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Implications of continuity of care on infant caloric intake in the neonatal intensive care unit

Abstract

Objective

To estimate the association of continuity of neonatologist care with caloric intake and growth velocity (GV) in very low birth weight (VLBW) infants.

Study design

We created a daily continuity index (DCI) defined as the number of days the neonatologist worked in the previous week. We estimated the independent associations between this index and infants’ daily caloric intake (kcal/kg/day) and GV (g/kg/day) through the first 6 weeks of life using regression analyses.

Results

Twenty-eight neonatologists cared for 115 infants over 4643 patient-days. The DCI was independently associated with increased caloric intake (β = 1.27 kcal/kg/day per each day of continuity, p < 10−4); this effect was magnified (β = 3.33, p < 10−4) in the first 2 weeks. No association was observed between the index and GV.

Conclusions

Neonatologist continuity may contribute to caloric intake in VLBW infants. Quality metrics focused on this area of health care delivery warrant further discovery.

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Fig. 1
Fig. 2: Variability of caloric intake by infant and neonatologist.
Fig. 3
Fig. 4
Fig. 5: Multivariable association of categories of daily continuity index (DCI) with caloric intake.

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Acknowledgements

The authors would like to thank Nina Srdanovic, MS, for statistical support.

Funding

No funding was received or contributed to this study.

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Authors and Affiliations

Authors

Contributions

Study design (KZM, GHF, KM, and DTR), data collection (KZM and GHF), analyses (KZM, GHF, and KM), first paper draft (KZM), all authors revised the paper critically for substantive content and approved the final version.

Corresponding author

Correspondence to Kerri Z. Machut.

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Conflict of interest

KM is a Board Member and Chair of the Children’s Hospitals Neonatal Consortium, 501(c)(3) nonprofit organization that manages and owns the Children’s Hospitals Neonatal Database, a data source used in this study. The other authors declare that they have no conflict of interest.

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Machut, K.Z., Robinson, D.T., Murthy, K. et al. Implications of continuity of care on infant caloric intake in the neonatal intensive care unit. J Perinatol 40, 1405–1411 (2020). https://doi.org/10.1038/s41372-020-0636-y

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