Few hospitals can cater to the proper nutrition of premature babies, study finds

10 Dec 2019 --- The majority of neonatal intensive care units (NICUs) participating in the Children’s Hospitals Neonatal Consortium are unable to reliably and consistently monitor caloric intake delivered to infants at risk for growth failure. This is according to research published in the Journal of Perinatology, which found a low prevalence of fully automated clinical decision support systems used to calculate and adjust nutritional intake for premature infants. The study suggests that automated systems may be necessary to improve quality in neonatal nutritional care, as well as better demonstrate the link between growth and nutrition to doctors.

The Children’s Hospitals Neonatal Consortium is a US-based organization dedicated to improving care and outcomes for infants in Children’s Hospital NICUs by sharing data, information and ideas for benchmarking R&D of safety and quality improvement initiatives. Managing optimal nutrition for premature babies is a complex process, especially when the baby is transitioned from receiving nutrition intravenously to enteral (via the gut) feeds.

Automating processes to boost results
“Delivery of appropriate amounts of calories, protein, fat and carbohydrates to premature infants in the NICU is associated with improved outcomes, including better growth and decreased risk of neurodevelopmental impairment,” says lead author Dr. Gustave Falciglia, Neonatologist at Ann & Robert H. Lurie Children’s Hospital of Chicago. 

NICUs employ electronic health records but most hospitals still lack a fully automated system to track the baby’s caloric intake.

“Having dietitians on rounds has helped with this problem; however, we are performing these calculations manually or retyping data already within the electronic health record (EHR). Automating these calculations would allow hospitals and NICUs to systematically track and improve nutrition delivery while giving clinicians more time to help balance the tradeoffs associated with nutrition delivery,” Dr. Falciglia tells NutritionInsight.

Using automated data to drive quality initiatives and improve experts’ understanding between growth and nutrition, may significantly improve the care of critically ill infants.If hospitals can use automated data to drive quality initiatives or use data to improve experts’ understanding between growth and nutrition, then this may significantly improve the care of critically ill infants. “Of course, these assumptions would need to be further tested,” he says.

What matters most in prenatal nutrition
Dr. Falciglia and colleagues surveyed 34 regional level IV NICUs on availability of clinical decision support systems to calculate nutrition and fluids the infant received in the prior 24 hours and to estimate projected nutrition and fluids that the infant should receive in the next 24 hours. They found that more NICUs have clinical decision support to calculate fluid intake compared to caloric or nutrient intake.

“Fluid intake is much more straightforward to calculate than caloric needs, so it is not surprising that clinical decision support is more commonly available for this function,” says Dr. Falciglia. “Caloric calculations involve many more factors and there is less consistency among NICUs in how nutrition calculations are approached. We need to establish and share best practices, in order to develop a standardized computerized solution.”

Dr. Falciglia also explains that experts should measure what they value rather than value what they measure. Clinicians and parents should work together to define and prioritize healthcare goals for infants in the NICU and then ensure that meaningful data exist to support these goals. 

“I believe that delivering adequate nutrition and optimizing growth is important for every critically ill infant in the NICU. Automating nutrition data will require changes to how the EHR captures data, such as with less reliance on free-text instructions in feeding orders. However, the first step is to define what we are trying to achieve,” he says.

Doctor’s orders
Moreover, Dr. Falciglia notes that it is the collective duty of clinicians and parents or patients to define healthcare goals and then ensure that data are there to support these goals. 

“We should also recognize that there is a gap between the care we intend to provide (projected from orders) and the care we actually deliver. Clinicians may believe that they are the same (a reason, we noted, for some discrepancy in our survey responses); however, they are not,” he asserts.

“If we want to improve nutrition delivery then we should not only ensure that our orders are optimal but they are executed properly,” Dr. Falciglia concludes.

Research has previously noted that administering probiotics to premature babies via breast milk may be the key to preventing severe gut infections and other intestinal problems. In this space, a three-strain probiotic blend from Chr. Hansen has shown potential in supporting intestinal health and development in preterm babies. The strain has been shown to reduce the risk of Necrotizing enterocolitis (NEC) by 50 percent, according to the company.

By Kristiana Lalou