Feeding volume advancement in preterm neonates: A level 4 neonatal intensive care unit quality improvement initiative

Area of Science:

• Neonatalogy
• Pediatric Nutrition
• Quality Improvement Science

Background:

• Provider variability in feeding guidelines for preterm infants necessitates standardization.
• A quality improvement (QI) initiative aimed to standardize feeding initiation and advancement.
• Specific aims included reducing time to full feeds by 35% and central line duration by 30%.

Purpose of the Study:

• To implement and evaluate a feeding quality improvement initiative for preterm infants.
• To standardize feeding protocols in a neonatal intensive care unit (NICU).
• To assess the impact on feeding timelines, central line use, and key neonatal morbidities.

Main Methods:

• Registered dietitians monitored central line days, parenteral nutrition (PN), enteral nutrition, fortification, and guideline adherence.
• Data on anthropometrics, necrotizing enterocolitis (NEC), and central line-associated bloodstream infections (CLABSIs) were collected.
• QI progress was tracked and reviewed monthly.

Main Results:

• Mean central line days reduced from 7.3 to 5.8; PN days decreased from 6.7 to 5.1.
• Enteral feeds were initiated earlier (day 0.5 vs 1.1), and fortification was added sooner (2.3 vs 3.4 days after feeds started).
• Full enteral feeds achieved 2 days earlier; birth weight regain occurred faster (9.6 vs 10.2 days); no increase in NEC or CLABSI.

Conclusions:

• Implementation of the feeding QI initiative in a level 4 NICU successfully reduced central line duration and PN use.
• Preterm infants reached full enteral feeds earlier following the QI initiative.
• The initiative achieved its goals without increasing the incidence of NEC, CLABSI, or delaying birth weight regain.