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Am J Perinatol 2016; 33(01): 009-019
DOI: 10.1055/s-0035-1554794
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Variation in Enteral Feeding Practices and Growth Outcomes among Very Premature Infants: A Report from the New York State Perinatal Quality Collaborative

Timothy P. Stevens
1   Division of Neonatology, Department of Pediatrics, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, New York
,
Eileen Shields
2   New York State (NYS) Department of Health, Albany, New York
,
Deborah Campbell
3   Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
,
Adriann Combs
4   Division of Neonatology, Department of Pediatrics, Stony Brook University Hospital, Stony Brook, New York
,
Michael Horgan
5   Division of Neonatology, Department of Pediatrics, Children's Hospital at Albany Medical Center, Albany Medical College, Albany, New York
,
Edmund F. La Gamma
6   Division of Neonatology, Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York
,
KuangNan Xiong
2   New York State (NYS) Department of Health, Albany, New York
,
Marilyn Kacica
2   New York State (NYS) Department of Health, Albany, New York
7   State University of New York, School of Public Health, University at Albany, Rensselaer, New York
› Author Affiliations
Further Information

Publication History

19 October 2014

15 April 2015

Publication Date:
17 June 2015 (online)

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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.

Conclusion 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.

Keywords

extrauterine growth restriction - infant - premature - infant growth - neonatal nutrition - quality improvement

Funding Sources

The New York State Department of Health (NYSDOH) provided financial support to the New York State Perinatal Quality Collaborative (NYSPQC) for the quality improvement activities reported here. Funding was also made possible by grant U38DP003782 from the Centers for Disease Control and Prevention (CDC).


 

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