Statewide Initiative to Reduce Postnatal Growth Restriction among Infants < 31 Weeks of Gestation

Authors

Timothy P. Stevens
Eileen Shields
Deborah Campbell
Adriann Combs
Michael Horgan
Edmund F. La Gamma, New York Medical CollegeFollow
KuangNan Xiong
Marilyn Kacica

DOI

10.1016/j.jpeds.2018.01.074

Journal Title

The Journal of Pediatrics

First Page

82

Last Page

89.e2

Document Type

Article

Publication Date

June 2018

Department

Pediatrics

Abstract

OBJECTIVE: To decrease the incidence of postnatal growth restriction, defined as discharge weight <10th percentile for postmenstrual age, among preterm infants cared for in New York State Regional Perinatal Centers. STUDY DESIGN: The quality improvement cohort consisted of infants <31 weeks of gestation admitted to a New York State Regional Perinatal Center within 48 hours of birth who survived to hospital discharge. Using quality improvement principles from the Institute for Healthcare Improvement and experience derived from successfully reducing central line-associated blood stream infections statewide, the New York State Perinatal Quality Collaborative sought to improve neonatal growth by adopting better nutritional practices identified through literature review and collaborative learning. New York State Regional Perinatal Center neonatologists were surveyed to characterize practice changes during the project. The primary outcome-the incidence of postnatal growth restriction-was compared across the study period from baseline (2010) to the final (2013) years of the project. Secondary outcomes included differences in z-score between birth and discharge weights and head circumferences. RESULTS: We achieved a 19% reduction, from 32.6% to 26.3%, in postnatal growth restriction before hospital discharge. Reductions in the difference in z-score between birth and discharge weights were significant, and differences in z-score between birth and discharge head circumference approached significance. In survey data, regional perinatal center neonatologists targeted change in initiation of feedings, earlier breast milk fortification, and evaluation of feeding tolerance. CONCLUSIONS: Statewide collaborative quality improvement can achieve significant improvement in neonatal growth outcomes that, in other studies, have been associated with improved neurodevelopment in later infancy.

Recommended Citation

Stevens, T., Shields, E., Campbell, D., Combs, A., Horgan, M., La Gamma, E., Xiong, K., & Kacica, M. (2018). Statewide Initiative to Reduce Postnatal Growth Restriction among Infants < 31 Weeks of Gestation. The Journal of Pediatrics, 197, 82-89.e2. https://doi.org/10.1016/j.jpeds.2018.01.074