Feeding volume advancement in preterm neonates: A level 4 neonatal intensive care unit quality improvement initiative

医学 指南 肠内给药 新生儿重症监护室 肠外营养 坏死性小肠结肠炎 儿科 出生体重 低出生体重 胎龄 重症监护 重症监护医学 怀孕 遗传学 生物 病理
作者
E. Lagerquist,Benjamin J.S. al-Haddad,Jill D. Irvine,Lucy Muskthel,A. Gonzalez Rios,Kirtikumar Upadhyay
出处
期刊:Nutrition in Clinical Practice [Wiley]
卷期号:38 (5): 1175-1180 被引量:5
标识
DOI:10.1002/ncp.10992
摘要

Because of provider variability in feeding guideline application, a quality improvement (QI) initiative was begun to better standardize feeding initiation and advancement for preterm infants. Our specific, measurable, achievable, relevant, and timely aims included decreasing the time to reach full feeds by 35% and reducing the duration of central lines by 30% over 12 months in infants born between 25 and 30 weeks' gestation or with birth weight between 600 and 1250 g.Registered dietitians tracked central line days, parenteral nutrition (PN), enteral nutrition, fortification, guideline adherence, anthropometrics, necrotizing enterocolitis (NEC) cases, and central line-associated bloodstream infections (CLABSIs). QI progress charts were reviewed monthly.Mean central line days decreased from 7.3 to 5.8. Days of PN decreased from 6.7 to 5.1. The day of life that enteral feeds were started decreased from 1.1 to 0.5. The number of days between starting enteral feeds and adding fortification decreased from 3.4 to 2.3 days. Full enteral feeds were achieved on average 2 days earlier. Birth weight was regained at around 10.2 days of life before the guideline was implemented and at a mean of 9.6 days after the guideline. There was no increase in cases of CLABSI or diagnoses of NEC.After implementation of this feeding QI initiative at a level 4 neonatal intensive care unit, central line duration and PN use were decreased and infants reached full enteral feeds earlier without changes in cases of NEC, CLABSI, or time to regain birth weight.
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