Prevention of postnatal growth restriction by the implementation of an evidence-based premature infant feeding bundle

Objective:to develop an evidence-based feeding bundle to safely decrease the rate of pngr in vlbw infants.study design:the bundle was developed and implemented in january 2010, followed by 3 years of monitoring bundle compliance and infant outcomes (days to first feed (fd), days to reach full feeds (ff), and birth-discharge growth trajectories (delta z-score)).results:data were collected on 482 infants (119 pre-bundle). pngr decreased from 35% to 19% (p<0.01) and weight delta z-score improved from −0.82 to –0.45 (p<0.001). percentage of infants with head circumference (hc) below 10th percentile at discharge decreased from 21% to 9% (p<0.01) and hc delta z-score improved from −0.65 to –0.17 (p<0.001). fd and ff also decreased significantly. rates of necrotizing enterocolitis, peak alkaline phosphatase and peak direct bilirubin levels all trended downward.conclusions:an evidence-based, standardized feeding bundle was safe and effective in reducing the rate of pngr and in improving head growth in vlbw infants.