P3B216: Nutritional Management of Preterm Infants by Community Pediatricians: Prevailing Trends and Areas for Improvement

Background: Growth failure and its comorbidities is a significant risk for preterm infants both during and after hospitalization. Nutritional recommendations for preterm infants are “scarce and conflicting”. Due to the paucity of data and lack of clear recommendations, post-discharge practices regarding feeding vary widely by region and provider. However, there are evidence-based practices that have support from current literature. Per the 2006 European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines (ESPGHAN) “ evidence supports use of fortified formulas in formula-fed preterm infants after hospital discharge.” Our aim was to create a survey that captures the local practices regarding preterm formulas for those infants (born < 34 weeks gestational age) discharged from the hospital.

Methods: An electronic survey was sent to practicing pediatric providers in Western New York from September 2022 through December 2022. Information about the survey was sent out electronically to the local pediatric society, of which many local pediatricians are members, and then distributed to interested practices electronically. Emails were sent out twice regarding recruitment of interested practices, and a reminder was sent out to participating practices regarding survey completion. The survey was also administered to resident physicians and academic pediatricians associated with the children’s hospital. The survey consisted of 11 questions, which evaluated the comfort of pediatric providers managing preterm infants’ formula, preferred formula for this age group, factors influencing providers’ decisions to change the formula and informational sources used to guide decision making. Descriptive statistics were used to represent numbers and percentages of participants' responses to survey items.

Results: We received a total of 39 responses from 103 surveyed pediatric providers (response rate of 37.8%). 35.9% of providers were comfortable managing nutrition in a preterm infant. Preterm infant formula was most frequently recommended (76.9%), with most providers (64.1%) continuing whichever formula was started in the NICU. Feeding intolerance (95%) was the most common reason for formula change. Reflux, fussiness and gassiness being the most commonly encountered symptoms of formula intolerance. There was significant variability in the duration of use of preterm formulas, with majority (34%) of providers continuing the preterm formula until 6 months. Dietician recommendation was the most common informational resource used to make decisions regarding nutritional management.

Conclusion: The results of this study indicate that there is a lack of provider comfort and standardization in the management practices of nutritional needs of preterm babies. Providers report utilizing a wide range of resources and many report relying on clinical experience to guide recommendations. Future directions include distributing ESPGHAN guidelines regarding use of premature infant formula, creation of recommendations for how long to continue premature infant formula, and increasing availability of dietician support to community providers (ie contact information for NICU dietician, increased availability of community dieticians).