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Standardising Preterm Infant Nutrition – Optimising Nutrition and Growth in Preterm Infants using an Evidence-Based Complex Intervention

Presented at the Neonatal Society 2013 Summer Meeting (programme).

Johnson MJ1,2, Pond JP1,2, Pearson F2, Emm A3, Leaf AA1,2

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

Background: Postnatal growth failure is common in preterm infants and is associated with adverse neurodevelopmental outcomes (1). One reason for poor growth is that nutritional care is often variable and nutrient intakes suboptimal, despite increasing literature regarding best practice in this area. Optimising nutrient intakes has the potential to improve both growth and developmental outcomes.

Methods: We developed an evidence-based, complex intervention to improve the nutritional care of preterm infants and introduced this in stages. Stage one (Aug-Dec 2011) included improved parenteral nutrition solutions, multi-disciplinary nutrition team and staff education sessions. Stage two (Jan-Dec 2012) included nutrition guidelines, screening tool and ‘nutrition nurse champions’. Nutrient intake and growth were collected on infants less than 30 weeks or 1500g at birth during each period, and compared with a pre-intervention cohort born during 2009 using linear regression, with adjustment for gestational age and weight at birth in each period (Stata v12.1).

Results: For the majority of nutrients, mean daily intake (as a percentage of recommended amounts) increased across study periods, particularly for energy, protein, calcium, zinc and vitamins D and E (see table 1). Actual mean protein intakes increased from 2.45 to 2.82 and 2.94g/kg/day. Growth also improved, with the mean change in standard deviation score (SDS) for weight between birth and discharge of -0.90, -0.68 and -0.53 in 2009, 2011 and 2012 respectively (p<0.01 for difference between 2009 and 2012 only). For head circumference the mean change in SDS between birth and discharge was -0.37, -0.34 and -0.30 respectively (NS).

Conclusion: The complex intervention used in this study improved nutrient intakes and in turn resulted in improved growth, with significant improvements in weight gain and a trend towards improved head growth. This suggests that implementing evidence based practice changes can significantly improve care and outcomes.

Corresponding author:

1. Ehrenkranz, R.A., et al., Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics, 2006. 117(4): p. 1253-61
2. Tsang, R.C., Nutrition of the preterm infant. 2nd. 2005, Cincinnati: Digital Educational Publishing. viii, 427

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