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PEDIATRICS Vol. 111 No. 4 April 2003, pp. e461-e470

ELECTRONIC ARTICLE

Evaluation, Development, and Implementation of Potentially Better Practices in Neonatal Intensive Care Nutrition

Barbara Kuzma-O’Reilly, LD, RD, MA, MAHE*, Maria L. Duenas, MD{ddagger}, Coleen Greecher, MS, RD, CNSD§, Lois Kimberlin, MS, RNC§, Dennis Mujsce, MD§, Debra Miller, BSC|| and Donna Jean Walker, MD

* Mercy Children’s Hospital, Toledo, Ohio
{ddagger} St John Hospital and Medical Center, Detroit, Michigan
§ Milton S. Hershey Medical Center, Hershey, Pennsylvania
|| St. Joseph Health Centre, London, Ontario, Canada
Jackson Madison General Hospital, Jackson, Tennessee

--> Objective. The desire for evidence-based clinical guidelines for nutritional support of the preterm infant has been identified. Published evidence has not yielded clear guidelines about the best method of delivery, substrate use, or appropriate outcome measure to evaluate nutrition support. In addition, reports on research of nutrition support often fail to give the most rudimentary process necessary to improve quality in various unit settings.

Methods. The Vermont Oxford Network "Got Milk" focus group developed eight potentially better practices for nutrition support, implementation strategies for these practices, and a comprehensive appraisal process to measure nutrition outcome in preterm infants.

Results. After implementation of the potentially better practices, all participating institutions showed earlier initiation of nutrition support, earlier attainment of adequate energy intakes, reduced delay in reaching full enteral feeds, more consistent nutrition support practice, decreased length of stay, cost savings, and improved growth at time of discharge.

Conclusions. Development and implementation of evidence-based better nutrition support practices in neonates led to improved nutrient intake and growth with reduced length of stay and related costs. Consistent, comprehensive, multidisciplinary appraisal of practice is an integral component of improving nutrition outcomes in the neonatal population.

Key Words: collaborative quality improvement • NIC/Q 2000

Abbreviations: VLBW, very low birth weight • NICU, neonatal intensive care unit • PBPs, potentially better practices • PDSA, plan-do-study-act • NIC/Q 2000, Neonatal Intensive Care Quality Improvement Collaborative Year 2000 • NEC, necrotizing enterocolitis • VON, Vermont Oxford Network • CAT, critically appraised topic • TPN, total parenteral nutrition

Received for publication Aug 13, 2002; Accepted Oct 24, 2002.


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