P2C028: Improved Growth at Discharge in Very-low-birth-weight Infants After Changing Nutritional Practices

Purpose/Objectives: Despite recent advances in nutritional support, very-low-birth-weight (VLBW) infants continue to experience growth failure in the NICU. Maternal or perinatal factors and suboptimal nutrition often cause growth failure. Poor growth is correlated with poor long-term neurodevelopmental outcomes and post-NICU growth failure. In 2021, in collaboration with pharmacy and nutrition, our unit made three changes in the VLBW feeding protocol: 1) concentrating TPN, 2) adding NaCl supplementation of 2mEq/kg/day when at full enteric feeds, and 3) providing medical nutrition therapy (MNT) whereby the unit nutritionist adjusts daily feeding volume to maintain volume goals. The purpose of this study was to examine if the implementation of these interventions decreased the rate of postnatal growth restriction, defined as < 10%ile for weight at discharge.

Design/Methods: A retrospective cohort analysis of infants with birthweight (BW) less than 1250 grams and gestational age (GA) < 32 weeks was performed. Baseline maternal characteristics related to growth were collected including GA, multiple gestation, antenatal steroid administration, preeclampsia, maternal diabetes, chorioamnionitis, and ethnicity. Baseline infant characteristics related to growth were collected including PDA, sepsis, and non-surgical NEC. Infants with surgical NEC and genetic anomalies were excluded. We compared the respective percentile for weight (W), length (L) and head circumference (HC) at birth and discharge during two time epochs: before (Epoch 1: 2019-2021, n=118) and after (Epoch 2: 2021-2022, n=45) the implementation of the changes.

Results: Statistical analysis was done using Fisher’s exact test and independent sample t-test. Maternal and infant characteristics were similar between the two epochs except for GA (26.4 vs 27.1 weeks, p=0.05), Table 1.The rate of subnormal growth defined as W, L or HC below 10% was not different between the two epochs at birth (W: 19% vs 24%, p=0.59, L: 24% vs 29%, p=0.68, and HC: 23% vs 22%, p=0.34). The rate of postnatal growth restriction was significantly lower in Epoch 2 compared to 1 for W (63% vs 21%, p=0.01) and L (74% vs 55%, p=0.02) but not for HC (48% vs 36%, p=0.16),Table 2-3.

Conclusion/Discussion: Our study demonstrates that VLBW infants achieved better postnatal weight and length at discharge after changing nutritional practices. These results underscore the importance of a multidisciplinary team approach with neonatologists, pharmacy, and nutrition to improve growth. A limiting factor includes the difference of GA between the 2 groups. In addition, this study warrants a larger sample size to assess treatment effect which will be possible when all infants in Epoch 2 reach discharge.