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Development of an electronic assessment tool to guide nutritional management in neonatal intensive care

Presented at the Neonatal Society 2012 Summer Meeting (programme).

Johnson MJ1,2, Pearson F2, Schofield J1, Emm A2, Leaf AA1,2

1 NIHR Southampton Biomedical Research Centre, Southampton, UK
2 Department of Neonatal Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK

Background: Poor growth is common in VLBW infants in the neonatal period identified by slow weight gain, short stature and altered body composition compared to term infants. Achieving recommended nutrient intakes is difficult, but is hard to demonstrate in routine clinical practice.

Methods: We developed a customised electronic system to capture and analyse nutritional data and growth. Daily entry of intake of fluids, feeds and nutritional supplements generates a comprehensive report of individual nutrient intakes against recommended amounts. Reports can be produced for each baby on a daily or weekly basis, or to provide an overview of nutrition throughout stay, or can be summarised at population level to reflect unit practice. As part of a larger study aimed at improving the nutritional care of preterm infants, the tool was used to characterise the nutrient intakes and growth of a cohort of 64 VLBW inborn infants born in 2009.

Results: This tool has been successful in providing individualised, contemporaneous reports which can be easily used to guide nutritional care during stay (see figure 1).

Figure 1: Example of an assessment of a typical infant showing A: Patient details, B:Relative contributions of PN and enteral feeds during stay, the bold line ( ̶̶̶̶̶̶̶̶̶ ) represents PN and the shaded areas represent milk (see key) C: Nutrient Intakes of (clockwise from top left) Energy, Protein, Carbohydrate and Fat, together with reference nutrient intake ranges (pale shaded areas) and D: NICM WHO growth charts for (top to bottom) weight, length and head circumference.

Summarised population data revealed patterns of nutrient intake which, consistent with other published data, fell short of current recommendations (1), particularly for protein and vitamins. Growth was also poor with SDS of -1.76 and -1.7 for weight and head circumference respectively at 36 weeks post-conceptual age. These findings have been used to guide the development of a comprehensive nutrition support package and guideline which is currently being evaluated.

Conclusion: Nutrient delivery and growth in preterm infants is currently suboptimal. Our electronic tool has the potential to aid clinical decision making and improve nutritional care for individual patients, but also allows exploration of relationships between nutrient delivery and growth, which may have much wider beneficial impact at the population level.

Corresponding author:

1.Tsang C et al.(eds.) Nutrition of the Preterm Infant: Scientific Basis and Practical Guidelines. 2nd ed. Cincinnati, Ohio: Digital Educational Publishing; 2005. p45-80.

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