Implementation of Feeding Guidelines for Neonates

Background:Preterm neonates in the Neonatal Intensive Care Unit (NICU) require specialized care when it comes to their nutrition. Poor nutrition will further worsen an already complicated clinical course as well as increase morbidity, mortality, and poor neurodevelopmental outcomes. A thorough review of the literature identified that implementation of feeding guidelines and/or protocols have been shown to improve post-natal growth and improve quality of care for these at risk neonates. Despite this data there are many providers and NICU's that do not use a feeding guideline which results in inconsistent care.Methods: A quality improvement project was developed to implement a feeding protocol in a small urban mountain west NICU. A pre/post education assessment survey was distributed to the staff to determine feelings and thoughts on the new and old feeding guidelines. Chart reviews were performed to determine if improvements were seen in weight and head circumference with the use of a feeding protocol.Results: 62.5 percent of nurses surveyed agreed that previous feeding orders were not consistent and 79.2 percent of nurses felt that a standardized feeding protocol would improve care in the NICU. Post-natal growth measures slight improved, however were not significantly changed following pilot. The comparison of the change in growth metrics from birth to fortification between the pre-implementation group and the post-implementation group identified p-value of 0.56 for weight, p-value of 0.63 for length, and p-value of 0.28 for head circumference. Conclusion: Post-natal growth data results were not significantly different with new feeding guidelines however this is likely due to the small sample size of the pilot. Further research should be done to better determine long-term PNG improvements in the neonates on a feeding protocol. Despite the limitations a significant number of nurses are in favor of a standardized process with feedings.