Improving Preterm Babies’ Nutrition in the NICU
Cedars-Sinai Physician Presented Results of a Statewide Quality Improvement Collaborative Targeting Preterm Infant Nutrition at the Pediatric Academic Societies Meeting
With the goal of bettering nutrition for the smallest babies, Cedars-Sinai neonatologist helped lead a collaborative quality improvement project of 22 California Neonatal Intensive Care Units targeting reducing malnutrition in preterm babies.
The 18-month study, implemented by the California Perinatal Quality Care Collaborative and led by Kurlen Payton, MD, interim director of the Cedars-Sinai Neonatal Intensive Care Unit (NICU), looked at approximately 2,000 babies with a birth weight ranging from 1 pound to about 3 pounds. The babies were followed from birth until they were sent home from the hospital.
"The problem is that preterm babies are at risk for malnutrition and poor growth, and this may increase the risk of several problems, including neurodevelopmental issues later on," said Payton. "We are trying to improve the babies' growth and nutrition while they are in the NICU to make a long-term impact on their future development."
According to Payton, historically, NICU nurses and physicians would not consider a baby malnourished until they were at the 10th percentile or less for their weight. As part of this collaborative effort, quality improvement teams at the 22 NICUs worked to develop innovative processes to make it easier for NICU physicians and nurses to identify babies with malnutrition early and respond more aggressively.
Helping premature infants gain weight is challenging, Payton said. Very small infants have trouble tolerating increased feedings, which can lead to serious complications, including necrotizing enterocolitis, a life threatening disease affecting preterm infants. One of the advances to combat this problem has been prioritizing maternal milk and donor maternal milk instead of formulas, Payton said.
"This is a safer way to feed these babies and it allows us to give them appropriate nutrition earlier and get them up to full feeds faster with less risk of complications," Payton said. “Providing optimal nutrition in these fragile babies is easier said than done. A study like this provides a fertile ground for innovation and sharing ideas among many NICUs. Each NICU may require a unique approach to be successful in their NICU.”
Ten months into the study, researchers were able to see 23% fewer babies being discharged with malnutrition .
Findings from the study were presented at the Pediatric Academic Societies meeting in Denver in the hopes of sharing the improvements and strategies with NICU caregivers everywhere.
Read more on the Cedars-Sinai Blog: How a 101-Day NICU Stay Led to Bliss