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Standardised neonatal nutrition care bundle and growth velocity in infants <32 weeks: a single-centre
Lina Alsherbini1,2, Mohanned Alrahili1,2, Sabreen Asiry1
1Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Insights
A new nutrition care bundle significantly improved growth velocity in preterm infants. This intervention accelerated enteral feeding and caloric delivery without increasing feeding intolerance or necrotising enterocolitis.
Area of Science:
- Neonatal intensive care
- Pediatric nutrition
- Clinical quality improvement
Background:
- Preterm infants often experience suboptimal growth due to challenges in achieving adequate enteral nutrition.
- Early and optimized nutrition is critical for improving in-hospital growth and long-term outcomes in premature infants.
Purpose of the Study:
- To evaluate the impact of a unit-level nutrition care bundle on in-hospital growth in preterm infants.
- To assess if accelerated enteral feeding and optimized early caloric delivery improve growth velocity (GV).
Main Methods:
- A single-centre, pre-post observational study was conducted in a tertiary neonatal intensive care unit.
- Infants born before 32 weeks' gestation were analyzed during baseline and post-quality improvement (QI) periods.
- A multicomponent nutrition care bundle focused on earlier enteral feeds, protocolized fortification, and higher early energy delivery was implemented.
Main Results:
- Average growth velocity (GV) significantly increased from 12.52 g/kg/day pre-QI to 15.50 g/kg/day post-QI (p<0.001).
- Time to full feeds decreased by 6.05 days, and mean week 1 caloric intake increased by 11.38 kcal/kg/day.
- Rates of feeding intolerance and necrotising enterocolitis remained unchanged.
Conclusions:
- Implementation of the nutrition care bundle led to improved in-hospital growth velocity in preterm infants.
- The bundle facilitated earlier achievement of feeding milestones without compromising safety.
Objective:
To test whether a unit-level nutrition care bundle that accelerates enteral feed and optimises early caloric delivery improves in-hospital growth in preterm infants.
Design:
Single-centre pre-post observational study.
Setting:
Tertiary neonatal intensive care unit.
Participants:
Infants born at less than 32 weeks' gestation admitted during two epochs: baseline (1 January 2023-30 April 2024) and post-quality improvement (QI) (1 May 2024-31 August 2025). Complete cases were analysed for each endpoint (growth velocity (GV) cohort: pre n=163, post n=149).
Intervention:
A multicomponent nutrition care bundle promoting earlier initiation and advancement of enteral feeds, protocolised fortification and higher early energy delivery.
Main Outcome Measures:
Primary outcome was infant-level average GV (g/kg/day) calculated from weekly GV from week 3 onwards. Secondary outcomes included week-specific GV, change in weight Z-score from birth to discharge (Δ weight Z), discharge anthropometry, feeding process measures (time to full feeds, week 1 calories) and safety outcomes (feeding intolerance and necrotising enterocolitis).
Results:
Average GV increased from 12.52±2.49 pre-QI to 15.50±2.30 g/kg/day post-QI (mean difference+2.98, 95% CI 2.45 to 3.52; p<0.001). Weekly GV was higher post-QI across weeks 3-12, with the largest difference at week 8 (+4.31 g/kg/day, 95% CI 2.34 to 6.27; p<0.001). Δ weight Z was less negative post-QI (-1.21±0.75 vs -1.43±0.81; difference+0.22, 95% CI 0.05 to 0.39; p=0.012). Discharge weight was higher post-QI (+152 g, 95% CI 13 to 290; p=0.033), while discharge length and head circumference Z-scores were similar between epochs. Time to full feeds decreased by 6.05 days (95% CI -11.77 to -0.33), and mean week 1 caloric intake increased by 11.38 kcal/kg/day (95% CI 6.16 to 16.60). Feeding intolerance and necrotising enterocolitis rates did not differ between periods.
Conclusions:
Implementation of a care bundle was associated with improved GV and earlier feeding milestones without increased feeding intolerance or necrotising enterocolitis.
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