227 - Reducing Procedural Pain by Avoiding Intravenous Access Through Designing and Implementing a Feeding Protocol for Stable Late Preterm Infants

Poster Number: 227
Publication Number: 227.127

Jennifer Hanford, University of Missouri-Columbia School of Medicine, Columbia, MO, United States; Christine McQuay, University of Missouri-Columbia School of Medicine, Columbia, MO, United States; Anjali Anders, University of Missouri-Columbia School of Medicine, Columbia, MO, United States; Akshaya J. Vachharajani, University of Missouri-Columbia School of Medicine, Columbia, MO, United States; Olugbemisola Obi, University of Missouri-Columbia School of Medicine, Columbia, MO, United States

Background: Worldwide, preterm infants between 32 0/7-36 6/7 weeks gestation account for up to 84% of all preterm births and constitute a large portion of the healthcare load.1,2 There is lack of evidence on how to best provide enteral nutrition to this age group.1-4 Recommendations are often based on fetal and term infant nutritional requirements as well as clinical judgement.3 Nutrition in the neonatal period needs to be optimized to improve neurodevelopmental outcomes and growth;4 supplementing oral feedings early ensures appropriate protein intake thus preventing protein deficits and improving outcomes.2
In our level III NICU, this subset of neonates was placed on intravenous fluids (IVF) or total parenteral nutrition (TPN) on admission. Initiation of enteral feedings was per provider preference and was variable. 

References:  
1. Blencowe H…National, regional...implications. Lancet 2012; 379: 2162–72
2. Bloomfield FH…The DIAMOND trial…BMC Pediatrics2018;18:220
3. Asadi, S…Nutrition in Late Preterm Infants.Seminperinat.2019;43
4. Harding JE…Advances in nutrition of the newborn infant. Lancet 2017;389:1660-1668
 

Objective: Reduce unnecessary, painful IV attempts and IVF/TPN use in stable, late preterm infants by 50% within 6 months of implementing a feeding guideline

Design/Methods: Baseline data was collected in a RedCap database from 01/2020-8/2020 for stable, late preterm infants admitted to the NICU, born between 34 0/7-36 6/7 weeks gestation, requiring minimal respiratory support. After reviewing the data, we created a SMART AIM. Education was provided for staff on current and evidence-based feeding practices; and families were educated on the benefits of early gut stimulation. Following this, the feeding guideline was implemented as the initial PDSA cycle. The second PDSA cycle included incorporation of an auto-text reminder in admission notes. Post-implementation data was collected until 03/2021. Categorical data was analyzed using Fischer’s exact t test and continuous data was analyzed using either the student t test or ANOVA. A p value < 0.05 was considered significant.

Results: The pre and post intervention groups were demographically similar. Run charts were created for IVF and TPN use. Both charts illustrate signs of initial improvement although a shift has not yet occurred likely related to small sample size and also recent implementation of the second PDSA cycle. Balancing measures were similar indicating no adverse effects of this approach.Conclusion(s): Introduction of enteral feedings instead of IVF on NICU admission reduced use of IVF and IV access without adverse effects.
Late Preterm Infant Feeding Guideline
Key Driver Diagram