Improved growth of extremely and very preterm babies: Evaluation of a quality‐of‐care initiative

Abstract

Aim To measure growth outcomes in preterm infants after introduction of a nutritional care bundle. Methods A total of 509 infants of less than 32 weeks’ gestation in a level III neonatal intensive care unit in the UK were studied until they were discharged home. Growth and feeding data were extracted from a prospective data registry for 18 months before and after the intervention. The intervention consisted of earlier routine bovine‐derived multi‐component fortification once the infant has reached 120ml/kg/day of enteral feed from the first day of life and an exclusive human milk diet with routine bovine‐derived multi‐component fortification of 120 mL/kg/day. Results After the intervention, growth velocity between birth and 28 days increased from 9.7 ± 4.1 to 12.2 ± 4.6 g/kg/day (mean ± standard deviation), and weight z score change decreased from −1.06 ± 0.56 to −0.76 ± 0.59 (P < 0.00002). For the entire group, growth velocity by the discharge home time point increased by 1 g/kg/day. However, the growth velocity of infants who were discharged on an exclusive human milk diet increased the most, from 10.8 ± 2.2 to 13.0 ± 2.8 g/kg/day (P < 0.00001), eliminating the difference seen between these infants and those discharged on infant formula before the intervention. Conclusion The introduction of a simple nutritional package improved weight gain, particularly in infants fed exclusive human milk at discharge.

A Systematic Review and Meta-Analysis of Human Milk Feeding and Short-Term Growth in Preterm and Very Low Birth Weight Infants

“…Forty-four papers were identified for this review and included nine RCTs [ 15 , 19 , 20 , 21 , 31 , 32 , 33 , 34 , 35 ], one non-randomised intervention trial [ 36 ], three secondary analyses of RCTs [ 9 , 37 , 38 ], six interrupted time series studies [ 8 , 28 , 39 , 40 , 41 , 42 ], and 25 cohort studies [ 7 , 22 , 29 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ]. Thirty-seven studies could be included in the meta-analyses [ 7 , 8 , 9 , 15 , 19 , 20 , 21 , 22 , 28 ,…”

“…Of the non-randomised and observational studies, 28 were assessed as low risk of bias [ 7 , 8 , 9 , 15 , 19 , 20 , 21 , 22 , 35 , 38 , 39 , 40 , 41 , 42 , 43 , 45 , 47 , 49 , 50 , 52 , 55 , 57 , 58 , 59 , 60 , 61 , 63 , 64 ], 11 as moderate [ 28 , 29 , 36 , 37 , 44 , 46 , 48 , 51 , 54 , 56 , 62 ], and 1 as high [ 53 ] ( Table 1 ).…”

“…Weight gain was reported in 41 studies [ 7 , 8 , 9 , 19 , 20 , 21 , 22 , 28 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ]. Twenty-four studies reported g/kg/d, with 20 included in the meta-analysis [ 9 , 19 , 20 , 21 , 28 , 29 , 33 , 34 , 35 , 39 , 40 , 47 , ...…”

“…Four studies reported weight gain in g/d [ 31 , 36 , 48 , 53 ], with three included in the meta-analysis [ 31 , 36 , 48 ]. Nineteen studies reported weight gain as change in z-scores with 14 included in meta-analyses [ 7 , 8 , 22 , 28 , 32 , 42 , 44 , 47 , 49 , 50 , 51 , 55 , 61 , 63 ] and five not included [ 38 , 41 , 43 , 46 , 62 ].…”

“…Thirteen studies were included in the meta-analysis for weight gain (g/kg/d) for this comparison [ 20 , 28 , 29 , 33 , 39 , 40 , 47 , 50 , 52 , 58 , 59 , 60 , 61 ]. Lower doses of HM were associated with a higher rate of weight gain (g/kg/d) (MD 0.56, 95% CI 0.09 to 1.03, n = 3162, I 2 = 72%, Figure 2 , very low certainty evidence, Table S3 ).…”