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  • Quality Improvement Article
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Reducing time to initiation and advancement of enteral feeding in an all-referral neonatal intensive care unit

Journal of Perinatology volume 38, pages 936–943 (2018)Cite this article

Subjects

Abstract

Objective:

Decrease time to enteral feeding initiation and advancement.

Study Design:

In our all-referral neonatal intensive care unit, we developed an evidence-based guideline addressing feeding initiation and advancement. During 6 months before and 7 months after guideline implementation, we measured time to initiate feeding, time to 100 ml/kg/day of feeding, gastric residual measurement frequency, and incidence of necrotizing enterocolitis (balancing measure).

Result:

Two hundred twenty-three infants were studied. Time from admission to feeding initiation was shorter after guideline implementation (mean 0.5 days [95% CI: 0.4–0.7] vs. 1.1 days [95% CI: 0.7–1.5], p = 0.01). Time from admission to 100 ml/kg/day feeding was also shorter (3.6 days [95% CI: 2.8–4.4] vs. 6.2 days [95% CI: 4.4–8.1], p = 0.01). After guideline implementation, routine gastric residual measurements were discontinued.

Conclusion:

After implementation of an enteral feeding guideline, which included discontinuation of routine gastric residual assessment, we observed a faster initiation of enteral feeding and shorter time to reach 100 ml/kg/day.

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Acknowledgements

We thank all the patients, families, and care providers who participated in the study. We thank Munish Gupta MD, MMSc for providing guidance regarding project design. We used the SQUIRE 2.0 guideline to write this manuscript (31).

Funding:

Funding provided by the Program for Patient Quality and Safety at Boston Children’s Hospital.

Author information

Authors and Affiliations

  1. Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA, 02115, USA

    Sarah U. Morton & Anne Hansen

  2. Division of Newborn Medicine, Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA

    Mandy B. Belfort

  3. Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, MA, 02115, USA

    Prerna S. Kahlon

  4. Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA, 02115, USA

    Sara Hajizadeh Barfjani, Coral Rudie, Emily Hashim & Susanna Y. Huh

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  1. Sarah U. Morton
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Correspondence to Sarah U. Morton.

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The authors declare that they have no conflict of interest.

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Morton, S.U., Belfort, M.B., Kahlon, P.S. et al. Reducing time to initiation and advancement of enteral feeding in an all-referral neonatal intensive care unit. J Perinatol 38, 936–943 (2018). https://doi.org/10.1038/s41372-018-0110-2

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  • DOI: https://doi.org/10.1038/s41372-018-0110-2

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