Variation in Enteral Feeding Practices and Growth Outcomes among Very Premature Infants: A Report from the New York
Timothy P Stevens1, Eileen Shields2, Deborah Campbell3
1Division of Neonatology, Department of Pediatrics, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, New York.
Insights
Extrauterine growth restriction (EUGR) in preterm infants varied significantly across New York State centers. Nutrition practices, like timing of enteral feeding and parenteral nutrition, impacted EUGR risk.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Growth Monitoring
Background:
- Extrauterine growth restriction (EUGR) negatively impacts neurodevelopmental outcomes in preterm infants.
- Significant variation in EUGR incidence exists among regional perinatal centers (RPCs).
Purpose of the Study:
- To analyze growth outcomes and enteral nutrition practices in preterm infants across New York State (NYS) RPCs.
- To identify specific nutritional practices associated with the risk of EUGR.
Main Methods:
- Retrospective analysis of growth and enteral nutrition data for infants <31 weeks gestation admitted in 2010.
- Survey of NYS RPC neonatologists regarding center-specific nutritional practices.
- Statistical analysis correlating nutritional practices with EUGR risk.
Main Results:
- 32.6% of 1,387 infants experienced EUGR at discharge.
- EUGR incidence varied more than fivefold among RPCs.
- Delayed trophic feeding and earlier discontinuation of total parenteral nutrition were linked to increased EUGR risk; larger trophic volumes and later TPN discontinuation were associated with lower risk.
Conclusions:
- Marked variation in nutrition practices and EUGR incidence observed among NYS RPCs.
- A statewide quality improvement initiative is in progress to standardize practices and enhance preterm infant growth.
Background:
Extrauterine growth restriction (EUGR) is inversely related to neurodevelopmental outcome. We analyzed growth outcomes and enteral nutrition practices among preterm infants at New York State (NYS) regional perinatal centers (RPCs) to identify practices associated with risk of EUGR.
Methods:
Surviving infants < 31 weeks' gestation admitted to a NYS RPC during 2010 were identified and data collected on their growth and enteral nutrition from a statewide database. Neonatologists at NYS RPCs were surveyed to identify center-specific nutritional practices. Survey responses, nutrition, and growth data were then analyzed to identify factors associated with risk of EUGR.
Results:
Of the 1,387 infants, 32.6% were discharged with EUGR. Incidence of EUGR varied more than fivefold among RPCs. Nutritional practices directly related to EUGR included age at first enteral feeding and full enteral feedings. Among the surveyed nutrition practices, longer duration of trophic feeding before advancing was associated with an increased risk of EUGR while later discontinuation of total parenteral nutrition and larger trophic feeding volume were associated with lower risk.
Conclusion:
Our study found marked variation in nutrition practices and incidence of EUGR among preterm infants at NYS RPCs. A statewide quality improvement initiative to reduce practice variation and improve growth in preterm infants is underway.
