Background
Implementation of a standardized feeding strategy in the neonatal ICU (NICU) has been shown to effectively minimize practice variability and accelerate the attainment of key milestones without adverse morbidities. However, tracking feeding and nutrition metrics remains a challenge.
Purpose
A new feeding protocol was implemented at a 16 bed, level III NICU, beginning in 2020. In order to understand the history and progression of the current standard of care, we reviewed and analyzed 5 years of nutrition practices in the unit. We evaluate the effectiveness of our protocol implementation by utilizing a NutritionIQ software application to track the detailed nuance of NICU feeding and nutrition.
Methods
Data for 957 patients was analyzed, including over 130,000 feeding events. Retrospective and prospective key measurements included daily weight and amount of enteral feeds; days to first and full feeds and growth measurements. By incorporating the feeding protocol, we track adherence to the guidelines as well as providing live support for the daily nutritional clinical decision process. Data was analyzed comparing the medians and quartiles for key benchmarks including birth to discharge Z-Scores.
Results
This solution provided longitudinal, high resolution, data on feeding and nutrition as well as milestones. Detailed data mining showed a statistically significant improvement in day of initiation and achievement of full enteral feedings (Figure 1).
Mean Growth Velocity improved from 14.75 g/kg/d in 2017 to 17.22 g/kg/d in 2021 (P = 0.0079 Table 1). All VLBW infants saw improvements in growth velocity with the 1st quartile improving from 13 to 15 grams/Kg/day (Figure 2). Birth to discharge delta Z-Scores for weight also improved (Figure 3).
Conclusion
Standardization of feeding practices has long been established as a route to improved NICU outcomes. By using a NutritionIQ solution to measure and analyze large amounts of nuanced care data we were provided immediate feedback while simultaneously being able to analyze the progression of nutritional and developmental milestones. This furthers the impact of protocol implementation by tailoring nutritional practices and improve protocol adherence. Measuring and improving our key care metrics allowed us to achieve important and statistically significant improvement in critical developmental outcomes.
Gomez Pomar, E., MD, MsC1; Byrns, M., RD1; Genetti D.2
1St Bernards Regional Medical Center and 2Astarte Medical Partners
