Change in practice used to quantify breast milk intake of pre-term infants in a neonatal intensive care unit : test-weighing to 'Salt Lake City Feed Plan'
Treloar, Allison Kirsch.
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A local community hospital in Montana expressed a desire to establish a written clinical guideline for transitioning preterm infants from enteral gavage feedings to oral feedings. This desire was prompted by a change in the method of quantifying breast milk intake of preterm infants when transitioning them from enteral gavage feedings to at-breast feedings in a Neonatal Intensive Care Unit (NICU). The hospital changed from the practice of test-weighing as a clinical indicator to quantify breast milk intake to the "Salt Lake City Feed Plan". Procedures: Retrospective data from four consecutive years were collected from quality assessment chart audit data provided to the author in aggregate form. Twenty-nine records met the selection criteria. A descriptive presentation of the aggregate data follows. Results: The average number of total deliveries per year was 1,151. The average percentage of preterm deliveries that occurred between 32 - 37 completed weeks of gestation was 16.3 percent. Of the twenty-nine records that met the selection criteria, 17 were male and 12 were female. The birth weight ranged from 1.75 kilograms (kg) to 2.31 kg. Weight at discharge ranged from 2.66 kg. to 2.99 kg., indicating a weight gain of 0.68 kg. to 0.91 kg. at discharge. Number of days with an indwelling nasogastric enteral feeding tube ranged from 1 to 23 days. Length of hospital stay ranged from 7 to 29 days. The length of stay for exclusively bottle fed preterm infants ranged from 13 to 27 days, whereas the breastfeeding preterm infants who utilized test -weighing or the "Salt Lake City Feed Plan" ranged from 7 to 29 days. Breast fed preterm infants in whom test-weighing or the "Salt Lake City Feed Plan" was utilized had 4 to 4.315 fewer days of hospitalization compared to preterm infants who were exclusively bottle-fed. Conclusion: The literature review and the aggregate data collected by the rural community hospital provide baseline information to create, implement and support an evidence-based clinical guideline to transition preterm infants from enteral gavage feedings to oral feeding.