Related Experiment Video
Updated: May 20, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
A quality improvement approach to growth in moderate and late preterm infants in small NICUs
Mindy Morris1, Jessica Liu1,2, Maria C Hetherton3
1California Perinatal Quality Care Collaborative (CPQCC), Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
Insights
The Growth Advancement in the NICU (GAIN) initiative reduced growth restriction in infants by 41.6%. This quality improvement project focused on low-volume Neonatal Intensive Care Units (NICUs).
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Quality Improvement Science
Background:
- Growth restriction is a significant concern for infants in the Neonatal Intensive Care Unit (NICU).
- Quality improvement collaboratives can enhance patient outcomes in specialized care settings.
Purpose of the Study:
- To decrease the percentage of eligible infants experiencing a weight-for-age z-score decline greater than 1.0 Standard Deviation (SD) upon NICU discharge.
- To achieve a 20% reduction in significant growth restriction among NICU infants.
Main Methods:
- A quality improvement collaborative, Growth Advancement in the NICU (GAIN) Ten Point Nine (10.9), was implemented in seven low-volume NICUs (average daily census ≤10.9).
- The study included inborn infants with birthweights between 1500-2500g and a NICU stay of at least seven days.
- NICU teams participated in monthly virtual meetings and three in-person learning sessions.
Main Results:
- The GAIN 10.9 initiative resulted in a 41.6% relative reduction in infants with z-score declines > 1.0 SD.
- All participating NICUs successfully adopted weight-based feeding guidelines.
- Implementation of weekly nutrition rounds was a key component of the intervention.
Conclusions:
- A targeted quality improvement initiative can effectively reduce growth restriction in moderate and late preterm infants.
- Low-volume NICUs can successfully implement evidence-based practices to improve infant growth outcomes.
Objective:
Reduce the proportion of eligible infants who leave the NICU with a decline in weight-for-age z-score >1.0 SD by 20%.
Study Design:
Designed to engage NICUs with an average daily census ≤10.9, the California Perinatal Quality Care Collaborative conducted a quality improvement collaborative titled Growth Advancement in the NICU (GAIN) Ten Point Nine (10.9) among seven NICUs between 05/2021 and 07/2023. Inborn infants with a birthweight between 1500 and 2500 g and a minimum NICU stay of seven days were included. NICU teams took part in virtual monthly meetings and three half-day Learning Sessions.
Results:
GAIN 10.9 achieved a 41.6% relative reduction in infants with z-score declines > 1.0 SD. All seven NICUs adopted weight-based feeding guidelines and implemented weekly nutrition rounds.
Conclusions:
A quality improvement initiative among low volume NICUs successfully reduced growth restriction in moderate or late preterm infants.
