Adjustable feedings plus accurate serial length measurements decrease discharge weight-length disproportion in very preterm infants: quality improvement project

• Published in: Journal of perinatology Vol. 39; no. 8; pp. 1131 - 1139
• Main Authors: Brion, Luc P., Rosenfeld, Charles R., Heyne, Roy, Brown, Steven L., Lair, Cheryl S., Burchfield, Patti J., Caraig, Maria
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-08-2019; Nature Publishing Group
• Subjects: 692/700/1720; 692/700/459/1994; Adolescents; Adults; Birth weight, Low; Blood pressure; Body Height; Body mass; Body Mass Index; Body size; Body Weight; Care and treatment; Complications and side effects; Dietitians; Feeding Methods; Female; Gestational age; Health aspects; Hospitals; Humans; Hypertension; Infant; Infant, Extremely Premature - growth & development; Infant, Newborn; Infant, Premature - growth & development; Infant, Very Low Birth Weight - growth & development; Infants; Infants (Premature); Intensive care; Intensive Care Units, Neonatal; Length-weight relationships; Leptin; Leptin - blood; Low birth weight; Male; Medical nutrition therapy; Medicine; Medicine & Public Health; Metabolic diseases; Metabolic syndrome; Methods; Neonatal intensive care; Neonates; Newborn babies; Nutrition; Obesity; Parenteral nutrition; Pediatric Surgery; Pediatrics; Physical measurements; Premature babies; Premature birth; Proteins; Quality control; Quality Improvement; Quality Improvement Article; Quality management; Risk factors; Weight; United States
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/s41372-019-0424-8

Background
Preterm very-low-birth-weight (≤1500 g) infants exhibit disproportionate weight-for-length growth in the Neonatal Intensive Care Unit.
Local problem
High frequency of body mass index (BMI) > 90th centile at discharge and 1-year postnatal age associated with elevated blood pressure and serum leptin in infancy and adolescence.
Methods
Single-institution quality improvement project in appropriately grown infants born at 23
0/7
–28
6/7
weeks gestational age and discharged home.
Intervention
Adjustable feeding protocol based on valid serial length measurements (board or caliper).
Results
The average monthly percentage of weight-for-length disproportion at discharge decreased from 13% in
Epoch 1
to 0% in
Epoch
2 (
P
 < 0.05). Although the average Z-score for BMI at discharge was lower in
Epoch
2 versus
Epoch
1 (
P
 < 0.01), this was absent by 1 year follow-up (
P
 = 0.91).
Conclusions
Adjustable feedings plus use of accurate serial length measurements decreases weight-for-length disproportion at hospital discharge but not at 1 year.