Jadcherla Sudarshan R, Dail James, Malkar Manish B, McClead Richard, Kelleher Kelly, Nelin Leif
The Neonatal and Infant Feeding Disorders Program Center for Perinatal Research Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
Neonatal Quality Improvement Service, Nationwide Children's Hospital, Columbus, Ohio, USA.
JPEN J Parenter Enteral Nutr. 2016 Jul;40(5):646-55. doi: 10.1177/0148607115571667. Epub 2015 Mar 2.
We hypothesized that the implementation of a feeding quality improvement (QI) program among premature neonates accelerates feeding milestones, safely lowering hospital length of stay (LOS) compared with the baseline period.
Baseline data were collected for 15 months (N = 92) prior to initiating the program, which involved development and implementation of a standardized feeding strategy in eligible premature neonates. Process optimization, implementation of feeding strategy, monitoring compliance, multidisciplinary feeding rounds, and continuous education strategies were employed. The main outcomes included the ability and duration to reach enteral feeds-120 (mL/kg/d), oral feeds-120 (mL/kg/d), and ad lib oral feeding. Balancing measures included growth velocities, comorbidities, and LOS.
Comparing baseline versus feeding program (N = 92) groups, respectively, the feeding program improved the number of infants receiving trophic feeds (34% vs 80%, P < .002), trophic feeding duration (14.8 ± 10.3 days vs 7.6 ± 8.1 days, P < .0001), time to enteral feeds-120 (16.3 ± 15.4 days vs 11.4 ± 10.4 days, P < .04), time from oral feeding onset to oral feeds-120 (13.2 ± 16.7 days vs 19.5 ± 15.3 days, P < .0001), time from oral feeds-120 to ad lib feeds at discharge (22.4 ± 27.2 days vs 18.6 ± 21.3 days, P < .01), weight velocity (24 ± 6 g/d vs 27 ± 11 g/d, P < .03), and LOS (104.2 ± 51.8 vs 89.3 ± 46.0, P = .02). Mortality, readmissions within 30 days, and comorbidities were similar.
Process optimization and the implementation of a standardized feeding strategy minimize practice variability, accelerating the attainment of enteral and oral feeding milestones and decreasing LOS without increasing adverse morbidities.
我们假设在早产儿中实施喂养质量改进（QI）计划可加速喂养里程碑的达成，与基线期相比，安全地缩短住院时间（LOS）。
在启动该计划前的15个月内收集了基线数据（N = 92），该计划包括为符合条件的早产儿制定和实施标准化喂养策略。采用了流程优化、喂养策略实施、监测依从性、多学科喂养查房以及持续教育策略。主要结局包括达到肠内喂养量120（毫升/千克/天）、经口喂养量120（毫升/千克/天）以及随意经口喂养的能力和持续时间。平衡指标包括生长速度、合并症和住院时间。
分别比较基线组和喂养计划组（N = 92），喂养计划提高了接受微量喂养的婴儿数量（34%对80%，P <.002）、微量喂养持续时间（14.8±10.3天对7.6±8.1天，P <.0001）、达到肠内喂养量120的时间（16.3±15.4天对11.4±10.4天，P <.04）、从开始经口喂养到达到经口喂养量120的时间（13.2±16.7天对19.5±15.3天，P <.0001）、从经口喂养量120到出院时随意喂养的时间（22.4±27.2天对18.6±21.3天，P <.01）、体重增长速度（24±6克/天对27±11克/天，P <.03）以及住院时间（104.2±51.8对89.3±46.0，P =.02）。死亡率、30天内再入院率和合并症相似。
流程优化和标准化喂养策略的实施可最大程度减少实践差异，加速肠内和经口喂养里程碑的达成，并缩短住院时间，且不增加不良合并症。
