083 - Decreasing the mean time to reach full feeds for very low birth weight (VLBW) patients in a level 3 community NICU by creating a standardized enteral feeding protocol.

Publication Number: 83.4501

Jenny C. Jin, MidAtlantic Neonatology Associates, Morristown, NJ, United States; Tatyana Kopp, New York Presbyterian- Queens, Woodmere, NY, United States

Background: Standardizing enteral feeding practices in very low birth weight (VLBW) NICU patients is a key method associated with improving patient safety and improving neurodevelopmental outcomes. Due to a lack of consistency in feeding practices, the mean time to reach full enteral feeds in a VLBW at our NICU was 19 days and only 27% were initiated on trophic feeds within 72 hours.

Objective: SMART

Aim: To decrease the mean time to reach full enteral feeds of VLBW NICU admissions from 19 days to 13 days within 14 months.

Design/Methods: We conducted our QI project from January 2023 to March 2024 by creating enteral feeding guidelines (PDSA Cycle 1) for infants with birth weight (BW) < 1500g in our urban 20-bed Level 3 community NICU in Queens, NY, to reach full feeds of 160mL/kg/day by day of life 10 if tolerated. Patients with congenital gastrointestinal malformations and known metabolic disorders were excluded. PDSA Cycle 2 reviewed guidelines and enteral feeding progression of recent patients in monthly staff meetings. PDSA Cycle 3 added a flowsheet in patients’ charts to guide providers. PDSA Cycle 4 identified nursing educator champions. Our primary outcome was the mean number of days required to reach full enteral feeds. Our secondary outcome was the percentage of VLBWs that began trophic feeds (a volume of 15-20mL/kg/day) within 72 hours of admission. Balancing measure: incidence of feeding intolerance as defined by any combination of emesis, abdominal distension/tenderness, or radiographic findings requiring holding feeds for at least 3 hours or development of necrotizing enterocolitis (NEC) within 2 weeks of life.

Results: We collected baseline data from 15 VLBWs prior to initiating the project. The mean days to reach full enteral feeds in VLBW admissions decreased from 19.4 to 13.3 days at the project’s conclusion. The percentage of VLBWs that began trophic feeds within 72 hours of admission increased from 27% to 69%. A Pareto chart identified common reasons for delaying initiation of trophic feeds. There were no patients who experienced known metabolic disorders, NEC, or spontaneous intestinal perforation within 2 weeks of life, although 3 subsequently were diagnosed with medical NEC requiring NPO and antibiotics for at least one week (all milder than Bell’s stage 2A). The incidence of feeding intolerance pre- and post-implementation was 23% and 24%, respectively.

Conclusion(s): Standardizing enteral feeding guidelines for VLBW admissions in our Level 3 community NICU decreased the time required to reach full enteral feeds, including initiation of trophic feeds within 72 hours.