Complications and Outcomes of Nutritional Guidelines Implementation in Low Birth Weight Infants

Chayanit Punsawat¹, Thananjit wongsinin¹

Affiliation : ¹ Department of Pediatrics, Bhumibol Adulyadej Hospital, Royal Thai Air Force Bangkok, Thailand

Background: Necrotizing enterocolitis (NEC) is one of the most disastrous complications of premature infants. Using preterm feeding protocols can decrease NEC risk and improve feeding intolerance.
Objective: To compare the rate of NEC and other comorbidities between low-birth-weight (LBW) infants that received a Bhumibol Adulyadej Hospital (BAH) standardized feeding protocol and those that underwent previous nutritional practice.
Materials and Methods: A quasi-experimental study was conducted at neonatal intensive care unit (NICU) in BAH, Thailand. Participants were LBW newborns delivered at BAH between December 1, 2018 and March 31, 2020. The subjects were divided into the control group who underwent previous nutritional practice and the study group who were implemented with a new nutritional guideline. Primary outcome was NEC rate. Secondary outcomes were preterm complications such as neonatal sepsis, catheter-related bloodstream infection, parenteral nutrition-associated liver disease, osteopenia of prematurity, and intraventricular hemorrhage. Feeding achievement outcomes and growth outcome parameters were also evaluated.
Results: Data were analyzed on 71 infants in the control group and 68 infants in the study group. The rate of NEC was not different between the two groups with 7% in the control versus 5.9% in the study (p=1.000). In addition, other preterm complications were not different between groups. However, the time to reaching full enteral feeding was shorter in the study group at 14 in the control versus 10 in the study (p<0.001). Day of life when the fortification start was significantly earlier in the study group at 15.5 in the control versus 12 in the study (p=0.008). Other feeding achievement outcomes also improved, which was evidenced by fewer parenteral nutrition (PN) days at 11.55 in the control versus 7.0 in the study (p=0.004) and shorter duration of indwelling central line at 9.5 in the control versus  in the study (p=0.001).
Conclusion: Initiation of the new nutritional guideline produced a lower rate of NEC as compared to previous practice. Furthermore, the time to full enteral feeding, PN days, and central line days were decreased without increasing other preterm complications.

Received 4 April 2022 | Revised 7 August 2023 | Accepted 11 August 2023
DOI: 10.35755/jmedassocthai.2023.09.13889

Keywords : Low birth weight; Nutrition; Complication; NEC

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