Adjustable feedings plus accurate serial length measurements decrease discharge weight-length disproportion in very preterm infants: quality improvement project

Background Preterm very-low-birth-weight (<= 1500 g) infants exhibit disproportionate weight-for-length growth in the Neonatal Intensive Care Unit. Local problem High frequency of body mass index (BMI) > 90th centile at discharge and 1-year postnatal age associated with elevated blood pressure and serum leptin in infancy and adolescence. Methods Single-institution quality improvement project in appropriately grown infants born at 23(0/7)-28(6/7) weeks gestational age and discharged home. Intervention Adjustable feeding protocol based on valid serial length measurements (board or caliper). Results The average monthly percentage of weight-for-length disproportion at discharge decreased from 13% in Epoch 1 to 0% in Epoch 2 (P < 0.05). Although the average Z-score for BMI at discharge was lower in Epoch 2 versus Epoch 1 (P < 0.01), this was absent by 1 year follow-up (P = 0.91). Conclusions Adjustable feedings plus use of accurate serial length measurements decreases weight-for-length disproportion at hospital discharge but not at 1 year.