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Improving extrauterine growth: evaluation of an optimized, standardized neonatal parenteral nutrition protocol

Maj Cory J Darrow1,2, Hong Li3, Allison Prince3,4

  • 1Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, MD, USA.

Journal of Perinatology : Official Journal of the California Perinatal Association
|December 12, 2018
PubMed

Insights

Optimizing parenteral nutrition improved growth in very low birth weight (VLBW) infants. This intervention reduced growth restriction, leading to better outcomes for these vulnerable newborns.

Area of Science:

  • Neonatalogy
  • Pediatric Nutrition
  • Growth and Development

Background:

  • Poor extrauterine growth is prevalent in very low birth weight (VLBW) neonates, correlating with adverse long-term health outcomes.
  • Growth restriction in VLBW infants necessitates targeted interventions to improve neonatal care standards.

Purpose of the Study:

  • To reduce growth restriction in VLBW infants by improving the change in weight z-score from birth to 36 weeks post menstrual age.
  • To shift the mean weight z-score from -1.13 to below -1 within a 12-month timeframe.

Main Methods:

  • The Model for Improvement framework guided the development and implementation of a standardized parenteral nutrition protocol.
  • Three iterative Plan-Do-Study-Act cycles were employed to refine the intervention.
  • A statistical process control chart (Xbar and S chart) monitored the primary outcome: weight z-score change.

Main Results:

  • The mean weight z-score change from birth to 36 weeks post menstrual age demonstrated a 23% improvement, reaching -0.87.
  • Significant enhancements were observed in early infant weight gain velocity.
  • Improvements in linear growth parameters were also noted in the VLBW cohort.

Conclusions:

  • Implementing an optimized, standardized parenteral nutrition protocol using the Model for Improvement effectively enhances extrauterine growth in VLBW infants.
  • This evidence-based approach offers a viable strategy to mitigate growth restriction and improve neonatal outcomes.
Abstract

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