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  • Quality Improvement Article
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Quality improvement initiative to decrease time to full feeds and central line utilization among infants born less than or equal to 32 0/7 weeks through compliance with standardized feeding guidelines

Journal of Perinatology volume 39, pages 1140–1148 (2019)Cite this article

Subjects

Abstract

Background

There are emerging evidences that support more aggressive feeding advancement among preterm infants. Our NICU had conservative feeding advancement guidelines that delayed enteral feeding and prolonged central line use. We aimed to reduce time to full feeds among infants born ≤ 32 0/7 weeks from 12.8 days to 8 days.

Methods

A multidisciplinary team implemented evidence-based feeding guidelines using quality improvement methods. Days to full enteral feeds, central line days, necrotizing enterocolitis (NEC) rates, and extrauterine growth restriction (EUGR) rates were analyzed.

Results

Average days to full enteral feeds decreased from 12.8 to 7.7 days and from 17.5 to 9.1 days for infants born ≤ 32 0/7 weeks and ≤ 28 0/7 weeks respectively, without significant change in NEC rate. Central line days decreased by 35%. Insignificant improvement in EUGR rate was found.

Conclusions

Faster feeding advancement guidelines led to earlier full enteral feeds and reduced central line utilization without increasing complications.

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Acknowledgements

We thank the nutrition committee at the UMMC NICU for constantly striving toward improving the nutritional outcome of all the babies in the unit and being actively involved in this initiative. We also thank the entire staff in the NICU for participating in the discussion and implementation of the modified feeding guidelines.

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Authors and Affiliations

  1. University of Massachusetts Memorial Medical Center, Worcester, MA, USA

    Sherman Chu, Alexander Procaskey, Susan Tripp, Mary Naples, Heather White & Lawrence Rhein

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  1. Sherman Chu
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Contributions

Dr. Chu conceptualized and designed this quality improvement project, assisted with data collection and analysis, and reviewed, critically revised and completed the final manuscript. Dr. Procaskey conceptualized and designed this quality improvement project, drafted the initial manuscript, assisted with data collection and analysis, and reviewed and critically revised the manuscript. Ms. Tripp RD conceptualized and designed this quality improvement project and reviewed and critically revised the manuscript. Ms. Naples RN and Ms. White assisted with data collection and analysis and reviewed and critically revised the manuscript. Dr. Rhein conceptualized and designed this quality improvement project, reviewed and critically revised the manuscript, and assisted with data collection and analysis. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Sherman Chu.

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Chu, S., Procaskey, A., Tripp, S. et al. Quality improvement initiative to decrease time to full feeds and central line utilization among infants born less than or equal to 32 0/7 weeks through compliance with standardized feeding guidelines. J Perinatol 39, 1140–1148 (2019). https://doi.org/10.1038/s41372-019-0398-6

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  • DOI: https://doi.org/10.1038/s41372-019-0398-6

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