Improving and Sustaining VLBW Infant Growth Through a Quality Collaborative in California

INTRODUCTION: Very low birth weight (VLBW) infants experience inadequate postnatal growth, which may be associated with poor neurodevelopmental outcomes. This statewide quality improvement collaborative aimed to improve VLBW infant growth.
METHODS: The collaborative was conducted from October 2018 to March 2020. The aim was to reduce the primary outcome measure of proportion of weight <10th percentile at discharge among VLBW infants by 20% in 1 year. The secondary outcome measure was a z-score deficit ≥0.8 from birth. Process measures were early fortification, nutrition rounds, and feeding guideline compliance. Balancing measures were necrotizing enterocolitis and human milk feeding at discharge. Measures were analyzed with statistical process control charts. Outcome measures were compared among participant and nonparticipant neonatal intensive care units (NICUs) for a total of 6 years including 2 years after the collaborative. RESULTS: 22 NICUs participated in the collaborative. The 78-month analysis included 7856 VLBW infants. The participant group reduced growth restriction at discharge (45% to 37.6%) and z-score deficit ≥0.8 (44.4% to 33.3%). Postcollaborative improvement was sustained for 24 months. The 114 nonparticipant NICUs did not reduce rates of growth outcome measures. Several process measures showed sustained improvement. Balancing measures were unchanged during the collaborative period. However, post hoc analysis showed a higher necrotizing enterocolitis rate when 2 years after the collaborative were included. CONCLUSION: Quality improvement collaborative NICUs improved nutrition processes and VLBW growth. Improvement was sustained for 24 months after the collaborative. Nonparticipant NICUs did not show similar improvement. Implementing NICU nutrition processes may lead to sustained improvements in VLBW infant growth.