Sustaining improved nutritional support for very low birthweight infants

Area of Science:

• Neonatal intensive care
• Pediatric nutrition
• Quality improvement science

Background:

• Postnatal growth failure (PGF) affects a significant majority (84%) of appropriately grown very low birthweight (VLBW) infants.
• Contributing factors include prematurity, acute illness, and inadequate nutritional support.
• A quality improvement initiative was launched to address high PGF rates in VLBW infants.

Purpose of the Study:

• To reduce the incidence of PGF in VLBW infants to less than 50% at discharge within two years.
• To sustain PGF rates below 50% long-term.
• To enhance nutritional support strategies for VLBW infants.

Main Methods:

• Inclusion criteria: All inborn VLBW infants without congenital anomalies.
• Intervention: Implemented evidence-based practices including earlier initiation of starter total parenteral nutrition (TPN), aggressive advancement of regular TPN, and timely human milk fortification.
• Methodology: Utilized three Plan-Do-Study-Act (PDSA) cycles to test and refine interventions.

Main Results:

• Significantly reduced time to initiation of starter TPN from 5.5 hours to under 3 hours.
• Increased frequency of achieving amino acid and lipid goals with regular TPN.
• Improved rates of human milk fortification at 80 mL/kg/day intake.

Conclusions:

• Achieved a sustained reduction in PGF for VLBW infants, decreasing from 84% to below 50% starting in 2010-2011.
• Reported a PGF rate of 23.1% in 2016, demonstrating long-term success.
• Validated the effectiveness of the model for improvement in enhancing nutritional support for VLBW infants.