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265 Evaluation of a nutrition protocol on infectious and growth outcomes

Purpose of study Standardised feeding protocols can improve infectious outcomes like necrotizing enterocolitis (NEC). An internal review revealed a non-uniform approach to the nutrition of preterm infants and high NEC rates. Donor human milk (DHM) was not available. We hypothesised that a nutrition bundle quality improvement (QI) initiative would result in decreased NEC, shortened time to first and full enteral feedings, and decreased central-line days. Methods used Our Nutrition QI Team created a rounding tool consisting of a feeding advancement protocol. Infants received DHM if maternal breast milk was unavailable. Central lines were removed when enteral feedings reached 130 ml/kg/day. The QI intervention started September 2016. Outcomes of very low birthweight (VLBW) infants born in the year preceding QI intervention were used as controls. Summary of results In the first 9 months of intervention, 101 VLBW infants (69 Control group; 42 QI Intervention group) were studied. NEC was reduced by 70% (p=0.036; figure 1). Median time to feeding initiation was reduced from 27 hours to 13.5 hours (p<0.001). Median time to full enteral feeds and median central line days decreased as well. Weight, length, and head circumference were similar between groups at birth and 36 weeks adjusted age. There were 14 deaths (20.3%) in the control epoch, but zero in the QI intervention group. Conclusions This QI initiative has significantly reduced NEC and mortality in our NICU to date. Ongoing data collection and analysis continues. Abstract 265 Figure 1. Number of NEC cases per month