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McKinley LT, Przystac L, Tucker R, Trail-Burns E, Vohr BR, Laptook AR, Bliss JM. Implementation of a Nutrition Care Bundle and Improved Weight Gain of Extremely Preterm Infants to 36 Weeks Post-Menstrual Age. J Pediatr. 2021 Oct 20:S0022-3476(21)01009-X.

Objective: To evaluate the effect of a nutrition care bundle to improve growth among premature infants during neonatal hospitalization.

Study design: The study was a retrospective analysis of prospectively collected data for 584 surviving infants with birth weight ≤1000 g and gestational age 24 to 29 weeks admitted to a single-center neonatal intensive care unit between 7/3/2005 and 6/6/2016. Participants were divided into 3 discrete epochs based on evolving nutrition practices during the study period (Epoch 1: baseline, open-bay setting; Epoch 2: improved lactation staffing, introduction of high protein formula, single family room setting; Epoch 3: complete nutrition care bundle). Infants in each epoch were evaluated for the primary outcome of change in weight z-score between postnatal day 7 and 36 weeks post menstrual age or discharge if sooner. Univariate and multivariable regression analyses were conducted to evaluate the effect of clinical variables on outcome.

Results: Significant increases in weight z-score between day of life 7 and 36 weeks post-menstrual age were observed across epochs, which accounted for 31% (p<0.0001) of the variance. Variables that were positive predictors of weight z-score change included birth weight z-score, Cesarean delivery, and later epochs of nutritional support. Variables that were negative predictors of weight change included gestational age, postnatal steroids, and days on parenteral nutrition.

Conclusion: Implementation of a nutrition care bundle was associated with improved weight gain in extremely low birth weight infants

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