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Quality improvement initiative to decrease extrauterine growth restriction in preterm neonates.

Nitasha Bagga1, Kiran Kumar Reddy1, Ashik Mohamed2

  • 1Neonatology, Rainbow Children's Hospital, Hyderabad, India.

Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition
|July 10, 2021
PubMed
Summary
This summary is machine-generated.

A quality improvement initiative aimed to reduce extrauterine growth restriction (EUGR) in preterm neonates. While EUGR rates did not significantly decrease, the initiative improved neonatal growth metrics and feeding practices.

Keywords:
enteral nutritiongrowthnutrition supportpremature infantquality improvementweight gain

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Area of Science:

  • Neonatalogy
  • Pediatric Nutrition
  • Quality Improvement Science

Background:

  • Extrauterine growth restriction (EUGR) in preterm neonates is a significant clinical challenge.
  • Nutritional practice inconsistencies contribute to EUGR.
  • A quality improvement (QI) initiative was implemented to address EUGR.

Purpose of the Study:

  • To decrease the proportion of extrauterine growth restriction (EUGR) in preterm neonates.
  • To standardize nutrition practices for preterm infants.

Main Methods:

  • A prospective, nonrandomized QI study was conducted from May 2018 to July 2019.
  • Ninety-six preterm neonates were compared to 111 historical controls.
  • Plan-do-study-act cycles were used for continuous feedback and analysis.

Main Results:

  • EUGR rates were 93.7% in controls vs. 87.5% post-intervention (not statistically significant).
  • Significant improvements observed in discharge weight percentile (1% to 3%), weight z-score difference (-1.84 to -1.65), birth weight regain, and growth velocity.
  • Earlier initiation and achievement of full feeds were noted in the intervention group.

Conclusions:

  • The QI initiative did not significantly reduce EUGR but improved key neonatal growth indicators.
  • Written nutrition practice guidelines enhanced outcomes, including discharge weight percentile and growth velocity.
  • Early birth weight regain and improved feeding milestones were achieved.