title: Variation in Enteral Feeding Practices and Growth Outcomes among Very Premature Infants: A Report from the New York State Perinatal Quality Collaborative.
abstract: BACKGROUND
  Extrauterine growth restriction (EUGR) is inversely related to neurodevelopmental outcome. We analyzed growth outcomes and enteral nutrition practices among preterm infants at New York State (NYS) regional perinatal centers (RPCs) to identify practices associated with risk of EUGR.
  
  
  METHODS
  Surviving infants < 31 weeks' gestation admitted to a NYS RPC during 2010 were identified and data collected on their growth and enteral nutrition from a statewide database. Neonatologists at NYS RPCs were surveyed to identify center-specific nutritional practices. Survey responses, nutrition, and growth data were then analyzed to identify factors associated with risk of EUGR.
  
  
  RESULTS
  Of the 1,387 infants, 32.6% were discharged with EUGR. Incidence of EUGR varied more than fivefold among RPCs. Nutritional practices directly related to EUGR included age at first enteral feeding and full enteral feedings. Among the surveyed nutrition practices, longer duration of trophic feeding before advancing was associated with an increased risk of EUGR while later discontinuation of total parenteral nutrition and larger trophic feeding volume were associated with lower risk.
  
  
  CONCLUSIONS
  Our study found marked variation in nutrition practices and incidence of EUGR among preterm infants at NYS RPCs. A statewide quality improvement initiative to reduce practice variation and improve growth in preterm infants is underway.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, New York.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Stevens
authors.affiliation: New York State (NYS) Department of Health, Albany, New York.
authors.forename: Eileen
authors.initials: E
authors.lastname: Shields
authors.affiliation: Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Deborah
authors.initials: D
authors.lastname: Campbell
authors.affiliation: Division of Neonatology, Department of Pediatrics, Stony Brook University Hospital, Stony Brook, New York.
authors.forename: Adriann
authors.initials: A
authors.lastname: Combs
authors.affiliation: Division of Neonatology, Department of Pediatrics, Children's Hospital at Albany Medical Center, Albany Medical College, Albany, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Horgan
authors.affiliation: Division of Neonatology, Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York.
authors.forename: Edmund F
authors.initials: EF
authors.lastname: La Gamma
authors.affiliation: New York State (NYS) Department of Health, Albany, New York.
authors.forename: KuangNan
authors.initials: K
authors.lastname: Xiong
authors.affiliation: New York State (NYS) Department of Health, Albany, New York.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Kacica
mesh_terms: D001724:Birth Weight; D004750:Enteral Nutrition / Q000592:standards*; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology*; D005865:Gestational Age; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature / Q000254:growth & development*; D007231:Infant, Newborn; D016014:Linear Models; D015999:Multivariate Analysis; D009518:New York; D009749:Nutrition Surveys; D010288:Parenteral Nutrition / Q000592:standards*; D018805:Sepsis / Q000453:epidemiology*