Quality improvement initiative to decrease extrauterine growth restriction in preterm neonates

2021 ◽  
Author(s):  
Nitasha Bagga ◽  
Kiran Kumar Reddy ◽  
Ashik Mohamed ◽  
Nalinikant Panigrahy ◽  
Dinesh Kumar Chirla
Keyword(s):  
Quality Improvement ◽  
Growth Restriction ◽  
Preterm Neonates ◽  
Quality Improvement Initiative ◽  
Extrauterine Growth Restriction

Quality Initiative to Reduce Extrauterine Growth Restriction in Very Low Birth Weight Infants

2022 ◽  
Author(s):  
Ramasubbareddy Dhanireddy ◽  
Patricia A. Scott ◽  
Brenda Barker ◽  
Theresa A. Scott
Keyword(s):  
Birth Weight ◽  
Primary Outcome ◽  
Very Low Birth Weight ◽  
Caloric Intake ◽  
Growth Restriction ◽  
Quality Improvement Initiative ◽  
Low Birth Weight Infants ◽  
Process Measures ◽  
Extrauterine Growth Restriction ◽  
Parenteral Protein

BACKGROUND: We report a statewide quality improvement initiative aimed to decrease the incidence of extrauterine growth restriction among very low birth weight infants cared for in Tennessee NICUs. METHODS: The cohort consisted of infants born appropriate for gestational age between May 2016 and December 2018 from 9 NICUs across Tennessee. The infants were 23 to 32 weeks gestation and 500 to 1499 g birth weight. The process measures were the hours of life (HOL) when parenteral protein and intravenous lipid emulsion were initiated, the number of days to first enteral feeding, and attainment of full enteral caloric intake (110–130 kcal/kg per day). The primary outcome was extrauterine growth restriction, defined as weight <10th percentile for weight at 36 weeks postmenstrual age. Statistical process control charts and the Shewhart control rules were used to find special cause variation. RESULTS: Although special cause variation was not indicated in the primary outcome measure, it was indicated for the reduction in specific process measures: HOL when parenteral protein was initiated, HOL when intravenous lipid emulsion was initiated, and the number of days to attainment of full enteral caloric intake (among the hospitals considered regional perinatal centers). CONCLUSIONS: A statewide quality improvement initiative led to earlier initiation of parenteral and enteral nutrition and improved awareness of the importance of postnatal nutrition.

scholarly journals Extrauterine Growth Restriction: Definitions and Predictability of Outcomes in a Cohort of Very Low Birth Weight Infants or Preterm Neonates

Nutrients ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1224 ◽  
Author(s):  
Chiara Peila ◽  
Elena Spada ◽  
Francesca Giuliani ◽  
Giulia Maiocco ◽  
Melissa Raia ◽  
...  
Keyword(s):  
Very Low Birth Weight ◽  
Growth Restriction ◽  
Preterm Neonates ◽  
Low Birth Weight Infants ◽  
Term Outcome ◽  
Cross Sectional ◽  
Long Term Outcome ◽  
Nutritional Interventions ◽  
Definition Of ◽  
Extrauterine Growth Restriction

Extrauterine Growth Restriction (EUGR) refers to inadequate growth during hospitalization. Current definitions for EUGR are varied and can be classified as cross-sectional (weight at a given t-time <10th centile) or longitudinal (weight loss between birth and a given t-time >1SD). Different t-times are also considered in literature, such as 36 weeks of gestational age (GA) or age at discharge. The aim of this study is to investigate whether EUGR could predict the auxological outcome at 24–30 months, and to evaluate the agreement between cross-sectional and longitudinal definitions. In total, 1589 infants with GA <30 weeks or birthweight ≤ 1500 g and without major congenital anomalies were included in this study. Cross-sectional and longitudinal EUGR were calculated at 36 and 40 weeks of GA, at discharge, and at 28 days. The concordance between the two definitions was estimated by Kappa coefficient. At 24–30 months, 803 infants were measured again. The agreement between the two definitions of EUGR was low. Both EUGR and not-EUGR groups were at lower centiles for weight, but at higher centiles for head circumference at 24–30 months than at birth. Longitudinal EUGR was associated with a poorer growth outcome for weight and height circumference than cross-sectional EUGR. No differences were observed for length. An agreed definition of EUGR is highly desirable in clinical practice to assess medical and nutritional interventions in preterm neonates. Based on the results of this study, we recommend the use of the longitudinal evaluation, that proved to better predict the auxological long-term outcome with respect to the cross-sectional one.

