661 - Improving Neonatal Nutrition in the NICU

We conducted a QI project from May 2020 through February 2022. We included infants born prior to 34 weeks gestation with birth weight less than 1.5 kg and length of stay greater than two weeks, excluding infants with major congenital anomalies or known/suspected metabolic disorders. There were 4 PDSA cycles in the study period: PDSA cycle 1 was the utilization of a feeding advancement guideline, PDSA cycle 2 was the utilization of a fortification guideline, PDSA cycle 3 allowed for feeding advancement and fortification on the same day, and PDSA 4 was the utilization of a new fortifier allowing fortification up to 30 kcal/oz.  The primary outcome is the reduction in mean weight-for-age Z-score change from birth to discharge. Secondary outcomes are central line days and time to reach full enteral feed, defined as 140 ml/kg/day. Our balancing measures include incidence of feeding intolerance (FI) as defined by emesis or distention requiring NPO for greater than 3 hours, and necrotizing enterocolitis (NEC).

Results:

There was significant reduction in mean weight-for-age Z-score change from birth to discharge, from -1.11 to -0.75. As infants in the after group received trophic feed and feeding advancement sooner, time to full enteral feeding decreased from 12.6 days to 10.9 days. As a result, the mean central line day for parental nutrition decreased significantly from 15.6 to 10.9. There was an increased incidence of FI compared to baseline (22.5% [18/80] vs 6.7% [1/15]). The incidence of NEC increased compared to baseline (3.75% [3/80] vs 0% [0/15]).

Conclusion(s): An established enteral feeding protocol helps to reduce the incidence of malnutrition in VLBW infants, while decreasing central line days and time to full enteral feeds. There was increased incidence of FI and NEC compared to baseline, however, this may be due to the small sample size in the baseline period.