Impact of Nurse-Regulated Feedings on Growth Velocity and Weight Gain of 1200-1500 g Preterm Infants

PURPOSE: To evaluate the impact of nurse-regulated feedings (NRFs) on growth velocity and weight gain of 1200–1500 g preterm infants. SUBJECTS: Cohort 1: All preterm infants 1200–1500 g between 1997 and 2001 not on NRF protocol; Cohort 2: All preterm infants 1200–1500 g between 2003 and 2006 on NRF protocol. Both cohorts screened out for small gestation age, major congenital anomalies, intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), culture positive infection at birth, meningitis, and those requiring surgery. MATERIALS AND METHODS: A before and after matched cohort study was conducted in the years 1997–2001 and 2003–2006, enrolling infants from Covenants Neonatal Intensive Care unit (Level III) using these studies screening protocol. Data on first 62 enrolling infants from both cohorts were used for this study. Both cohorts were matched using gestational age, birth weight, length of stay, initial length. A modified data tool collection set was used for collecting and analyzing nutritional data, this included intake (cal/kg/d, cc/kg/d, and total intake in cc) and route (initial parenteral feedings, mixed parenteral and enteral feedings, full enteral feedings), NRF, and non-NRF (NNRF). Data collection continued until discharge, initiation of adlib feeding, or greater than 50% of nutrition from breast. DISCUSSION: Of the entire population sampled from 1997 to 2006, there were only 59 for NRF and 58 for NNRF. The mean growth velocity (g/kg/d) to reach full enteral feedings for both cohorts was insignificant (t=0.233; P=0.816). This suggested both groups were well matched up to the point of NRF institution for the 2003–2006 cohort years. RESULTS: NRF had a 71% greater growth velocity than NNRF (P<0.001, t=6.618) at the time of discharge, initiation of adlib feeding, or greater than 50% of nutrition from breast. CONCLUSIONS: This study demonstrated that the NRF protocol offers a significant advantage in nutritional support than previous feeding regimens in this institution.