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Quality Initiative to Reduce Extrauterine Growth Restriction in Very Low Birth Weight Infants
Ramasubbareddy Dhanireddy1,2, Patricia A Scott2,3, Brenda Barker2,4
1Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee.
Hospital Pediatrics
|January 10, 2022
Summary
A quality improvement initiative in Tennessee NICUs improved early nutrition for very low birth weight infants. This led to earlier parenteral and enteral nutrition, enhancing postnatal nutrition awareness.
Area of Science:
- Neonatology
- Pediatric Quality Improvement
- Infant Nutrition
Background:
- Statewide quality improvement initiative targeting extrauterine growth restriction in very low birth weight infants.
- Focus on infants born appropriate for gestational age (23-32 weeks gestation, 500-1499g) across 9 Tennessee NICUs.
Purpose of the Study:
- To decrease the incidence of extrauterine growth restriction (EGR) in very low birth weight (VLBW) infants.
- To evaluate the impact of a quality improvement initiative on nutritional delivery in NICUs.
Main Methods:
- Utilized statistical process control charts to analyze process measures.
- Key process measures included hours of life (HOL) for parenteral protein and lipid initiation, days to first enteral feeding, and time to full enteral caloric intake.
- Primary outcome: EGR defined as weight <10th percentile at 36 weeks postmenstrual age.
Main Results:
- Special cause variation was identified for reductions in specific process measures, not the primary outcome of EGR.
- Initiation of parenteral protein and intravenous lipid emulsion was earlier.
- Time to attainment of full enteral caloric intake was reduced, particularly in regional perinatal centers.
Conclusions:
- The statewide quality improvement initiative successfully accelerated the initiation of parenteral and enteral nutrition.
- The initiative enhanced awareness regarding the critical importance of postnatal nutrition for VLBW infants.
- While EGR incidence was not significantly reduced, improvements in nutritional delivery processes were observed.