A Quality Improvement Initiative: Improving Exclusive Breastfeeding Rates of Preterm Neonates

2017 ◽  
Vol 84 (4) ◽  
pp. 322-325 ◽  
Author(s):  
Amanpreet Sethi ◽  
Meena Joshi ◽  
Anu Thukral ◽  
Jagjit Singh Dalal ◽  
Ashok Kumar Deorari
Keyword(s):  
Quality Improvement ◽  
Exclusive Breastfeeding ◽  
Preterm Neonates ◽  
Quality Improvement Initiative ◽  
Breastfeeding Rates

Impact of a standardised parenteral nutrition protocol: a quality improvement experience from a NICU of a developing country

2021 ◽  
pp. archdischild-2021-321552
Author(s):  
Gul Ambreen ◽  
Vikram Kumar ◽  
Syed Rehan Ali ◽  
Uswa Jiwani ◽  
Waqar Khowaja ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Weight Gain ◽  
Parenteral Nutrition ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Rate Of Change ◽  
Preterm Neonates ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Z Scores

ObjectiveNutrition societies recommend using standardised parenteral nutrition (SPN) solutions. We designed evidence-based SPN formulations for neonates admitted to our neonatal intensive care unit (NICU) and evaluated their outcomes.DesignThis was a quality improvement initiative. Data were collected retrospectively before and after the intervention.SettingA tertiary-care level 3 NICU at the Aga Khan University in Karachi, Pakistan.PatientsAll NICU patients who received individualised PN (IPN) from December 2016 to August 2017 and SPN from October 2017 to June 2018.InterventionsA team of neonatologists and nutrition pharmacists collaborated to design two evidence-based SPN solutions for preterm neonates admitted to the NICU.Main outcome measuresWe recorded mean weight gain velocity from days 7 to 14 of life. The other outcomes were change in weight expressed as z-scores, metabolic abnormalities, PN-associated liver disease (PNALD), length of NICU stay and episodes of sepsis during hospital stay.ResultsNeonates on SPN had greater rate of change in weight compared with IPN (β=13.40, 95% CI: 12.02 to 14.79) and a smaller decrease in z-scores (p<0.001). Neonates in the SPN group had fewer hyperglycemic episodes (IPN: 37.5%, SPN: 6.2%) (p<0.001), electrolyte abnormalities (IPN: 56.3%, SPN: 21%) (p<0.001), PNALD (IPN: 52.5%, SPN: 18.5%) (p<0.001) and sepsis (IPN: 26%, SPN: 20%) (p<0.05). The median length of stay in NICU was 14.0 (IQR 12.0–21.0) for the IPN and 8.0 (IQR 5.0–13.0) days for the SPN group.ConclusionsWe found that SPN was associated with shorter NICU stay and greater weight gain. In-house preparation of SPN can be used to address the nutritional needs in resource-limited settings where commercially prepared SPN is not available.

scholarly journals Vertically transmitted infections and extrauterine growth restriction in preterm neonates: a new risk factor

2021 ◽  
Vol 21 (1) ◽  
pp. 107-115
Author(s):  
Verônica Cheles Vieira ◽  
Raquel Cristina Gomes Lima ◽  
Daiane Borges Queiroz ◽  
Danielle Souto de Medeiros
Keyword(s):  
Premature Infants ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Positive Association ◽  
Final Analysis ◽  
Growth Restriction ◽  
Preterm Neonates ◽  
Clinical Practices ◽  
Increased Risk ◽  
Extrauterine Growth Restriction

