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Debbie Hans MD, Fellow, University of MN Mary Pylipow MD, University of ……………..

NICU Best Practice: Recommended vs. Reality Analysis of 2006 Neonatal Nutrition Survey October 12, 2006. Debbie Hans MD, Fellow, University of MN Mary Pylipow MD, University of …………….. Michael Georgieff MD, University of MN Patti Thureen, MD, University of Colorado. Background.

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Debbie Hans MD, Fellow, University of MN Mary Pylipow MD, University of ……………..

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  1. NICU Best Practice: Recommended vs. RealityAnalysis of 2006 Neonatal Nutrition SurveyOctober 12, 2006 Debbie Hans MD, Fellow, University of MN Mary Pylipow MD, University of …………….. Michael Georgieff MD, University of MN Patti Thureen, MD, University of Colorado

  2. Background • The last published extensive survey on neonatal feeding practices was in 1985 (n=269). • Churella HR, Bachhuber WL, and MacLean WC. Pediatrics. (1985). 76: 243-249. • We conducted a similar survey on a smaller scale (n=25) in 2001 (unpublished data).

  3. Methods • 775 surveys were sent via e-mail and mail • NICU Unit Directors as listed in AAP Directory (n=434) • Neonatal-Perinatal Fellowship Directors (n=96) • Past Ross Nutrition Conference attendees (n=245) • A total of 176 responses (23% returned) • MD (staff or fellow) – 70% • RD – 24% • NNP – 3% • Other or Unknown – 3%

  4. Methods • For each individual question, the response rate was determined by subtracting the number of “no response” and “inappropriate response” from the total number of surveys • “Inappropriate response” was defined as • Multiple responses to a given question • Responses that did not correspond to a provided choice • e.g. responding “1.5” when choices were 0, 1, 2, etc.

  5. DOMAIN I Parenteral and Enteral Feeding Strategies In 3 preterm infant weight groups

  6. 1. On what day of life is TPN started?

  7. Patti’s slide: • What is the science behind when to start TPN.

  8. 2. How much protein (g/kg/day) do you prescribe on the first day of TPN?

  9. Patti’s slide • Recommended parenteral protein intakes at different gestational ages

  10. 3. Do you advance protein daily? YES 91% NO 9% (N=174) If yes, what increment (g/kg) do you advance by?

  11. Patti • Comment on the need/rationale for protein advancement

  12. 4. What is your maximum protein (g/kg/day) when at full TPN?

  13. Patti • Once again emphasize Zeigler’s work on protein intake at different gest ages.

  14. 5a. How much IV lipid (g/kg/day) do you prescribe on first day TPN for non-ventilated infant?

  15. 5b. How much IV lipid (g/kg/day) do you prescribe on first day TPN for ventilated infant?

  16. 6. Do you give different amounts of lipid to infants who have lung disease? (N=168)YES 7% NO62%SOMETIMES 31% 7. Are there any contraindications to starting lipids? (N=174) YES 40% NO60%

  17. 8. How fast do you advance your lipids (g/kg/day)?

  18. Patti • 2-3 slides on lipid safety, contraindications, what we know and don’t know about lipid aministration, rate of advancement

  19. 9a. On what day do you start enteral feeds in non-ventilated infants?

  20. 9b. On what day do you start enteral feeds in ventilated infants?

  21. 10. Do you initially use continuous or bolus method of enteral feedings?

  22. ?Patti review scientific data on bolus vs continuous feeds?

  23. 11a. How quickly are enteral feedings advanced for non-ventilated infants (cc/kg/day)?

  24. 11b. How quickly are enteral feedings advanced for ventilated infants (cc/kg/day)?

  25. 12a. How do you define “early small feeds”? Is it less than, equal to, or more than 20 cc/kg/day?

  26. 12b. Do you use “trophic feeds”…?

  27. 13. What is the composition of the first enteral feed for infants?

  28. 14. How many days do you maintain babies on “trophic feeds”?

  29. Patti • 1-3 slides on MEF

  30. 15. Do you feed babies with…?

  31. Patti-brief comments on prior slide

  32. 16. Do you feed SGA infants differently than AGA infants? If yes, which nutrients differ?

  33. Patti • 2 slides on feeding SGA infant

  34. 17. Who is a candidate for elemental formula (e.g. Pregestamil)? (N=171) Other candidates?

  35. 18. How long do you keep an infant on premature formula or supplemented breast milk? (N=149)

  36. 19. Do you prescribe a post-discharge nutritional strategy? (N=171)YES 84% NO 16% 20. If yes, what percent of preterm infants are on…?

  37. Patti • 2 slides on formula enrichment and post-discharge nutrition

  38. 21. In the 24-26 week gestation infants, do you target a specific GIR?YES 60% NO 40%

  39. Patti • 1-2 slides on max ox glucose capacity

  40. DOMAIN II Parenteral and Enteral Nutritional Additives and Supplements

  41. 1. Do you use insulin in your NICU?

  42. 2. Do you add any of the following to your TPN solution?

  43. patti • Brief comment on each of these additives

  44. 3a. Do you use any of the following to enhance your enteral formula?

  45. 3b. Do you add any of the following to breast milk?

  46. Patti • 1-2 slides on risks and benefits of these supplements

  47. 4. Do you use any of the following supplements?

  48. DOMAIN III Demographics of Your Institution

  49. 1. What best describes your Level II-III nursery?

  50. 2. Who writes your TPN orders? (N=176)

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