Improving Nutrition in Extremely Low Birth Weight Infants: A Quality Improvement Project

Abstract 

The nutritional management of the extremely low birth weight infant has been a source of controversy and practice variation between and within facilities [Clin Perinatol 29 (2002) 225–244]. By using proven quality improvement methods, a multidisciplinary team implemented processes such as Feeding Guidelines and a Feeding Intolerance Algorithm to standardize nutrition and impact clinically relevant outcomes including (1) reduced days to initiate feedings, add fortifier, and reach full fortified feedings; (2) central line days reduced by 30%; (3) increased discharge weight; and (4) more than 50% reduction of infants discharged home with head circumference less than the third percentile. This project is a straightforward improvement process of getting “back to the basics” and improving quality and consistency of nutrition in extremely low birth weight Infants. By researching the supporting evidence, achieving staff and physician buy-in, and having the commitment of a dedicated team, this project can be safely implemented and result in standardization of nutrition practice leading to reduction in practice variation and improved clinical outcomes.

Keywords: Extremely low birth weight (ELBW), Plan do study act, Feeding guidelines, Fenton fetal-infant growth chart, Feeding intolerance algorithm, Starter TPN, Early trophic feedings