milk was fortified using an acidified liquid HMF per the NICU feeding guidelines (39).…”