Benefits of a Standardized Enteral Feeding Protocol on the Nutrition and Health Outcomes of Very Low Birth Weight Preterm Infants

Publication: Canadian Journal of Dietetic Practice and Research
3 May 2022

Abstract

Purpose: To compare nutrition and health outcomes before and after implementing a standardized enteral feeding protocol on nutrition and health outcomes in very low birth weight preterm infants.
Methods: A retrospective chart review was performed evaluating preterm infants, born less than 34 weeks gestation and weighing less than 1500 g, before and after the implementation of a standardized enteral feeding protocol. Outcomes included weaning of parenteral nutrition, initiation and advancement of enteral feeds, initiation of human-milk fortifier (HMF), change in weight z-score and neonatal morbidities.
Results: Fifty-six infants (30 in pre-group, 26 in post-group) met the inclusion criteria. Infants in the standardized enteral feeding protocol group started enteral feeds earlier (p = 0.039) and received full HMF fortification at lower weights (p = 0.033) than those in the pre-group. Fewer days on continuous positive airway pressure (p = 0.021) and lower rates of bronchopulmonary dysplasia (p = 0.018) were also observed in the post-group. Weaning of parenteral nutrition and weight z-score were not significantly different between groups. There were no differences in other morbidities.
Conclusion: Study results suggest that adopting a standardized enteral feeding protocol may promote early initiation of enteral feeds and fortification.

Résumé

Objectif. Comparer les résultats sur le plan de la nutrition et de la santé avant et après la mise en place d’un protocole normalisé d’alimentation entérale chez des enfants prématurés de très faible poids à la naissance.
Méthodes. Un examen rétrospectif des dossiers a été réalisé pour évaluer des enfants prématurés, nés à moins de 34 semaines de grossesse et pesant moins de 1 500 g à la naissance, avant et après la mise en place d’un protocole normalisé d’alimentation entérale. Les résultats comprenaient le sevrage de l’alimentation parentérale, l’introduction et la progression de l’alimentation entérale, l’introduction de fortifiant de lait maternel (FLM), l’évolution de l’écart réduit du poids et les morbidités néonatales.
Résultats. Cinquante-six nourrissons (30 à la phase pré-groupe, 26 à la phase post-groupe) répondaient aux critères d’inclusion. Les nourrissons du groupe du protocole normalisé d’alimentation entérale ont commencé l’alimentation entérale plus tôt (p = 0,039) et ont reçu une fortification par FLM complète à un poids plus faible (p = 0,033) que ceux du pré-groupe. Un nombre inférieur de jours de ventilation en pression positive continue (p = 0,021) et des taux inférieurs de dysplasie broncho-pulmonaire (p = 0,018) ont également été observés dans le post-groupe. Le sevrage de l’alimentation parentérale et l’écart réduit du poids n’étaient pas significativement différents entre les groupes. On n’a constaté aucune différence quant aux autres morbidités.
Conclusions. Les résultats de l’étude suggèrent que l’adoption d’un protocole normalisé d’alimentation entérale pourrait favoriser l’introduction précoce de l’alimentation entérale et de la fortification.

Get full access to this article

View all available purchase options and get full access to this article.

