title: Prevention of postnatal growth restriction by the implementation of an evidence-based premature infant feeding bundle.
abstract: OBJECTIVE
  To develop an evidence-based feeding bundle to safely decrease the rate of PNGR in VLBW infants.
  
  
  METHODS
  The bundle was developed and implemented in January 2010, followed by 3 years of monitoring bundle compliance and infant outcomes (days to first feed (FD), days to reach full feeds (FF), and birth-discharge growth trajectories (delta z-score)).
  
  
  RESULTS
  Data were collected on 482 infants (119 pre-bundle). PNGR decreased from 35% to 19% (P<0.01) and weight delta z-score improved from -0.82 to -0.45 (P<0.001). Percentage of infants with head circumference (HC) below 10th percentile at discharge decreased from 21% to 9% (P<0.01) and HC delta z-score improved from -0.65 to -0.17 (P<0.001). FD and FF also decreased significantly. Rates of necrotizing enterocolitis, peak alkaline phosphatase and peak direct bilirubin levels all trended downward.
  
  
  CONCLUSIONS
  An evidence-based, standardized feeding bundle was safe and effective in reducing the rate of PNGR and in improving head growth in VLBW infants.
authors.affiliation: Nursing (Neonatology), Albany Medical Center, Albany, NY, USA.
authors.forename: P D
authors.initials: PD
authors.lastname: Graziano
authors.affiliation: Pediatrics (Neonatology), Children's Hospital at Albany Medical Center, Albany, NY, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Tauber
authors.affiliation: Pediatrics (Neonatology), Children's Hospital at Albany Medical Center, Albany, NY, USA.
authors.forename: J
authors.initials: J
authors.lastname: Cummings
authors.affiliation: Epidemiology, Albany Medical Center, Albany, NY, USA.
authors.forename: E
authors.initials: E
authors.lastname: Graffunder
authors.affiliation: Pediatrics (Neonatology), Children's Hospital at Albany Medical Center, Albany, NY, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Horgan
mesh_terms: D004750:Enteral Nutrition / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000517:prevention & control*; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D062071:Infant, Extremely Premature / Q000254:growth & development*; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000254:growth & development*; D008297:Male; D008895:Milk, Human; D011446:Prospective Studies; D015430:Weight Gain