Quality Initiative to Reduce Extrauterine Growth Restriction in Very Low Birth Weight Infants

2022 ◽  
Author(s):  
Ramasubbareddy Dhanireddy ◽  
Patricia A. Scott ◽  
Brenda Barker ◽  
Theresa A. Scott
Keyword(s):  
Birth Weight ◽  
Primary Outcome ◽  
Very Low Birth Weight ◽  
Caloric Intake ◽  
Growth Restriction ◽  
Quality Improvement Initiative ◽  
Low Birth Weight Infants ◽  
Process Measures ◽  
Extrauterine Growth Restriction ◽  
Parenteral Protein

BACKGROUND: We report a statewide quality improvement initiative aimed to decrease the incidence of extrauterine growth restriction among very low birth weight infants cared for in Tennessee NICUs. METHODS: The cohort consisted of infants born appropriate for gestational age between May 2016 and December 2018 from 9 NICUs across Tennessee. The infants were 23 to 32 weeks gestation and 500 to 1499 g birth weight. The process measures were the hours of life (HOL) when parenteral protein and intravenous lipid emulsion were initiated, the number of days to first enteral feeding, and attainment of full enteral caloric intake (110–130 kcal/kg per day). The primary outcome was extrauterine growth restriction, defined as weight <10th percentile for weight at 36 weeks postmenstrual age. Statistical process control charts and the Shewhart control rules were used to find special cause variation. RESULTS: Although special cause variation was not indicated in the primary outcome measure, it was indicated for the reduction in specific process measures: HOL when parenteral protein was initiated, HOL when intravenous lipid emulsion was initiated, and the number of days to attainment of full enteral caloric intake (among the hospitals considered regional perinatal centers). CONCLUSIONS: A statewide quality improvement initiative led to earlier initiation of parenteral and enteral nutrition and improved awareness of the importance of postnatal nutrition.

Extrauterine Growth Restriction in Low Birth Weight Infants

2019 ◽  
Vol 38 (1) ◽  
pp. 27-33 ◽  
Author(s):  
Kari Bonnar ◽  
Debbie Fraser
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Neurodevelopmental Outcome ◽  
Growth Failure ◽  
Postnatal Growth ◽  
Growth Restriction ◽  
Low Birth Weight Infants ◽  
Extrauterine Growth Restriction ◽  
Postnatal Growth Failure

Extrauterine growth restriction (EUGR) affects a significant number of very low birth weight (VLBW) infants and has the potential to impact neurodevelopmental outcome as well as other aspects of long-term health. More aggressive nutritional approaches have reduced the incidence of postnatal growth failure but many questions remain about the expected rate of growth for very preterm infants, the best ways to measure growth velocity, and the optimal approaches to supporting growth. This article examines some of the outstanding issues regarding postnatal growth failure and summarizes current practice recommendations.

scholarly journals Nutritional Factors Associated with Late-Onset Sepsis in Very Low Birth Weight Newborns

Nutrients ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 196
Author(s):  
Juliany Caroline Silva de Sousa ◽  
Ana Verônica Dantas de Carvalho ◽  
Lorena de Carvalho Monte de Prada ◽  
Arthur Pedro Marinho ◽  
Kerolaynne Fonseca de Lima ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Very Low Birth Weight ◽  
Late Onset ◽  
Growth Restriction ◽  
Low Birth Weight Infants ◽  
Late Onset Sepsis ◽  
Extrauterine Growth Restriction

Background: Delayed onset of minimal enteral nutrition compromises the immune response of preterm infants, increasing the risk of colonization and clinical complications (e.g., late-onset sepsis). This study aimed to analyze associations between late-onset sepsis in very low birth weight infants (<1500 g) and days of parenteral nutrition, days to reach full enteral nutrition, and maternal and nutritional factors. Methods: A cross-sectional study was carried out with very low birth weight infants admitted to a neonatal intensive care unit (NICU) of a reference maternity hospital of high-risk deliveries. Data regarding days of parenteral nutrition, days to reach full enteral nutrition, fasting days, extrauterine growth restriction, and NICU length of stay were extracted from online medical records. Late-onset sepsis was diagnosed (clinical or laboratory) after 48 h of life. Chi-squared, Mann–Whitney tests, and binary logistic regression were applied. Results: A total of 97 preterm infants were included. Of those, 75 presented late-onset sepsis with clinical (n = 40) or laboratory (n = 35) diagnosis. Maternal urinary tract infection, prolonged parenteral nutrition (>14 days), and extrauterine growth restriction presented 4.24-fold, 4.86-fold, and 4.90-fold higher chance of late-onset sepsis, respectively. Conclusion: Very low birth weight infants with late-onset sepsis had prolonged parenteral nutrition and took longer to reach full enteral nutrition. They also presented a higher prevalence of extrauterine growth restriction than infants without late-onset sepsis.

scholarly journals Analysis of Nutrition Support in Very Low-Birth-Weight Infants With Extrauterine Growth Restriction

