Improving Clinical Outcomes of Very Low Birth Weight Infants by Early Standardized Nutritional Management

Background. Optimal nutrition for very low birth weight (VLBW, <1500 grams) preterm infants is critical in the neonatal period. With substantial variation in clinical practice, there is limited data on impact of early nutrition on growth and outcomes. Objective. The purpose of this study was to conduct a quality improvement project evaluating growth and clinical outcomes after implementing standardized enteral feeding guidelines for preterm infants. Methods. Evidence based clinical practice feeding guidelines were developed and implemented for VLBW infants in NICU. Primary outcome measures were (1) the rate of early initiation of enteral feeds (< 5 days of life) and (2) growth outcomes as measured by weight and head circumference from birth to discharge. Secondary outcome measures were total TPN days and rate of cholestasis. Retrospective data prior to initiation of guidelines were compared with data from post-implementation period in logistic and linear regression models. Results. Pre and post-implementation cohorts consisted of 121 and 114 VLBW infants respectively. Standardized guidelines resulted in early initiation of enteral feeds by day 5 (OR = 3.57; p< 0.001) and an average weight gain >20gm/day during hospital stay (OR= 1.89; p< 0.05). In both groups there was early achievement of full feeds with early initiation of feeds (p<0.001). Similarly, infants who initiated early enteral feeds were less likely to develop cholestasis (direct bilirubin >2 mg/dl) (p<0.01) Conclusions. Consistent and standardized approach to early nutrition in VLBW infants results in improved growth and clinical outcomes with less duration of TPN and decreased rate of cholestasis.