Abstract Objectives: to investigate the association between Vertically Transmitted Infections (VTI) and Extrauterine Growth Restriction (EUGR) among premature infants in Neonatal Intensive Care Units (NICU). Methods: part of a large non-concurrent cohort study with medical records analysis. We evaluated EUGR in premature infants at a gestational age at birth of > 32 weeks and <36 weeks and presented a corrected gestational age of 36 completed weeks during a 27-day birth follow-up. Premature infants with major congenital anomalies were excluded. We analyzed associations among EUGR, VTI and covariables related to maternal disease, birth characteristics, perinatal morbidities and clinical practices. Results: out of the 91 premature infants, 59.3% (CI95%=48.9-69.0%) developed EUGR. VTI were observed in 4.4%o of the population; all premature infants affected by VTI had EUGR. The VTI found were syphilis, cytomegalovirus disease and toxoplasmosis. The final analysis has showed a positive association between VTI and EUGR (RR=1.57; CI95%o=1.07-2.30); the female covariables (RR=1.50; CI95%=1.11-2.02), moderate premature classification (RR=1.41; CI95%=1.06-1.87) and small for gestational age (RR=2.69; CI95% 1.853.90) have also influenced this outcome. Conclusion: this study revealed VTI as an important morbidity factor, with impact on the increased risk of EUGR between premature infants affected by these diseases.

A quality improvement initiative to improve management of procedural pain in preterm neonates

2020 ◽  
Author(s):  
Rajendra Prasad Anne ◽  
Saikiran Deshabhotla ◽  
Shaista Waheed Ahmed ◽  
Saadiya Jaleel Ahmed ◽  
Navneeth Reddy ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Procedural Pain ◽  
Preterm Neonates ◽  
Quality Improvement Initiative

scholarly journals Extrauterine Growth Restriction in Very Low Birth Weight Infants: Concordance Between Fenton 2013 and INTERGROWTH-21st Growth Charts

2021 ◽  
Vol 9 ◽  
Author(s):  
Lara González-García ◽  
Enrique García-López ◽  
Belén Fernández-Colomer ◽  
Laura Mantecón-Fernández ◽  
Sonia Lareu-Vidal ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Neonatal Morbidity ◽  
Growth Restriction ◽  
University Hospital ◽  
Preterm Neonates ◽  
Low Birth Weight Infants ◽  
Cross Sectional ◽  
Extrauterine Growth Restriction

Postnatal growth restriction has high prevalence in very low birth weight (VLBW) preterm neonates, and this could affect their long-term prognosis. Nowadays, there is no consensus on how to monitor growth in these neonates.Objective: This study aimed to compare prevalence of intra- and extrauterine growth restriction (IUGR and EUGR) in a sample of VLBW infants according to the Fenton 2013 charts and INTERGROWTH-21st (IW-21) standards and to analyze concordance between both in the different EUGR definitions criteria (cross-sectional, dynamic, and true).Patients and Methods: An observational retrospective study of 635 VLBW preterm was performed. The study was carried out in Central University Hospital of Asturias. Body measurements (weight, length, and head circumference) were collected at birth and at hospital discharge and expressed in z-scores for the two references (Fenton 2010 and IW-21). Kappa concordance was calculated.Results: Kappa concordance between Fenton and IW-21 was 0.887 for IUGR and 0.580 for static EUGR. Prevalence was higher according to Fenton in IUGR (36.5 vs. 35.1%), in static EUGR (73.8 vs. 59.3%), and in dynamic EUGR (44.3 vs. 29.3%). Despite observing low prevalence of EUGR when IW-21 was used to define EUGR, a statistical association between neonatal morbidity and diagnosis of EUGR was observed.Conclusion: The Fenton and IW-21 concordance for IUGR is good. IW-21 is more restrictive than Fenton in EUGR. Patients diagnosed by IW-21 as EUGR are more likely to have neonatal morbidity, especially if we use EUGR dynamic definition. In our study, we cannot conclude that one graph is better than the other.

Oral Care with Mother’s Own Milk in Sick and Preterm Neonates: A Quality Improvement Initiative

2020 ◽  
Vol 88 (1) ◽  
pp. 50-57
Author(s):  
Kanhu Charan Digal ◽  
Jaya Upadhyay ◽  
Poonam Singh ◽  
Shantanu Shubham ◽  
Rajat Grover ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Oral Care ◽  
Preterm Neonates ◽  
Quality Improvement Initiative ◽  
Mother’S Own Milk
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