Wednesday, January 06, 2016
Enteral nutritional guidelines improve clinical outcomes in very low-birth-weight infants
Very low-birth-weight (VLBW) preterm infants are at risk for postnatal growth failure. With the improved survival of such newborns, nutrition has become an important facet of management in the neonatal intensive care unit (NICU). However, enteral feeding practices are known to vary due to the absence of a standardised protocol.
A study published in the journal Infant, Child and Adolescent Nutrition, demonstrated the benefit of standardised enteral feeding guidelines for VLBW preterm infants with respect to nutritional and clinical outcomes. The aim of this study was to conduct a quality improvement (QI) project for evaluating growth and clinical outcomes in VLBW infants after the implementation of a standardised enteral nutrition toolkit.
The QI project collected retrospective data 12 months prior to the implementation of the guidelines (n=121) and for 12 months after their implementation (n=114). The primary outcomes that were measured included the improvement in the rate of early initiation of enteral feeds (<5 days of life) and reduction in growth failure till discharge. The secondary outcomes included the number of days on total parenteral nutrition (TPN) and the rate of cholestasis.
Infants in the post-implementation phase were more likely to initiate enteral feeds by the fifth day of life compared to those in the pre-implementation phase. The average daily weight gain from birth to discharge (goal >20g/day) improved for the post-implementation group compared to the pre-implementation group. Moreover, the goal for an increase in head circumference of >0.8 cm/week was met by higher percentage of infants in the post-implementation phase compared to the infants in the pre-implementation phase.
However, the study has significant limitations. Compliance with the standardised protocol was not assessed. The reporting of length as a growth parameter was not done. Clinical variables such as catheter-related bloodstream infections were not recorded; this may have had a confounding effect on clinical outcomes. The study was not designed as a randomised controlled trial that could have provided stronger evidence for a causal association.
In conclusion, the early initiation of enteral feeds and improved growth, as well as less cholestasis, is possible following early-standardised enteral nutrition guidelines for VLBW preterm infants admitted to the NICU.
News Source: Shakeel F, et al. Improving Clinical Outcomes of Very Low Birth Weight Infants by Early Standardized Nutritional Management. ICAN: Infant, Child, & Adolescent Nutrition December 2015 7(6): 328-337.