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Improving and Sustaining VLBW Infant Growth Through a Quality Collaborative in California

Mindy Morris1, Xin Cui1,2, Courtney Breault1,2

  • 1California Perinatal Quality Care Collaborative, Stanford, California.

Pediatrics
|November 5, 2025
PubMed

Insights

A quality improvement collaborative successfully enhanced nutrition processes in neonatal intensive care units (NICUs), leading to improved growth for very low birth weight (VLBW) infants. These positive outcomes were sustained post-intervention.

Area of Science:

  • Neonatal care
  • Quality improvement science
  • Pediatric nutrition

Background:

  • Very low birth weight (VLBW) infants often exhibit inadequate postnatal growth, potentially impacting neurodevelopmental outcomes.
  • Statewide quality improvement collaboratives offer a structured approach to address growth deficiencies in VLBW infants.

Purpose of the Study:

  • To implement and evaluate a quality improvement collaborative focused on enhancing growth in VLBW infants.
  • To reduce the proportion of VLBW infants experiencing growth restriction (<10th percentile) at discharge.

Main Methods:

  • A statewide collaborative involving 22 neonatal intensive care units (NICUs) from October 2018 to March 2020.
  • Utilized statistical process control charts to analyze primary (growth restriction), secondary (z-score deficit), process (fortification, nutrition rounds), and balancing measures (necrotizing enterocolitis, human milk feeding).
  • Compared outcomes between participating and non-participating NICUs over a 78-month period, including 2 years post-collaborative.

Main Results:

  • Participant NICUs achieved a significant reduction in growth restriction at discharge (45% to 37.6%) and z-score deficit (44.4% to 33.3%).
  • Improvements in growth outcomes were sustained for 24 months post-collaborative.
  • Non-participant NICUs did not demonstrate similar improvements in growth measures.

Conclusions:

  • Quality improvement initiatives targeting NICU nutrition processes can effectively improve VLBW infant growth.
  • The observed improvements in VLBW infant growth were sustained long-term after the collaborative concluded.
  • Implementing standardized NICU nutrition protocols is crucial for achieving lasting positive effects on infant development.
Abstract

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