Evaluation, development, and implementation of potentially better practices in neonatal intensive care nutrition.
OBJECTIVE
The desire for evidence-based clinical guidelines for nutritional support of the preterm infant has been identified. Published evidence has not yielded clear guidelines about the best method of delivery, substrate use, or appropriate outcome measure to evaluate nutrition support. In addition, reports on research of nutrition support often fail to give the most rudimentary process necessary to improve quality in various unit settings.


METHODS
The Vermont Oxford Network "Got Milk" focus group developed eight potentially better practices for nutrition support, implementation strategies for these practices, and a comprehensive appraisal process to measure nutrition outcome in preterm infants.


RESULTS
After implementation of the potentially better practices, all participating institutions showed earlier initiation of nutrition support, earlier attainment of adequate energy intakes, reduced delay in reaching full enteral feeds, more consistent nutrition support practice, decreased length of stay, cost savings, and improved growth at time of discharge.


CONCLUSIONS
Development and implementation of evidence-based better nutrition support practices in neonates led to improved nutrient intake and growth with reduced length of stay and related costs. Consistent, comprehensive, multidisciplinary appraisal of practice is an integral component of improving nutrition outcomes in the neonatal population.
Kuzma-O'Reilly
Barbara
B
Mercy Children's Hospital, Toledo, Ohio 43608, USA. barbara_kuzma_oreilly@mhsnr.org
Duenas
Maria L
ML
Greecher
Coleen
C
Kimberlin
Lois
L
Mujsce
Dennis
D
Miller
Debra
D
Walker
Donna Jean
DJ
D019985:Benchmarking; D001942:Breast Feeding; D003299:Cooperative Behavior; D004750:Enteral Nutrition / Q000592:standards*; D019317:Evidence-Based Medicine; D006284:Health Plan Implementation; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration; D015931:Intensive Care, Neonatal / Q000458:organization & administration / Q000592:standards*; D009936:Organizational Innovation; D009937:Organizational Objectives; D010289:Parenteral Nutrition, Total / Q000592:standards; D017410:Practice Guidelines as Topic; D016730:Program Development; D015397:Program Evaluation; D017749:Total Quality Management / Q000379:methods*; D014481:United States