Tracking Nutritional Protein Management in the Preterm Infant Using Vermont‐Oxford Benchmarks (LB318)

Abstract

Background: Extrauterine growth failure occurs in 80 to 100% of extremely low birth weight infants, and it is recognized that these infants require more protein than has typically been provided to them in the NICU. This is of particular concern, as poor NICU growth is associated with poor developmental outcome. However, there is a need to balance providing higher protein intake with the metabolic consequences of doing so. Over the past 7 years, we have instituted practices to improve protein intake in our preterm infants and have used the Vermont Oxford Network (VON) data as a benchmark to evaluate our success. Objective: To describe the impact of nutritional strategies to increase protein intake on growth and clinical outcomes in preterm infants. Methods: Data was collected from Northshore University Hospital (NS), a Level 3 NICU in suburban Chicago. Growth outcomes and the incidence of NEC were recorded from 2006-2013 (avg. 586 patients/year) and compared to data from Level 3 NICU’s in the VON. Increasing protein intake may result in metabolic intolerance and incidence of Bicitra treatment was recorded after our implementation of a higher protein acidified liquid human milk fortifier (ALHMF) product in 2011-12. Results: After the introduction of high protein preterm formulas, fewer infants were discharged below the 10th percentile in head circumference on Fenton growth curves, as well as lower rates of NEC (Figure). We observed a similar pattern for weight at discharge. In the 6 months preceding the ALHMF, 8.9% of infants (weight <2kg) received Bicitra vs. 2.4% in the first 5 months after ALHMF introduction. Conclusion: It appears all recommended interventions improved incidence of extrauterine growth failure and higher protein formula/fortifier had the most pronounced effects. Moreover, higher protein was safe and well tolerated.