title: Improved outcomes with a standardized feeding protocol for very low birth weight infants.
abstract: OBJECTIVE
  The objective of this study was to evaluate the impact of a standardized enteral feeding protocol for very low birth weight (VLBW) infants on nutritional, clinical and growth outcomes.
  
  
  METHODS
  Retrospective analysis of VLBW cohorts 9 months before and after initiation of a standardized feeding protocol consisting of 6-8 days of trophic feedings, followed by an increase of 20 ml/kg/day. The primary outcome was days to reach full enteral feeds defined as 160 ml/kg/day. Secondary outcomes included rates of necrotizing enterocolitis and culture-proven sepsis, days of parenteral nutrition and growth end points.
  
  
  RESULTS
  Data were analyzed on 147 VLBW infants who received enteral feedings, 83 before ('Before') and 64 subsequent to ('After') feeding protocol initiation. Extremely low birth weight (ELBW) infants in the After group attained enteral volumes of 120 ml/kg/day (43.9 days Before vs 32.8 days After, P=0.02) and 160 ml/kg/day (48.5 days Before vs 35.8 days After, P=0.02) significantly faster and received significantly fewer days of parenteral nutrition (46.2 days Before vs 31.3 days After, P=0.01). Necrotizing enterocolitis decreased in the After group among VLBW (15/83, 18% Before vs 2/64, 3% After, P=0.005) and ELBW infants (11/31, 35% Before vs 2/26, 8% After, P=0.01). Late-onset sepsis decreased significantly in the After group (26/83, 31% Before vs 6/64, 9% After, P=0.001). Excluding those with weight <3rd percentile at birth, the proportion with weight <3rd percentile at discharge decreased significantly after protocol initiation (35% Before vs 17% After, P=0.03).
  
  
  CONCLUSIONS
  These data suggest that implementation of a standardized feeding protocol for VLBW infants results in earlier successful enteral feeding without increased rates of major morbidities.
authors: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, 750 Welch Road, Palo Alto, CA 94304, USA. kmccallie@stanford.edu
authors: K R
authors: KR
authors: McCallie
authors: H C
authors: HC
authors: Lee
authors: O
authors: O
authors: Mayer
authors: R S
authors: RS
authors: Cohen
authors: S R
authors: SR
authors: Hintz
authors: W D
authors: WD
authors: Rhine
mesh_terms: D004750:Enteral Nutrition; D005526:Food, Formulated; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D010289:Parenteral Nutrition, Total