Timothy P Stevens1, Eileen Shields2, Deborah Campbell3, Adriann Combs4, Michael Horgan5, Edmund F La Gamma6, KuangNan Xiong2, Marilyn Kacica2. 1. Division of Neonatology, Department of Pediatrics, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, New York. 2. New York State (NYS) Department of Health, Albany, New York. 3. Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York. 4. Division of Neonatology, Department of Pediatrics, Stony Brook University Hospital, Stony Brook, New York. 5. Division of Neonatology, Department of Pediatrics, Children's Hospital at Albany Medical Center, Albany Medical College, Albany, New York. 6. Division of Neonatology, Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York.
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. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Authors: Daniel S Tawfik; Jochen Profit; Eileen T Lake; Jessica B Liu; Lee M Sanders; Ciaran S Phibbs Journal: Health Serv Res Date: 2019-12-23 Impact factor: 3.402