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  • Quality Improvement Article
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Improving extrauterine growth: evaluation of an optimized, standardized neonatal parenteral nutrition protocol

Journal of Perinatology volume 39, pages 504–512 (2019)Cite this article

Subjects

Abstract

Objective

Poor extrauterine growth in very low birth weight (VLBW) neonates is common and associated with worsened long-term outcomes. We aimed to decrease growth restriction, measured by the change in weight z-score from birth to 36 weeks post menstrual age, from − 1.13 (baseline) to < −1 within 12 months.

Study design

The Model for Improvement was used in the design and implementation of an optimized, standardized parenteral nutrition protocol. Three Plan-Do-Study-Act cycles were completed and a \(\bar X\) and S control chart was created for the primary outcome.

Result

Mean weight z-score change from birth to 36 weeks post menstrual age improved by 23% to − 0.87. Improvements in early weight gain and linear growth were seen as well.

Conclusion

Use of the Model for Improvement to implement an optimized, standardized parenteral nutrition protocol can help improve extrauterine growth among VLBW infants.

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Acknowledgements

We acknowledge Sharon Groh-Wargo, PhD, RD, LD, Allison Payne, MD, MS, Nancy Newman, RN, and Bonnie Siner RN for their dedicated assistance with this project. In addition, we thank the Rainbow Babies & Children’s Foundation for financial support.

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Authors and Affiliations

  1. Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, MD, USA

    Maj Cory J. Darrow

  2. 18th Medical Operations Squadron Kadena AB, Okinawa, Japan

    Maj Cory J. Darrow

  3. Case Western Reserve University, Cleveland, OH, USA

    Hong Li, Allison Prince, Jacquelyn McClary & Michele C. Walsh

  4. University Hospitals Cleveland Medical Center, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA

    Allison Prince, Jacquelyn McClary & Michele C. Walsh

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  1. Maj Cory J. Darrow
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  2. Hong Li
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  5. Michele C. Walsh
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Corresponding author

Correspondence to Michele C. Walsh.

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The authors declare that they have no conflict of interest.

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Darrow, M.C.J., Li, H., Prince, A. et al. Improving extrauterine growth: evaluation of an optimized, standardized neonatal parenteral nutrition protocol. J Perinatol 39, 504–512 (2019). https://doi.org/10.1038/s41372-018-0279-4

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