Abstract 1397 Health Services Research: Quality Platform, Saturday, 5/1

Background: Preterm infants must demonstrate adequate growth and independent feeding prior to discharge home. Some NICUs may have practices which promote earlier achievement of these objectives.

Methods: We did a retrospective chart review of 360 healthy preterm infants consequently born at 12 Massachusetts NICUs (4 Level III and 8 Level II, n= 30/site) before 7/97. Eligible infants were born between 30 and 35 weeks GA; appropriately grown; with minimal respiratory disease (ventilated <3 days; in supplemental oxygen <7 days); without significant medical or surgical complications and discharged home from study hospital. Means and standard deviations (SD) for GA at birth (GAbirth), Birthweight(BW), discharge weight, GAdisch, growth rate, GA at first oral feed(GApofirst) and last gavage feed(GApglast) were calculated. Multi-variate models were constructed to predict discharge timing and growth.

Results: Means and SD were 33.8±1.0 wks for GApofirst and 34.6±1.1 wks for GApglast. GAdisch (35.8±1.1 wks) was constant for each week of GAbirth and occurred in a normal distribution. After controlling for slight inter-site differences in GA and BW, GAdisch for sites F and P averaged 6 days later than the mean for the entire group(p=0.001), while mean GAdisch for site T was 3.5 days earlier(p=0.04). Significant variation between sites (p<0.05) in GApofirst and in breastfeeding did not significantly affect GAdisch. GApglast was a major predictor of GAdisch(p=0.001) and varied significantly between sites. Sites F and T discharged 4 days later and 3 days earlier respectively even after accounting for GApglast. After adjusting for discharge timing, sites E, S and Q achieved superior growth.

Conclusions: In this population of healthy preterm infants, the gestational age at predicted by the end of gavage feeding. Both occurred in an essentially normative distribution. Two NICUs appear to prolong PG feeds. Three NICUs appear to have superior growth. Comparison of practices, organization and staffing in NICUs with earliest discharge and best growth may aid in identifying factors promoting earlier achievement of independent feeding and better growth. Funded by: Harvard Pilgrim Health Care, Blue Cross/Blue Shield of MA, Neighborhood Health Plans, Tufts Health Plan, Fallon Health Plan