title: Quantification of EUGR as a Measure of the Quality of Nutritional Care of Premature Infants.
abstract: OBJECTIVE
  To develop an index of the quality of nutritional care of premature infants based on the change in weight Z score from birth to discharge and to illustrate the use of this index in comparing the performance of different NICUs.
  
  
  METHODS
  Retrospective data analysis was performed to compare the growth of premature infants born in three perinatal centers. Infants with gestational age ≤ 32 weeks who survived to discharge from 2006 to 2010 were included. Weight Z scores at birth and discharge were calculated by the method of Fenton. Using data from one NICU as the reference, a multivariable linear regression model of change in weight Z score from birth to discharge was developed. Employing this model, a benchmark value of change in weight Z score was calculated for each baby. The difference between this calculated benchmark value and the baby's observed change in weight Z score was defined as the performance gap for that infant. The average value of the performance gaps in a NICU serves as its quality care index.
  
  
  RESULTS
  1,714 infants were included for analysis. Change in weight Z score is influenced by birth weight Z score and completed weeks of gestation; thus the model for calculating the benchmark change in weight Z score was adjusted for these two variables. We found statistically significant differences in the average performance gaps for the three units.
  
  
  CONCLUSIONS
  A quality care index was developed based on change in weight Z score from birth to discharge adjusted for two initial risk factors. This objective, easily calculated index may be used as a measurement of the quality of nutritional care to rank the performance of different NICUs.
authors.affiliation: Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China, 325027.
authors.forename: Zhenlang
authors.initials: Z
authors.lastname: Lin
authors.affiliation: Kravis Children's Hospital and Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, NY, 10029, United States of America.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Green
authors.affiliation: Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China, 325027.
authors.forename: Shangqin
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Neonatology, The First Hospital of Jilin University, Changchun, China, 130021.
authors.forename: Hui
authors.initials: H
authors.lastname: Wu
authors.affiliation: Department of Neonatology, The First Hospital of Jilin University, Changchun, China, 130021.
authors.forename: Tiantian
authors.initials: T
authors.lastname: Liu
authors.affiliation: Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China, 325027.
authors.forename: Jingyang
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China, 325027.
authors.forename: Jia
authors.initials: J
authors.lastname: Wei
authors.affiliation: Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China, 325027; Kravis Children's Hospital and Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, NY, 10029, United States of America.
authors.forename: Jing
authors.initials: J
authors.lastname: Lin
mesh_terms: D001724:Birth Weight / Q000502:physiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D019102:Infant, Very Low Birth Weight / Q000254:growth & development*; D007363:Intensive Care Units, Neonatal; D008297:Male; D009752:Nutritional Status; D018529:Nutritional Support; D012189:Retrospective Studies; D015430:Weight Gain / Q000502:physiology*