Timothy P Stevens1, Eileen Shields2, Deborah Campbell3, Adriann Combs4, Michael Horgan5, Edmund F La Gamma6, KuangNan Xiong2, Marilyn Kacica7. 1. Pediatrics (Neonatology), Golisano Children's Hospital at University of Rochester Medical Center, Rochester, NY. Electronic address: Timothy_stevens@urmc.rochester.edu. 2. New York State (NYS) Department of Health, Albany, NY. 3. Pediatrics (Neonatology), Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY. 4. Pediatrics (Neonatology), NYU Winthrop Hospital, Mineoloa, NY. 5. Pediatrics (Neonatology), Children's Hospital at Albany Medical Center, Albany Medical College, Albany, NY. 6. Pediatrics (Neonatology), Maria Fareri Children's Hospital, NY Medical College, Valhalla, NY. 7. New York State (NYS) Department of Health, Albany, NY; State University of New York, University at Albany School of Public Health, Albany, NY.
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.
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.
Authors: Tanis R Fenton; Barbara Cormack; Dena Goldberg; Roseann Nasser; Belal Alshaikh; Misha Eliasziw; William W Hay; Angela Hoyos; Diane Anderson; Frank Bloomfield; Ian Griffin; Nicholas Embleton; Niels Rochow; Sarah Taylor; Thibault Senterre; Richard J Schanler; Seham Elmrayed; Sharon Groh-Wargo; David Adamkin; Prakesh S Shah Journal: J Perinatol Date: 2020-03-25 Impact factor: 2.521
Authors: M Eva Dye; Caitlin Pugh; Christa Sala; Theresa A Scott; Tamara Wallace; Peter H Grubb; L Dupree Hatch Journal: Jt Comm J Qual Patient Saf Date: 2021-06-18