Reducing growth impairment in infants undergoing intestinal surgery: A quality improvement initiative

Area of Science:

• Neonatal care
• Surgical outcomes
• Pediatric nutrition

Background:

• Infants undergoing intestinal surgery face significant risks of impaired growth.
• A quality improvement initiative was launched to decrease growth impairment by 20% in this vulnerable population.
• The objective was to achieve and sustain this reduction over a 12-month period.

Purpose of the Study:

• To evaluate the effectiveness of a multisite quality improvement project in reducing growth impairment in infants post-intestinal surgery.
• To assess changes in adherence to nutrition guidelines and feeding practices.
• To monitor key safety indicators during the intervention.

Main Methods:

• Eight neonatal intensive care units (NICUs) participated in a 12-month quality improvement project (January 2021-June 2023).
• The study measured weight z-score decline from birthweight as the primary outcome, with adherence to parenteral nutrition, nutrition rounds, and feeding guidelines as process measures.
• Data were analyzed using control charts, with multisite learning sessions and local QI strategies implemented.

Main Results:

• Growth impairment remained at 25% during the active intervention phase.
• Adherence to parenteral nutrition guidelines increased from 49% to 68%, and feeding guidelines from 28% to 68%.
• In the sustainability phase, growth impairment slightly worsened to 27%, though adherence to parenteral nutrition reached 95%.

Conclusions:

• The quality improvement project successfully enhanced nutrition-related practices in NICUs caring for infants post-intestinal surgery.
• Despite improvements in nutritional care, the primary outcome of reduced growth impairment was not achieved.
• Future research should investigate nutrient delivery, anthropometrics, and non-nutritional factors impacting growth in these infants.