536 - National Formula Shortage Challenges Existing Outpatient Feeding Practice in Infants with Bronchopulmonary Dysplasia

Publication Number: 536.5849

Audrey Miller, Nationwide childrens hospital, Columbus, OH, United States; Chelsea Britton, Nationwide Children's Hospital, Columbus, OH, United States; Chance Alvarado, Nationwide Children's Hospital, Columbus, OH, United States; Sara Conroy, Nationwide Children's Hospital, Columbus, OH, United States; Edward Shepherd, Nationwide Children's Hospital, Columbus, OH, United States; Matthew Kielt, Nationwide Children's Hospital, Columbus, OH, United States; Leif D. Nelin, Nationwide Children's Hospital, Columbus, OH, United States; Melinda Ingram, Nationwide Children's Hospital, Columbus, OH, United States

Background: Nutrition and growth optimization are critical aspects of care for infants with bronchopulmonary dysplasia (BPD) after neonatal intensive care unit (NICU) discharge. Nutrition supports lung growth and repair, and growth is associated with improved short and long-term pulmonary outcomes. To support positive growth, many infants with BPD in the outpatient setting are prescribed a nutritional regimen of preterm or transitional preterm formula to increase protein and mineral delivery. However, this nutritional practice is extrapolated from the preterm literature, and there are no evidence-based recommendations for the outpatient nutritional management of children with BPD. An unforeseen national shortage in preterm and transitional formula required infants in our BPD outpatient clinic to prematurely transition to standard term formula, thereby lowering protein and micronutrient intake.

Objective: To determine if discontinuation of transitional preterm formula impacted growth outcomes for our outpatient BPD clinic population from time of NICU discharge to one-year of age.

Design/Methods: Patients were classified into two cohorts based on timing of discharge and one-year visit relative to shortage, those seen before the shortage and those seen during the shortage. Multivariable linear regression models adjusted for discharge z-scores and time from discharge to follow-up were developed for each relevant growth parameter. Changes in z-scores were compared between cohorts at the sample means for discharge z-scores and observation time.

Results: Demographics were similar between both cohorts (Table 1). There were no statistically significant differences between changes in z-scores for weight, length, and head circumference between the two cohorts (Table 2, weight: p = 0.30, length: p = 0.71, head circumference: p = 0.31). The mean change in z-score by cohort and observation time showed strong evidence of improving growth in both cohorts with no evidence of differential growth rates between groups (Figure).

Conclusion(s): Infants with BPD who prematurely transitioned off transitional preterm formulas before the one-year clinic visit had comparable growth anthropometrics compared to counterparts that received transitional preterm formulas until the one-year clinic visit. This suggests that less accessible and more costly transitional preterm formulas may not be necessary to achieve positive growth trends in infants with BPD. Further research is needed to determine evidence-based feeding recommendations for this population that can optimize short and long-term growth.

Table 1
Demographic information for both cohorts.

Table 2
For each measurement, the multivariable linear regression model estimate and 95% confidence intervals for each shortage cohort are shown. The model estimated differences between each cohort’s changes is additionally shown alongside 95% confidence intervals and p-values.

Figure
Multivariable linear regression model predictions for change in z-score for weight (left), length (center), and head circumference (right). The estimated change in z-score from discharge to follow-up is shown by month against the observed data. Estimates assume discharge z-scores at the sample means. Annotated is the estimated difference in slope parameters (model interaction term between time and cohort membership) for each measurement.