Reducing growth impairment in infants undergoing intestinal surgery: A quality improvement initiative.

Background: Infants undergoing intestinal surgery are at risk for impaired growth. Our objective was to reduce growth impairment in these infants by 20% in a 12-month period and sustain over 12 months.

Methods: Eight neonatal intensive care units (NICUs) participated in the California Perinatal Quality Care Collaborative-led multisite quality improvement (QI) project, comprising a baseline, active, and sustainability phase. Eligible infants underwent intestinal surgery in the NICU between January 2021 to June 2023. Outcome measure was infants leaving the NICU with a weight z-score decline exceeding (>)1.2 standard deviations from birthweight. Process measures included adherence to parenteral nutrition (PN) guidelines, nutrition rounds, and feeding guidelines. Balancing measures included necrotizing enterocolitis, metabolic acidosis, and feeding intolerance rates. Multisite learning sessions and meetings were held. Each NICU implemented local QI strategies. Measures were analyzed in control charts.

Results: 581 infants were included. During the active phase, growth impairment remained unchanged at 25%. Adherence to PN guidelines increased from 49% to 68%, nutrition rounds increased from 82% to 91%, and feeding guideline increased from 28% to 68%. In the sustainability phase, growth impairment worsened to 27%. Adherence to nutrition rounds decreased to 82%, PN guidelines increased to 95%, and feeding guidelines sustained at 68%. Balancing measures remained unchanged.

Conclusion: Despite no change in growth impairment, multiple centers implemented strategies to optimize nutrition in infants who underwent surgery. Additional data on nutrient delivery, other anthropometrics, and nonnutrition factors should be considered in future studies.