Implementation of a Nutrition Care Bundle and Improved Weight Gain of Extremely Preterm Infants to 36 Weeks
Leslie T McKinley1, Lynn Przystac1, Richard Tucker1
1Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI.
Insights
A nutrition care bundle significantly improved weight gain in premature infants during their hospital stay. This intervention is key for enhancing growth in extremely low birth weight infants.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Infant Growth
Background:
- Premature infants, particularly those with extremely low birth weight, face significant growth challenges during neonatal hospitalization.
- Optimizing nutritional support is critical for improving outcomes in this vulnerable population.
Purpose of the Study:
- To evaluate the impact of a comprehensive nutrition care bundle on the growth of premature infants.
- To assess changes in weight z-score from postnatal day 7 to 36 weeks postmenstrual age (PMA).
Main Methods:
- Retrospective analysis of prospectively collected data from 584 infants (birth weight ≤1000 g, gestational age 24-29 weeks).
- Infants were categorized into three epochs based on evolving nutrition practices, with the final epoch utilizing a complete nutrition care bundle.
- Weight z-score changes were analyzed using univariate and multivariable regression, controlling for clinical variables.
Main Results:
- Significant increases in weight z-score were observed across all three epochs (P < .0001), accounting for 31% of the variance.
- Positive predictors of weight gain included higher birth weight z-score, cesarean delivery, and later epochs of nutritional support.
- Negative predictors of weight gain included gestational age, postnatal steroid use, and duration of parenteral nutrition.
Conclusions:
- The implementation of a structured nutrition care bundle was associated with improved weight gain in extremely low birth weight infants.
- This finding highlights the effectiveness of targeted nutritional interventions in optimizing growth during neonatal intensive care.
Objective:
To evaluate the effect of a nutrition care bundle in improving growth in premature infants during neonatal hospitalization.
Study Design:
This study was a retrospective analysis of prospectively collected data for 584 surviving infants with birth weight ≤1000 g and gestational age 24-29 weeks admitted to a single-center neonatal intensive care unit between July 3, 2005, and June 6, 2016. Participants were divided into 3 discrete epochs based on evolving nutrition practices during the study period: epoch 1, baseline, open-bay setting; epoch 2, improved lactation staffing, introduction of high-protein formula, single-family room setting; epoch 3, complete nutrition care bundle. Infants in each epoch were evaluated for the primary outcome of change in weight z-score between postnatal day 7 and 36 weeks postmenstrual age (PMA) or discharge if sooner. Univariate and multivariable regression analyses were conducted to evaluate the effect of clinical variables on outcome.
Results:
Significant increases in weight z-score between day of life 7 and 36 weeks PMA were observed across the 3 epochs, which accounted for 31% (P < .0001) of the variance. Variables that were positive predictors of weight z-score change included birth weight z-score, cesarean delivery, and later epochs of nutritional support. Variables that were negative predictors of weight change included gestational age, postnatal steroids, and days on parenteral nutrition.
Conclusions:
Implementation of a nutrition care bundle was associated with improved weight gain in extremely low birth weight infants.
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