2018 ◽  
Vol 34 (3) ◽  
pp. 436-443 ◽  
Author(s):  
Fangwen Hu ◽  
Qingya Tang ◽  
Ying Wang ◽  
Jiang Wu ◽  
Huijuan Ruan ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Growth Restriction ◽  
Nutrition Support ◽  
Low Birth Weight Infants ◽  
Extrauterine Growth Restriction

scholarly journals Extrauterine Growth Restriction in Very Low Birth Weight Infants: Concordance Between Fenton 2013 and INTERGROWTH-21st Growth Charts

2021 ◽  
Vol 9 ◽  
Author(s):  
Lara González-García ◽  
Enrique García-López ◽  
Belén Fernández-Colomer ◽  
Laura Mantecón-Fernández ◽  
Sonia Lareu-Vidal ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Neonatal Morbidity ◽  
Growth Restriction ◽  
University Hospital ◽  
Preterm Neonates ◽  
Low Birth Weight Infants ◽  
Cross Sectional ◽  
Extrauterine Growth Restriction

Postnatal growth restriction has high prevalence in very low birth weight (VLBW) preterm neonates, and this could affect their long-term prognosis. Nowadays, there is no consensus on how to monitor growth in these neonates.Objective: This study aimed to compare prevalence of intra- and extrauterine growth restriction (IUGR and EUGR) in a sample of VLBW infants according to the Fenton 2013 charts and INTERGROWTH-21st (IW-21) standards and to analyze concordance between both in the different EUGR definitions criteria (cross-sectional, dynamic, and true).Patients and Methods: An observational retrospective study of 635 VLBW preterm was performed. The study was carried out in Central University Hospital of Asturias. Body measurements (weight, length, and head circumference) were collected at birth and at hospital discharge and expressed in z-scores for the two references (Fenton 2010 and IW-21). Kappa concordance was calculated.Results: Kappa concordance between Fenton and IW-21 was 0.887 for IUGR and 0.580 for static EUGR. Prevalence was higher according to Fenton in IUGR (36.5 vs. 35.1%), in static EUGR (73.8 vs. 59.3%), and in dynamic EUGR (44.3 vs. 29.3%). Despite observing low prevalence of EUGR when IW-21 was used to define EUGR, a statistical association between neonatal morbidity and diagnosis of EUGR was observed.Conclusion: The Fenton and IW-21 concordance for IUGR is good. IW-21 is more restrictive than Fenton in EUGR. Patients diagnosed by IW-21 as EUGR are more likely to have neonatal morbidity, especially if we use EUGR dynamic definition. In our study, we cannot conclude that one graph is better than the other.

scholarly journals Clinical and Nutritional Determinants of Extrauterine Growth Restriction Among Very Low Birth Weight Infants

2020 ◽  
Vol Volume 13 ◽  
pp. 1193-1200
Author(s):  
Wasim Khasawneh ◽  
Mohammad Khassawneh ◽  
Mai Mazin ◽  
Muath Al-Theiabat ◽  
Tuka Alquraan
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Growth Restriction ◽  
Low Birth Weight Infants ◽  
Extrauterine Growth Restriction

scholarly journals Extrauterine Growth Restriction: Definitions and Predictability of Outcomes in a Cohort of Very Low Birth Weight Infants or Preterm Neonates

Nutrients ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1224 ◽  
Author(s):  
Chiara Peila ◽  
Elena Spada ◽  
Francesca Giuliani ◽  
Giulia Maiocco ◽  
Melissa Raia ◽  
...  
Keyword(s):  
Very Low Birth Weight ◽  
Growth Restriction ◽  
Preterm Neonates ◽  
Low Birth Weight Infants ◽  
Term Outcome ◽  
Cross Sectional ◽  
Long Term Outcome ◽  
Nutritional Interventions ◽  
Definition Of ◽  
Extrauterine Growth Restriction

Extrauterine Growth Restriction (EUGR) refers to inadequate growth during hospitalization. Current definitions for EUGR are varied and can be classified as cross-sectional (weight at a given t-time <10th centile) or longitudinal (weight loss between birth and a given t-time >1SD). Different t-times are also considered in literature, such as 36 weeks of gestational age (GA) or age at discharge. The aim of this study is to investigate whether EUGR could predict the auxological outcome at 24–30 months, and to evaluate the agreement between cross-sectional and longitudinal definitions. In total, 1589 infants with GA <30 weeks or birthweight ≤ 1500 g and without major congenital anomalies were included in this study. Cross-sectional and longitudinal EUGR were calculated at 36 and 40 weeks of GA, at discharge, and at 28 days. The concordance between the two definitions was estimated by Kappa coefficient. At 24–30 months, 803 infants were measured again. The agreement between the two definitions of EUGR was low. Both EUGR and not-EUGR groups were at lower centiles for weight, but at higher centiles for head circumference at 24–30 months than at birth. Longitudinal EUGR was associated with a poorer growth outcome for weight and height circumference than cross-sectional EUGR. No differences were observed for length. An agreed definition of EUGR is highly desirable in clinical practice to assess medical and nutritional interventions in preterm neonates. Based on the results of this study, we recommend the use of the longitudinal evaluation, that proved to better predict the auxological long-term outcome with respect to the cross-sectional one.

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