Standardizing feeding strategies for preterm infants born greater than 1500 grams
Ting Ting Fu1,2, Maame Arhin3, Ashley T Schulz4
1Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. tingting.fu@cchmc.org.
Insights
A new feeding protocol for preterm infants over 1500g standardized feeding advancements, leading to more consistent achievement of full enteral volume. Donor breast milk intake was linked to decreased weight velocity in this population.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Clinical Implementation Science
Background:
- Standardized feeding protocols and donor breast milk (DBM) use are primarily studied in infants <1500g.
- Limited research exists on these interventions exclusively for infants born >1500g.
Purpose of the Study:
- To evaluate the clinical implementation of a feeding protocol for preterm infants >1500g.
- To assess the impact of the protocol on parenteral nutrition, feeding tolerance, growth, and maternal milk provision.
- To investigate the association between DBM intake and growth in this cohort.
Main Methods:
- Retrospective pre-post-implementation cohort study design.
- Evaluation of a standardized feeding protocol (advancements at 30 mL/kg/day) for preterm infants >1500g.
- Comparison of outcomes (central line placement, feeding tolerance, growth, maternal milk) before and after protocol implementation.
Main Results:
- No significant difference in peripherally inserted central catheters or maternal milk provision rates.
- A narrower distribution in time to full enteral volume post-implementation (p<0.001).
- Each 10% increase in DBM intake correlated with a 1.0 g/d decrease in weight velocity (p<0.001).
Conclusions:
- A feeding protocol for preterm infants >1500g promotes more consistent achievement of full enteral feedings.
- Further research is necessary to elucidate the precise impact of DBM on growth in this specific infant population.
- Donor breast milk, with appropriate fortification, can support growth but requires additional study for optimal use in infants >1500g.
Background:
Use of standardized feeding protocols and donor breast milk (DBM) have been studied primarily in infants born <1500 g and not examined exclusively in infants born >1500 g.
Methods:
In this retrospective pre-post-implementation cohort study, we evaluated a protocol for preterm infants born >1500 g that was implemented clinically to standardize feeding advancements at 30 mL/kg/day, with infants born <33 weeks eligible to receive DBM. We compared placement of peripherally inserted central catheters for parenteral nutrition, feeding tolerance, growth, and maternal milk provision in the 18 months before/after implementation. The association between DBM intake and growth was evaluated using multivariable linear regression.
Results:
We identified 133 and 148 eligible infants pre/post-implementation. Frequency of peripherally inserted central catheters and rate of maternal milk provision was not statistically different. While there was no difference in median days to full enteral volume, there was a narrower distribution post-implementation (p < 0.001). Growth was similar between eras, but each 10% increase in DBM was associated with 1.0 g/d decrease in weight velocity (p < 0.001).
Conclusions:
A feeding protocol for preterm infants >1500 g is associated with more consistent time to full enteral volume. Further investigation is needed to clarify DBM's impact on growth in this population.
Impact:
Despite practice creep, no study has examined the use of standardized feeding protocols or pasteurized donor breast milk exclusively in infants >1500 g. A feeding protocol in this population may achieve full enteral feedings more consistently. With appropriate fortification, donor breast milk can support adequate growth in infants born >1500 g but warrants further study.
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