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Successfully implementing and embedding guidelines to improve the nutrition and growth of preterm infants in neonatal

Mark J Johnson1,2, Alison A Leaf1,2, Freya Pearson2

  • 1National Institute for Health Research, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.

BMJ Open
|December 9, 2017
PubMed

Insights

A complex intervention improved nutritional care for preterm infants, leading to better protein intake and weight gain. Normalization Process Theory (NPT) facilitated the integration of evidence-based practices into routine neonatal intensive care.

Area of Science:

  • Neonatal Medicine
  • Healthcare Implementation Science
  • Nutritional Science

Background:

  • Improving nutritional support for preterm infants is critical for optimal growth and development.
  • Translating evidence-based nutritional guidelines into routine clinical practice remains a challenge.
  • The Normalization Process Theory (NPT) provides a framework for understanding and facilitating the integration of new practices into healthcare settings.

Purpose of the Study:

  • To develop and implement a multifaceted intervention to enhance the nutritional care of preterm infants.
  • To utilize NPT to guide the implementation process and embed new practices into standard care.
  • To evaluate the impact of the intervention on guideline compliance, nutrient intake, and infant growth.

Main Methods:

  • A prospective, before-and-after interventional study was conducted in a tertiary neonatal intensive care unit.
  • The intervention involved phased implementation of improved nutrition solutions, a dedicated nutrition team, education, guidelines, and screening tools.
  • Data on guideline compliance, NPT scores, nutrient intake, and growth were collected continuously, with bimonthly audits.

Main Results:

  • Guideline compliance consistently exceeded 75%, peaking at 85%, and showed a significant positive correlation with NPT scores.
  • Significant improvements in daily protein intake and weight gain were observed during the intervention phases compared to the control period.
  • These improvements in nutritional status and growth were sustained post-implementation.

Conclusions:

  • The complex intervention, guided by NPT, was successfully integrated into routine practice, achieving high guideline compliance.
  • The study demonstrates that NPT is an effective framework for implementing and sustaining changes in clinical care.
  • Evidence-based complex interventions can significantly improve both clinical practice and outcomes for preterm infants.
Abstract

Keywords:
change managementneonatology

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