REFERENCES

1
Lucas A. Long-term programming effects of early nutrition – implications for the preterm infant. J Perinat. 2005;25(S2):S2.
2
Lapillonne A and Griffin IJ. Feeding preterm infants today for later metabolic and cardiovascular outcomes. J Pediatr. 2013;162(3):S7–16.
3
Ong KK, Kennedy K, Castañeda-Gutiérrez E, Forsyth S, Godfrey KM, Koletzko B, et al. Postnatal growth in preterm infants and later health outcomes: a systematic review. Acta Paediatr. 2015;104(10):974–86.
4
Gephart SM and Hanson CK. Preventing necrotizing enterocolitis with standardized feeding protocols: not only possible, but imperative. Adv Neonatal Care. 2013;13(1):48–54.
5
Kish MZ. Improving preterm infant outcomes: implementing an evidence-based oral feeding advancement protocol in the neonatal intensive care unit. Adv Neonatal Care. 2014;14(5):346–53.
6
Viswanathan S, McNelis K, Super D, Einstadter D, Groh-Wargo S, and Collin M. Standardized slow enteral feeding protocol and the incidence of necrotizing enterocolitis in extremely low birth weight infants. J Parenter Enteral Nutr. 2015;39(6):644–54.
7
Loomis T, Byham-Gray L, Ziegler J, and Parrott JS. Impact of standardized feeding guidelines on enteral nutrition administration, growth outcomes, metabolic bone disease, and cholestasis in the NICU. J Pediatr Gastroenterol Nutr. 2014;59(1):93–8.
8
McCallie KR, Lee HC, Mayer O, Cohen RS, Hintz SR, and Rhine WD. Improved outcomes with a standardized feeding protocol for very low birth weight infants. J Perinatol. 2011;31(S1):S61.
9
Xu JH, Coo H, Fucile S, Ng E, Ting JY, Shah PS, et al. A national survey of the enteral feeding practices in Canadian neonatal intensive care units. Paediatr Child Health 2019 Aug 30;25(8):529–33.
10
Simon L, Hanf M, Frondas-Chauty A, Darmaun D, Rouger V, Gascoin G, et al. Neonatal growth velocity of preterm infants: the weight Z-score change versus Patel exponential model. PLoS One 2019;14(6):e0218746.
11
Walsh MC, Wilson-Costello D, Zadell A, Newman N, and Fanaroff A. Safety, reliability, and validity of a physiologic definition of bronchopulmonary dysplasia. J Perinatol. 2003;23(6):451.
12
Smith JR. Early enteral feeding for the very low birth weight infant: the development and impact of a research-based guideline. Neonatal Netw. 2005;24(4):9–19.
13
Donovan R, Puppala B, Angst D, and Coyle BW. Outcomes of early nutrition support in extremely low-birth-weight infants. Nutr Clin Pract. 2006;21(4):395–400.
14
Street JL, Montgomery D, Alder SC, Lambert DK, Gerstmann DR, and Christensen RD. Implementing feeding guidelines for NICU patients< 2000 g results in less variability in nutrition outcomes. J Parenter Enteral Nutr. 2006;30(6):515–8.
15
Wemhöner A, Ortner D, Tschirch E, Strasak A, and Rüdiger M. Nutrition of preterm infants in relation to bronchopulmonary dysplasia. BMC Pulm Med 2011;11(1):7.
16
Frank L and Sosenko IR. Undernutrition as a major contributing factor in the pathogenesis of bronchopulmonary dysplasia. Am Rev Respir Distress. 1988;138(3):725–9.
17
Coalson JJ. Pathology of new bronchopulmonary dysplasia. Semin Neonatol. 2003;8(1):73–81.
18
Jobe AH. Let’s feed the preterm lung. J Pediatr (Rio J). 2006;82(3):165–6.
19
Berwick DM. The science of improvement. JAMA. 2008;299(10):1182–4.

Supplementary Material

File (cjdpr-2022-003suppla.docx)
File (cjdpr-2022-003supplb.docx)
File (cjdpr-2022-003supplc.docx)

Information & Authors

Information

Published In

cover image Canadian Journal of Dietetic Practice and Research
Canadian Journal of Dietetic Practice and Research
Volume 83Number 3September 2022
Pages: 147 - 150
Editor: Naomi Cahill

History

Version of record online: 3 May 2022

Key Words

  1. Premature infant
  2. growth
  3. tube feeding

Mots-clés

  1. enfant prématuré
  2. croissance
  3. alimentation par sonde

Authors

Affiliations

Rhea D’Costa MD
Department of Pediatrics, Queen’s University, Kingston, ON
Sandra Fucile PhD, OT (reg)
Department of Pediatrics, Queen’s University, Kingston, ON
School of Rehabilitation Therapy, Queen’s University, Kingston, ON
Brittany Dickson RD
Neonatal Intensive Care Unit, Kingston Health Sciences Centre, Kingston, ON
Alessia Gallipoli MD
Department of Pediatrics, Queen’s University, Kingston, ON
Kimberly E Dow MD, FRCPC
Department of Pediatrics, Queen’s University, Kingston, ON

Metrics & Citations

Metrics

Other Metrics

Citations

Cite As

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

There are no citations for this item

View Options

Get Access

Login options

Check if you access through your login credentials or your institution to get full access on this article.

Subscribe

Click on the button below to subscribe to Canadian Journal of Dietetic Practice and Research

Purchase options

Purchase this article to get full access to it.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

View options

PDF

View PDF

Full Text

View Full Text

Media

Media

Other

Tables

Share Options

Share

Share the article link

Share on social media