Kathy Kay Pickerel1, Julee Waldrop2, Emily Freeman3, Jamie Haushalter3, Jennifer D'Auria4. 1. The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, United States of America. 2. The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, United States of America. Electronic address: jwaldrop@unc.edu. 3. The University of North Carolina Women's Hospital, Chapel Hill, NC, United States of America. 4. The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, United States of America. Electronic address: jdauria@email.unc.edu.
Abstract
PURPOSE: The purpose of this project was to improve the accuracy of newborn weight classification using a regional newborn growth reference (Olsen), an evidence-based method, to determine SGA, AGA and LGA in term infants compared to the current growth reference (Lubchenco). DESIGN: Quality improvement methods using Lewin's Change Theory guided the process. SETTING/LOCAL PROBLEM: At an academic medical center term infants were evaluated for weight-for-gestational age using the Lubchenco growth reference as well as other growth references based on provider preference. PATIENTS: All term newborns (N = 314) admitted to the newborn nursery during one month following a 3-months implementation of the practice change. INTERVENTION/MEASUREMENTS: Newborn nursery nursing staff and provider staff were provided education and training on using and interpreting the new growth reference. RESULTS: Use of the Olsen regional growth reference identified more infants as small and fewer infants as large for gestational age. Post hoc analysis with a more global growth reference (Fenton) also identified more infants as small and fewer infants as large for gestational age. There was no statistically significant difference between the Olsen or Fenton growth references. CONCLUSION: Use of either of these two updated growth references more accurately classifies infant weight for gestational age compared to the Lubchenco growth reference, potentially decreasing newborn health risks such as hypoglycemia.
PURPOSE: The purpose of this project was to improve the accuracy of newborn weight classification using a regional newborn growth reference (Olsen), an evidence-based method, to determine SGA, AGA and LGA in term infants compared to the current growth reference (Lubchenco). DESIGN: Quality improvement methods using Lewin's Change Theory guided the process. SETTING/LOCAL PROBLEM: At an academic medical center term infants were evaluated for weight-for-gestational age using the Lubchenco growth reference as well as other growth references based on provider preference. PATIENTS: All term newborns (N = 314) admitted to the newborn nursery during one month following a 3-months implementation of the practice change. INTERVENTION/MEASUREMENTS: Newborn nursery nursing staff and provider staff were provided education and training on using and interpreting the new growth reference. RESULTS: Use of the Olsen regional growth reference identified more infants as small and fewer infants as large for gestational age. Post hoc analysis with a more global growth reference (Fenton) also identified more infants as small and fewer infants as large for gestational age. There was no statistically significant difference between the Olsen or Fenton growth references. CONCLUSION: Use of either of these two updated growth references more accurately classifies infant weight for gestational age compared to the Lubchenco growth reference, potentially decreasing newborn health risks such as hypoglycemia.