Making weight: Ensuring that micro preemies gain pounds and inches

August 10, 2018, Children's National Medical Center
Tory Peitz, R.N., (left) and Victoria Catalano, RDN, LD, CNSC, CLC, (right) Pediatric Dietitian Specialist in the Neonatal Intensive Care Unit at Children's National Health System, measure the length of a micro preemie who weighed 1.5 pounds at birth. Credit: Children's National Health System

A quality-improvement project to standardize feeding practices for micro preemies—preterm infants born months before their due date— helped to boost their weight and nearly quadrupled the frequency of lactation consultations ordered in the neonatal intensive care unit (NICU), a multidisciplinary team from Children's National Health System finds.

According to the Centers for Disease Control and Prevention, about 1 in 10 infants in 2016 was preterm, born prior to completing 37 gestational weeks of pregnancy. Micro preemies are the tiniest infants in that group, weighing less than 1,500 grams and born well before their brain, lungs and organs like the liver are fully developed.

As staff reviewed charts for very preterm infants admitted to Children's NICU, they found dramatic variation in nutritional practices among clinicians and a mean decline in delta weight Z-scores, a more sensitive way to monitor infants' weight gain along growth percentiles for their gestational age. A multidisciplinary team that included dietitians, nurses, neonatologists, a lactation consultant and a quality-improvement leader evaluated nutrition practices and determined key drivers for improving nutrition status.

"We tested a variety of strategies, including standardizing feeding practices; maximizing intended delivery of feeds; tracking adequacy of calorie, protein and micronutrient intake; and maximizing use of the mother's own breast milk," says Michelande Ridoré, MS, a Children's NICU quality-improvement lead who will present the group's findings during the Virginia Neonatal Nutrition Association conference this fall. "We took nothing for granted: We reeducated everyone in the NICU about the importance of the standardized feeding protocol. We shared information about whether infants were attaining growth targets during daily rounds. And we used an infographic to help nursing moms increase the available supply of breastmilk," Ridoré says.

Children's National will continue to test drivers for weight gain, including zinc supplementation, enhanced electronic medical record use and expanded use of birth mothers' breast milk. Credit: Children's National Health System

On top of other challenges, very low birth weight preterm infants are born very lean, with minimal muscle. During the third trimester, pregnant women pass on a host of essential nutrients and proteins to help satisfy the needs of the fetus' developing muscles, bones and brain. "Because preterm infants miss out on that period in utero, we add fortification to provide preemies with extra protein, phosphorus, calcium and zinc they otherwise would have received from mom in the womb," says Victoria Catalano, RDN, LD, CNSC, CLC, a pediatric clinical dietitian in Children's NICU and study co-author. Babies' linear growth is closely related to neurocognitive development, Catalano says. A dedicated R.N. is assigned to length boards for Children's highest-risk newborns to ensure consistency in measurements.

Infants who were admitted within the first seven days of life and weighed less than 1,500 grams were included in the study. At the beginning of the quality-improvement project, the infants' mean delta Z-score for weight was -1.8. By December 2018, that had improved to -1.3. And the number of lactation consultation ordered weekly increased from 1.1 to four.

"We saw marked improvement in micro preemies' nutritional status as we reduced the degree of variation in nutrition practices," says Mary Revenis, M.D., NICU medical lead on nutrition and senior author for the research. "Our goal was to increase mean delta Z-scores even more. To that end, we will continue to test other key drivers for improved gain, including zinc supplementation, updating ' growth trajectories in the electronic medical record and advocating for expanded use of birth mothers' breast milk," Dr. Revenis says.

Explore further: Which targeted nutritional approaches can bolster micro-preemies' brain development?

Related Stories

Which targeted nutritional approaches can bolster micro-preemies' brain development?

May 5, 2018
The volume of carbohydrates, proteins, lipids and calories consumed by very vulnerable preemies significantly contributes to increased brain volume and white matter development, however additional research is needed to determine ...

Preterm newborns sleep better in NICU while hearing their mother's voice

June 6, 2018
Hearing a recording of their mother's voice may help neonates maintain sleep while in the neonatal intensive care unit (NICU), according to preliminary data from a new study.

45 percent of parents experience depression, anxiety and stress when newborns leave NICU

September 15, 2017
Almost half of parents whose children were admitted to Children's National Health System's neonatal intensive care unit (NICU) experienced postpartum depressive symptoms, anxiety and stress when their newborns were discharged ...

Mothers of children born with NAS are more likely to experience mental health problems

May 5, 2018
According to a new study, mothers of infants with neonatal abstinence syndrome (NAS) have a higher prevalence of mental health diagnoses in the first two months postpartum, in comparison to mothers of infants without NAS. ...

Study identifies risk factors associated with death of extremely low birth weight infants after NICU

February 9, 2012
Preterm infants born with extremely low birth weights have an increased risk of death during the first year of life. Although researchers have extensively studied risk factors that could contribute to the death of preterm ...

Slow enteral feeding protocol can reduce instances of death in extreme preterm infants

October 14, 2014
A standardized slow enteral feeding (SSEF) protocol significantly reduces the incidence of necrotizing enterocoltis (NEC), or death of intestinal tissue, and death in infants with extremely low birth weight, according to ...

Recommended for you

Urban and rural rates of childhood cancer survival the same, study finds

October 23, 2018
Childhood and adolescent cancer survival in the United States does not vary by rural/urban residence at the time of diagnosis, finds a new study from the Brown School at Washington University in St. Louis.

Breastfeeding protects infants from antibiotic-resistant bacteria

October 18, 2018
A recent study completed at the University of Helsinki investigated the amount and quality of antibiotic-resistant bacteria in breast milk and gut of mother-infant pairs. The findings have been published in the journal Nature ...

Inflammation in the womb may explain why some babies are more prone to sepsis after birth

October 9, 2018
Each year 15 million infants are born preterm and face high risks of short- and long-term complications, including sepsis, severe inflammation of the gut, and neurodevelopmental disorders. A new report in the American Journal ...

Dummies not to blame for common speech disorder in kids

October 9, 2018
New University of Sydney research shows bottles, dummies, and thumb sucking in the early years of life do not cause or worsen phonological impairment, the most common type of speech disorder in children.

'Genes are not destiny' when it comes to weight

October 9, 2018
A healthy home environment could help offset children's genetic susceptibilities to obesity, according to new research led by UCL.

Old drug could have new use helping sick premature babies

October 8, 2018
Researchers from The University of Western Australia, King Edward Memorial Hospital and Curtin University are investigating whether an old drug could be used to help very sick premature babies.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.