704 - Quality Improvement Project to Increase the Growth Velocity in Preterm Infants

Poster Number: 704
Publication Number: 704.153

Xiao Rong, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China (People's Republic); Yuan Yuan, Guangzhou Women and Children's Medical Center, GUANGZHOU, Guangdong, China (People's Republic); Li Tao, Guangzhou Women and Children's medical centre, GUANGZHOU, Guangdong, China (People's Republic); Yan Zhou, Guagnzhou women and children's medical Center, Guangzhou, Guangdong, China (People's Republic); Guanming Li, seventh affiliated hospital, sun yat sen university, Shenzhen, Guangdong, China (People's Republic); Jiahui Li, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China (People's Republic); Minxu Li, Dongguan Maternal and Child Health Care Hospital, Dongguan, Guangdong, China (People's Republic); Tingting Shi, Guangzhou women and children' medical center, Guangzhou, Guangdong, China (People's Republic); Jing Wang, Tongji Hospital, Tongji Medical College, HUST, Wuhan city, Hubei, China (People's Republic); Jun Zhang, Women's Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China (People's Republic); John Chuo, Children's Hospital of Philadelphia, SPROUT, University of Pennsylvania, Asian/Pacific American, PA, United States; Huayan Zhang, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, United States

Background: High rate of Extra Uterine Growth Restriction (EUGR) is a significant problem for preterm infants in NICU. Methods reported in the literature have not been effective in reducing the incidence of EUGR. An intervention bundle aimed at increasing the growth velocity (GV) in the early postnatal days may help decrease the rate of EUGR.

Objective: The objective of this quality improvement (QI) project was to increase the GV by 20% from DOL7 to PMA 36weeks or D/C home in preterm infants within 6 months.

Design/Methods: The QI initiative was conducted from April 2022 to October 2022 at Guangzhou Women and Children's Medical Center's NICU. The multidisciplinary project team identified the following drivers influencing GV: 1) poor adherence to the 2020 enteral nutrition (EN) protocol resulting in delays in the initiation and advance of enteral feeding and late fortification of breast milk; 2) delivery system problems (e.g. long extension tubes used for pump feeding); and 3) suboptimal staff knowledge of principles and concepts. An intervention bundle targeting these key drivers was developed (Figure 1) and executed between May 31 to Sep. 28 (Figure 2). Preterm infants born at < 32 weeks' gestation or with birth weight < 1.5kg admitted to our NICU within 24h of life were included. Infants with genetic or chromosomal defects and those with congenital malformations requiring surgical treatment during the neonatal period were excluded. The primary outcome was GV between DOL7 and PMA 36 weeks or discharge, which was analyzed by using x-chart, S-chart and CUSUM chart. Process measures included the precentage of EN protocol non-adherence, the rate of "EN Protocol Reminder" usage, and percentage of extension tube removal in pump feeding. The process measures were analyzed using p-chart and run charts. The balancing measure was the rate of necrotizing enterocolitis (NEC). Altogether, 8 PDSA ramps, each ranging 1-4 cycles, were completed.

Results: Baseline data was collected from April 1 to May 31, after which the intervention bundle was rolled out. Two upward shifts in the outcome were achieved after 3 months of intervention, accompanied by significant improvement in the process measures (Figure 3). GV increased by 31.4%, from a baseline of 12.25g/kg.d to 16.10g/kg.d (Figure 3). Incidence of NEC during the intervention period was 2.04%,which was significantly lower than the NEC rate of 13.5% in 2021.

Conclusion(s): Implementation of an intervention bundle including improving adherence to best practices, staff buy-in/training, and system practice improvement could increase the growth velocity of preterm infants.