209 - Improving Growth Outcomes Among Infants < 31 Weeks Gestation in New York State (NYS): Report from the NYS Perinatal Quality Collaborative

Poster Number: 209
Publication Number: 209.126

Timothy P. Stevens, University of Rochester, Rochester, NY, United States; Eileen Shields, NYS Department of Health, Albany, NY, United States; Deborah Campbell, Montefiore Medical Center, Bronx, NY, United States; Adriann J. Combs, Northwell Health, East Setauket, NY, United States; Michael Horgan, Bernard Millie Duker Childrens Hospital, albany, NY, United States; Edmund F. LaGamma, New York Medical College, Valhalla, NY, United States; Amanda Roy, New York State Department of Health, Albany, NY, United States; Marilyn Kacica, New York State Department of Health, Albany, NY, United States

Background: Greater weight gain and head growth between preterm birth and term equivalent age is associated with better neurodevelopmental outcome (NDO). Although also associated with better NDO, exclusive human milk feedings, either maternal breast milk (MBM) or pasteurized donor human milk (PDHM) is associated with slower postnatal growth. Improved somatic and head growth combined with greater human milk use offers potential additive benefits for improved NDO in preterm infants.

Objective: To increase use of human milk feedings and to reduce risk of postnatal growth restriction (PGR), defined as NICU discharge below the tenth percentile for postmenstrual age, among infants born at < 31 weeks’ gestational age in any of NYS’s Level III or Level IV NICUs.

Design/Methods: This was a prospective cohort study that enrolled surviving neonates < 31 wks gestation born or cared for in one of 18 NYS Regional Perinatal Center Level IV NICUs (RPCs) or 20 Level III NICUs. Each NICU reported birth characteristics, feeding practices and neonatal outcomes of infants born less than 31 weeks’ gestation using a statewide database of perinatal outcomes. We compared rates of human milk use, PGR and discharge head circumference (HC) < 10th percentile for age during the baseline (Jan 1 to Dec 31, 2015) versus those in the final 12 months of a 36 month project period (Jan 1 to Dec 31, 2018). Collaborative QI interventions consisted of informational calls led by NYSPQC, coaching calls and in person learning sessions to share nutritional practices, relevant medical literature and outcomes.

Results: The cohort consisted of 6,698 infants, 4,986 among the 18 RPC NICUs and 1,712 among 20 Level III NICUs. PGR decreased 24.2% and discharge HC < 10th centile trended down 10% between baseline and end of project periods (32.2% vs. 24.3%, p < 0.0001 and 25.1% vs. 22.6%, p=0.09, respectively). Among RPCs, exclusive human milk feedings increased at first enteral feeding (74.2% vs. 84.5%, p < 0.0001) but not first full enteral feeding or time of discharge. In contrast, at Level III NICUs, exclusive use of breast milk increased at first feeding (56.3% vs. 66.2%, p < 0.01), first full enteral feeding (42.8% vs. 56.0%, p < 0.0004) and feeding at NICU discharge (18.7% vs. 28.6%, p < 0.0001). At end of the project, RPC NICUs were more likely than Level III NICUs to use PDHM.Conclusion(s): In NYS RPC and Level III NICUs, interventions developed using collaborative QI methods significantly increased use of human milk and reduced incidence of PGR, collectively offering presumptive additive benefits for improved NDO and reduced long-term costs of health care.
Annotated Run Chart Showing Interventions And Primary Growth Outcome2015 served as a Pre-intervention Period (baseline). A Post-intervention Questionnaire was administered following the intervention phase of the project. Abbreviations: RP - Recruitment Package; IC - Informational Call; LS - Learning Session; CC - Coaching Call; S – Survey
Weight and Head Circumference at Discharge From Either a NYS RPC or Level III NICUPMA - Postmenstrual Age