Preterm Feeding Practices in a Regional Neonatalintensive Care Unit (Closing the Loop)

Introduction: The benefits of early transition to full enteral feeds in Low Birth Weight (LBW) infants, include reduced risk of nosocomial infection, parenteral nutrition associated liver disease and necrotising enterocolitis (NEC). A new guideline was introduced in our unit in 2011 and a national parenteral feeding guideline was introduced in 2015.

Aim: To investigate adherence to NICU enteral feeding guideline for infants ≤2kg, and ≤ 32weeks gestation

To compare the findings with a previous audit done in 2015

Method: A retrospective review of 35 charts of infants born between April 2018 and July 2019

Results: 43 % of infants commenced enteral feeds within 24 hours of life compared to 25% in the previous audit. 57% of these infants received breast milk which is an increase from 40% in the previous audit. All infants who required Parenteral Nutrition (PN) were prescribed PN, and the majority were commenced on PN within 6 hours of life. PN was infused via a central line in 48% of infants.

Conclusion: The audit demonstrated improvement in compliance to the new feeding guidelines with room for improvement.

A suggested approach to improving enteral and parenteral feeding standards is to develop a feeding standard documentation sticker which would include reminders for staff to initiate early enteral feeds, encourage expression of breast milk and initiation of PN as per unit guidelines