title: Evaluation, development, and implementation of potentially better practices in neonatal intensive care nutrition.
abstract: 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.
authors.affiliation: Mercy Children's Hospital, Toledo, Ohio 43608, USA. barbara_kuzma_oreilly@mhsnr.org
authors.forename: Barbara
authors.initials: B
authors.lastname: Kuzma-O'Reilly
authors.forename: Maria L
authors.initials: ML
authors.lastname: Duenas
authors.forename: Coleen
authors.initials: C
authors.lastname: Greecher
authors.forename: Lois
authors.initials: L
authors.lastname: Kimberlin
authors.forename: Dennis
authors.initials: D
authors.lastname: Mujsce
authors.forename: Debra
authors.initials: D
authors.lastname: Miller
authors.forename: Donna Jean
authors.initials: DJ
authors.lastname: Walker
mesh_terms: 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