(37) Standardizing Feeding Strategies in Moderately Preterm Infants

Ting Ting Fu, Cincinnati Children's Hospital Medical Center, United States; Maame Arhin, Cincinnati Children's Hospital Medical Center, United States; Laura P. Ward, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Stacie Chapman, University of Cincinnati Medical Center/Compass One, United States; Abigail Adamchak, University of Cincinnati Medical Center/Compass One, United States; Jae H. Kim, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Ashley T. Schulz, University of Cincinnati College of Medicine, Cincinnati, OH, United States

Background: Standardized feeding protocols and donor breast milk (DBM) as supplementation to maternal breast milk (MBM) are associated with a reduced incidence of necrotizing enterocolitis and improved feeding tolerance in very low birth weight (VLBW) infants born < 1500 g. Some neonatal intensive care units (NICUs) extend their use to moderately preterm (MPT) infants. It is unknown if these two strategies impact clinical outcomes or growth in this population.

Objectives: To evaluate the impact of a standardized feeding protocol and provision of DBM on central venous line (CVL) placement, feeding tolerance, growth, and provision of MBM in MPT infants (born 29 to 33 6/7 weeks gestational age).

Design/Methods: We retrospectively identified infants born 18 months before and after clinical implementation of a feeding protocol for MPT infants born >1500 g that was introduced at a level 3 NICU in January 2019. Infants who died/transferred in the first week of life were excluded. This protocol was designed to standardize feeding advancements faster than the existing VLBW protocol that necessitates a CVL. Enteral feedings were initiated at 20 ml/kg/day and advanced 15 ml/kg/day every 12 hours. At 110 ml/kg/day, IV fluids were stopped, human milk was fortified to 24 kcal/oz, and feedings were advanced by 10 ml/kg/day every 12 hours until goal. DBM was offered to infants < 33 weeks for up to 30 days. Clinical data were collected from the medical record, and growth velocities and anthropometric z-scores were calculated from birth to discharge and birth to 28 days. Pre- and post-implementation outcomes were compared by Chi-squared, Mann Whitney U, and t-tests.

Results: 131 and 144 infants were identified in the pre- and post-implementation eras respectively. 82/131 and 99/144 were born < 33 weeks. Days to full enteral volume (FEV) and need for CVL placement were similar between eras, but there was a narrower range of days to FEV post-implementation. No CVLs were in place at time of sepsis diagnoses. There was a higher incidence of human milk at first feeding (89.9% vs. 67.1%, p< 0.001) and percentage of DBM intake (17.5% vs 1.4%, p< 0.01) post-implementation. Length velocity was modestly decreased in the first 28 days (0.86 cm/week vs. 1.05 cm/week, p=0.08) with the availability of DBM, but this was not observed out to discharge.

Conclusion: Implementation of a feeding protocol for MPT infants is associated with more consistent time to FEV, but further opportunities exist to improve compliance and reduce CVL placements. With monitoring and fortification, DBM use in this population is not associated with worse growth outcomes.