title: Implementing feeding guidelines for NICU patients<2000 g results in less variability in nutrition outcomes.
abstract: BACKGROUND
  We devised a consistent approach to instituting and advancing enteral nutrition among neonatal intensive care unit (NICU) patients<2000 g birth weight. We then assessed variability in feeding-related outcomes during a period before (period 1) vs after (period 2) implementing these guidelines.
  
  
  METHODS
  Using data from period 1 vs period 2, we statistically compared the equivalence of variance, focusing on certain feeding-related outcomes. Specific outcomes we chose to examine were (1) day of life when the first enteral feedings were given, (2) number of days during the entire hospitalization when no feedings were given, (3) number of days parenteral nutrition (PN) was administered, and (4) day of life when feedings of 80 mL/k/d and 100 kcal/k/d enteral were achieved.
  
  
  RESULTS
  Fifty-eight patients<2000 g were admitted to the NICU in period 1, of which 56 survived to discharge home. In period 2, 68 patients<2000 g were admitted and 66 survived to discharge. Demographic features of the patients in periods 1 and 2 did not differ. In both periods, feedings were begun on a median of day 1. However, in period 1 the range was from day 0 to day 24, and in period 2, the range was from day 0 to day 6 (equivalence of variance p<.001). After feedings were initiated, they were withheld for a median of 2 days (range, 0-23) during the remainder of the hospitalization in period 1 vs a median of 1 day (range, 0-12) in period 2 (p<.001). During period 1, PN was used for a median of 10 days (range, 0-72) vs 7 (range, 0-47) in period 2 (p=.001). During period 1, more variability occurred in the day of life when 80 mL/k/d and 100 kcal/k/d were achieved (both p<.001). No differences were seen in necrotizing enterocolitis, intestinal perforation, mortality, or length of hospital stay.
  
  
  CONCLUSIONS
  Implementing feeding guidelines was associated with significantly less variability in feeding-related outcomes. We speculate that this is a reflection of better feeding tolerance, which resulted from a more consistent approach to initiating and advancing enteral feedings.
authors.affiliation: Intermountain Healthcare Neonatology Research, McKay-Dee Hospital Center, Ogden 84403, and Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Street
authors.forename: Dianne
authors.initials: D
authors.lastname: Montgomery
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Alder
authors.forename: Diane K
authors.initials: DK
authors.lastname: Lambert
authors.forename: Dale R
authors.initials: DR
authors.lastname: Gerstmann
authors.forename: Robert D
authors.initials: RD
authors.lastname: Christensen
mesh_terms: D004750:Enteral Nutrition; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007230:Infant, Low Birth Weight / Q000254:growth & development*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000592:standards; D007902:Length of Stay; D009751:Nutritional Requirements; D009752:Nutritional Status; D010288:Parenteral Nutrition; D017410:Practice Guidelines as Topic; D013997:Time Factors; D016896:Treatment Outcome; D015430:Weight Gain