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  • Quality Improvement Article
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Adjustable feedings plus accurate serial length measurements decrease discharge weight-length disproportion in very preterm infants: quality improvement project

Journal of Perinatology volume 39, pages 1131–1139 (2019)Cite this article

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A Correction to this article was published on 10 October 2019

This article has been updated

Abstract

Background

Preterm very-low-birth-weight (≤1500 g) infants exhibit disproportionate weight-for-length growth in the Neonatal Intensive Care Unit.

Local problem

High frequency of body mass index (BMI) > 90th centile at discharge and 1-year postnatal age associated with elevated blood pressure and serum leptin in infancy and adolescence.

Methods

Single-institution quality improvement project in appropriately grown infants born at 230/7–286/7 weeks gestational age and discharged home.

Intervention

Adjustable feeding protocol based on valid serial length measurements (board or caliper).

Results

The average monthly percentage of weight-for-length disproportion at discharge decreased from 13% in Epoch 1 to 0% in Epoch 2 (P < 0.05). Although the average Z-score for BMI at discharge was lower in Epoch 2 versus Epoch 1 (P < 0.01), this was absent by 1 year follow-up (P = 0.91).

Conclusions

Adjustable feedings plus use of accurate serial length measurements decreases weight-for-length disproportion at hospital discharge but not at 1 year.

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Change history

  • 10 October 2019

    An amendment to this paper has been published and can be accessed via a link at the top of the paper.

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Acknowledgements

Lara Pavageau, MD, validated and implemented serial length measurements that allowed characterization of growth patterns; these data were published previously [18]. Susan Chacko, RN and Maria DeLeon, RN were research coordinators for part of this study. Chen Du, RD, Elizabeth Brammer, RD, Audrey Edwards, RD, and Theresa Jacob, RD, dietitians at Parkland Hospital, obtained anthropometric measurements for this study and participated in patient recruitment, assessments of growth and laboratory results and recommendations for nutritional interventions. Elen Petrosyan, RD, dietitian at Parkland Hospital, helped organizing the logistics of patient recruitment, measurements and research planning. Christopher Clark, IT specialist at Parkland Hospital, extracted data from EPIC at Parkland. Sandra Gosser, NNP, helped with education of nurse practitioners and coordination of care with the dietitians and the physicians. Timothy Brannon, MD, helped with changes on EPIC, specifically with implementation of parameters to define AGA at birth. Rebecca Thomas, RN and Catherine Vanbeek, RN, NP, helped with changes in EPIC ordering and education of nurses. Lizette Torres, RN, Alicia Guzman, Cathy Boatman, Emily Lentz, RD, and Elizabeth Heyne, PA-C, helped with collection of follow-up data. Some of the patients included in the QI described in the current manuscript were enrolled in a blinded randomized trial: Clinicaltrials.gov NCT02372136. Preliminary results were submitted in abstract form to the following meetings: Brion LP, Rosenfeld CR, Heyne R, Brown LS, Lair C, Burchfield P. Quality Improvement Project Designed to Decrease Weight-Length Disproportion at Discharge in Very Preterm Infants. Poster presentation at AAP NCE, Orlando, FL, 11/2/2018. Brion LP, Rosenfeld CR, Heyne R, Brown LS, Lair C, Burchfield P, Caraig M. Adjustable Feedings plus Accurate Serial Length Measurements Can Decrease Weight-Length Disproportion in Very Preterm Infants. Poster presentation at Pediatric Academy Societies, Baltimore, MD, 4/29/2019.

Financial Support

George L. MacGregor Professorship (CRR) and Children’s Medical Center Clinical Advisory Committee (CCRAC) – Senior Investigator Research Award – New Direction (LPB, 2015–17)

Author information

Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Luc P. Brion, Charles R. Rosenfeld, Roy Heyne, Patti J. Burchfield & Maria Caraig

  2. Parkland Hospital and Health System, Dallas, TX, USA

    Steven L. Brown & Cheryl S. Lair

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  1. Luc P. Brion
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  2. Charles R. Rosenfeld
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Contributions

LPB: wrote the first draft of the manuscript. He conceptualized and designed the study. He collected and reviewed data from the database, participated in the interpretation of the data, conducted statistical analyses, critically reviewed the revisions, and approved the final manuscript as submitted. CRR: conceptualized and designed the study. He participated in the interpretation of the data, critically reviewed the revisions, and approved the final manuscript as submitted. RH: conceptualized and designed the study. He participated in the interpretation of the data, critically reviewed the revisions, and approved the final manuscript as submitted. LSB: conceptualized and designed the study. He calculated processes of care using data extracted electronically from EPIC, conducted statistical analyses, participated in the interpretation of the data, critically reviewed the revisions, and approved the final manuscript as submitted. CSL: conceptualized and designed nutritional guidelines for the NICU and discharge, anthropometric data and data extraction from EPIC. She obtained anthropometric measurements for this study and participated in patient recruitment, assessments of growth and laboratory results and recommendations for nutritional interventions. She participated in the interpretation of the data, critically reviewed the revisions, and approved the final manuscript as submitted. PJB: collected and entered data into the databases; she participated in the interpretation of the data, critically reviewed the manuscript and approved the final manuscript as submitted. MC: was research coordinator for a large part of this study. She recruited and measured patients in the NICU and at follow-up. She extracted data from medical records into databases, critically reviewed the manuscript and approved the final manuscript as submitted.

Corresponding author

Correspondence to Luc P. Brion.

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Brion, L.P., Rosenfeld, C.R., Heyne, R. et al. Adjustable feedings plus accurate serial length measurements decrease discharge weight-length disproportion in very preterm infants: quality improvement project. J Perinatol 39, 1131–1139 (2019). https://doi.org/10.1038/s41372-019-0424-8

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