Abstract
Background
As survival rates for preterm infants improve, there is increasing evidence that early diet can influence long-term health outcomes (1–3). Despite this, optimal management of nutrition in preterm infants remains challenging as evidence-based interventions are often not applied uniformly to daily practice. The development of standardized feeding protocols in the NICU aims to optimize postnatal growth and improve health outcomes of infants.
Objectives
To determine the impact of a standardized daily feeding protocol on nutrition and neonatal outcomes in low-birth-weight premature infants.
Design/Methods
This was a retrospective chart review evaluating infants born less than 34 + 0 weeks gestational age (GA) and birth weight (BW) less than 1500 grams who were admitted to the NICU at a Canadian Health Sciences Centre. Infants born between October 1, 2016 to April 1, 2017 comprised the general pre-intervention group and those born between April 2, 2017 to October 1, 2018 comprised the standardized nutrition group. Outcomes included initiation and weaning of parenteral nutrition, initiation of human milk fortifier, initiation and advancement of enteral feeds, change in weight Z score, neonatal morbidities and severity of medical illnesses throughout the hospitalization using the Nursery Neurobiological Risk Score (NBRS) (4).T-tests and chi-square tests were used to analyze outcomes.
Results
A total of 56 patients met inclusion criteria. 30 infants served as the general nutrition control group and 26 infants received the new standardized nutrition protocol. There were no baseline differences between groups with respect to BW, GA, sex, or being small for GA. Infants who participated in the standardized feeding protocol started enteral feeds earlier (p=0.05), received human milk fortification (HMF) at lower weights (p=0.033), had fewer days on CPAP (p=0.021) and demonstrated lower rates of BPD (p=0.018). This group also demonstrated a lower NBRS during their stay (p=0.014). Remaining analyzed parameters did not show statistically significant differences.
Conclusion
Use of a standardized feeding protocol in a Level 3 NICU was associated with earlier initiation of enteral feeds and HMF, and less medically complicated NICU hospital stays in preterm infants. These findings further demonstrate that adopting a standardized approach to feeding in the NICU can positively impact the nutrition and health of this high-risk population.
