447 - Faster Feeding Advance Does Not Improve Growth In Infants With Birth Weight of < 1250 GRAMS

Poster Number: 447
Publication Number: 447.335

JALAL M. Abu-Shaweesh, Cleveland Clinic Children's, North Royalton, OH, United States; Taylor Rice, Cleveland Clinic, Cleveland, OH, United States; AUDREY RUTHENBERG, Cleveland Clinic Children's, Cleveland, OH, United States; Tetyana H. Nesterenko, Cleveland Clinic Children's Hospital, Cleveland, OH, United States; Sabine Iben, Cleveland Clinic Children's, Chagrin Falls, OH, United States; Natalie K. Yeaney, Cleveland Clinic Children's, CHAGRIN FALLS, OH, United States; Hany Aly, Cleveland Clinic Children's Hospital, Cleveland, OH, United States; Firas Saker, Cleveland Clinic Foundation, Solon, OH, United States

Background: Growth retardation is associated with poor neurodevelopmental outcome in very low birth weight infants {VLBW) infant. Growth failure continues to be quite prevalent in preterm infants with both weight and head circumference (HC) being affected. Faster advance of enteral feeds can potentially achieve higher caloric targets and thus improve growth

Objective: To evaluate the effect of faster advancement of feeding in infants with birth weight < 1250 grams on growth parameters at 36 weeks (Wks) corrected gestational age (CGA)

Design/Methods: This was a quality improvement project to evaluate the effect of feeding advancement in two Epochs on growth parameters at 36 weeks CGA. The QI project was approved by IRB. All VLBW infants admitted to two level III NICUs were evaluated during baseline, epoch 1 (2017-2018) and after instituting a new feeding protocol characterized by faster feeding advance, Epoch 2 (2019-2021) . Data collected included demographics, TPN and line days, NPO days, days to regain birth weight, maximum direct bilirubin (DB) and alkaline phosphatase (AP) levels as well as growth parameters at 36 weeks CGA in the form of the difference of Z-score between birth and 36 weeks CGA. Linear regression was used to identify significant variables with multivariate regression to control for significant factors. Data is presented as Mean±SD with p value of < 0.05 considered significant

Results: Completed data from 216 and 162 infants were evaluated at baseline and Epoch 2, respectively. Table 1 summarizes demographic and feeding data in the two epochs. There was no difference in birth weight or gestational age between the two groups. Faster feeding protocol resulted in significantly shorter line and TPN days and days infants placed NPO. It also resulted in a significant decrease in maximum DB level. There was no differences between the two groups in weight or length growth parameter at 36 weeks CGA, however, Epoch 2 was associated with a small but significant increase in weight at at 36 weeks CGA and a significantly lower growth of HC, Table 2. Faster feeding advance was well tolerated and wasn't associated with feeding intolerance as indicated by shorter NPO days and babies more uniformly getting off TPN, Figure 1. NEC incidence was 1.2% in Epoch 2 compared to 3.1% in Epoch 1Conclusion(s): While faster feeding advance was well tolerated and resulted in less days of TPN and central lines as well as improved cholestasis , It wasn't associated with improved growth in VLBW infants. Individualized feeding approaches with emphasis on protein and caloric content might result in improved growth in VLBW infants
Table 1. Comparison of demographic and feeding data between the two EpochsThere was no difference between the infants in the two epochs in birth weight or gestational age. Feeding protocol during epoch two was associated with significantly less TPN, Line and NPO days, as well as less trophic days signifying earlier advance of feeds.
Table 2. Comparison of growth outcome between the two epochs.There was no difference between growth outcomes for weight, and length. However, there was a small but significant increase in weight at 36 weeks CGA as well as a significant decrease in growth of head circumferences in epoch 2.