A survey of neonatal nutrition policies and practices in the UK and Eire

Optimal nutrition is one of the fundamental components for infants to reach their full growth and neurodevelopmental potential. Best practice is facilitated by a contemporaneous, multidisciplinary, evidence-based nutrition policy. Such evidence has recently been reviewed. We have assessed: the prevalence of nutrition policies in neonatal units in the UK and Eire; their application to hypothetical cases; the availability of dietetic input; and whether any differences existed between non-regional and regional units. A standardized questionnaire was devised by a multidisciplinary group and posted to all 255 neonatal units in the UK and Eire in 2002. Replies from 67 neonatal units were received: 48 out of 233 non-regional and 19 out of 22 regional units. A feeding policy was present in 33 units, and regular access to dietitians occurred in 37 units. For a hypothetical infant less than 28 weeks' gestation, enteral feeds would be commenced at 0-2 days in 81% of non-regional and 94% of regional units (P = ns), and be continuous in 11% of non-regional and 32% of regional units, and bolus feeding in 89% of non-regional and 68% of regional units (P = ns). Routine fortification of breastmilk would occur more frequently in non-regional units (96%) than in regional units (79%) (P = 0.050). Vitamin and iron supplements would be given to infants receiving postdischarge or high-energy milks in 68% of non-regional units and in 79% of regional units (P = ns). Calorie counts (63% regional vs. 8% non-regional, P < 0.001), and daily weights (68% regional vs. 33% non-regional, P = 0.014), were used more frequently in regional units. Many units surveyed did not have a nutrition policy. Many infants receive unnecessary additional vitamins and supplements. Practice is variable throughout the country, but we found no evidence of major differences between regional and non-regional units, apart from their monitoring of growth and rates of breastmilk fortifier usage.