LAUSR

Aim Measure weight gain in preterm infants after introduction of a nutritional care bundle. Methods 509 infants less than 32 weeks gestation were studied until discharge home from the tertiary unit or their local neonatal unit. Growth and feeding data were prospectively collected for 18 months before and after the intervention. The intervention consisted of increasing the urgency of parenteral nutrition, routine introduction of enteral feeds from the first day of life, standardised weight-based daily increments of enteral feeds, use of donor human milk until at least 34 weeks corrected gestation (if insufficient mothers’ own milk) and routine fortification of human milk from 120 ml/kg/day. Results After the intervention, growth velocity by discharge home increased by 1 g/kg/day to 12.7 ± 2.2 g/kg/day (p<0.00002) and weight z score change reduced from -1.38 ± 0.77 to -1.16 ± 0.76 (p=0.005). The largest effect was seen in infants discharged home from the tertiary unit (z score change from -1.35 ± 0.73 to -1.04 ± 0.77, p=0.007) and in those discharged home on exclusive human milk (z score change from -1.65 ± 0.8 to -1.20 ± 0.9, p=0.006, growth velocity from 10.8 ± 2.2 g/kg/day to 13.0 ± 2.8 g/kg/day, p<0.00001). The significant differences in growth previously seen between infants discharged on exclusive human milk compared to any infant formula were eliminated. Conclusion Introduction of a simple nutritional bundle was associated with improved weight gain, particularly in those fed exclusive human milk at discharge. In order to achieve international growth recommendations further intensification of macronutrient provision may be required.