title: Implementation, process, and outcomes of nutrition best practices for infants <1500 g.
abstract: BACKGROUND
  Extrauterine growth restriction (EUGR; weight ≤10th percentile) affects many infants ≤1500 g birth weight (BW). EUGR is associated with poor neurodevelopmental outcomes. The objective of this study was to evaluate the impact of optimizing nutrition administration in infants ≤1500 g.
  
  
  METHODS
  A retrospective chart review compared infants ≤1500 g before (n = 32) and after (n = 49) implementation of nutrition practice changes designed to decrease EUGR. Changes included early aggressive parenteral nutrition (PN), early enteral feedings, trophic feedings, continuous feeding administration, protein fortification of 24-cal/oz mother's own breast milk, and development of a "feeding intolerance" algorithm. The authors evaluated demographics, growth parameters, secondary feeding, and discharge outcomes. Differences in subgroups of infants ≤1000 g and 1000-1500 g BW were assessed.
  
  
  RESULTS
  Implementation of the nutrition practice changes decreased EUGR as defined by weight ≤10th percentile at discharge from 57% in the preimplementation group to 28% in the postimplementation group (P = .01). Weight percentile ranking at 36 weeks' gestational age increased significantly in infants 1001-1500 g, from the 13th to the 27th percentile (P = .004 and P = .01, respectively). Chronic lung disease decreased significantly (P = .02). There was no increase in necrotizing enterocolitis (6% pre vs 3% post) or in blood urea nitrogen. Days of PN and central line use were decreased (P = .02 and P = .07, respectively).
  
  
  CONCLUSIONS
  Clearly defined changes in nutrition for infants ≤1500 g significantly improved growth outcomes without increasing undesired outcomes.
authors.affiliation: School of Allied Health Professionals, University of Nebraska Medical Center, Omaha, NE 68198-4045, USA. ckhanson@unmc.edu
authors.forename: Corrine
authors.initials: C
authors.lastname: Hanson
authors.forename: Julie
authors.initials: J
authors.lastname: Sundermeier
authors.forename: Laura
authors.initials: L
authors.lastname: Dugick
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lyden
authors.forename: Ann L
authors.initials: AL
authors.lastname: Anderson-Berry
mesh_terms: D000465:Algorithms; D001835:Body Weight; D004044:Dietary Proteins / Q000008:administration & dosage; D020345:Enterocolitis, Necrotizing; D005247:Feeding Behavior; D005260:Female; D005865:Gestational Age; D006130:Growth Disorders / Q000150:complications / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D007235:Infant, Premature, Diseases / Q000628:therapy*; D019102:Infant, Very Low Birth Weight / Q000254:growth & development*; D008171:Lung Diseases / Q000517:prevention & control; D008297:Male; D008895:Milk, Human; D018529:Nutritional Support; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
chemical_list: D004044:Dietary Proteins