Statewide Initiative to Reduce Postnatal Growth Restriction among Infants <31 Weeks of Gestation

Timothy P. Stevens, Eileen Shields, Deborah Campbell, Adriann Combs, Michael Horgan, Edmund F. La Gamma, Kuang Nan Xiong, Marilyn Kacica

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Objective: To decrease the incidence of postnatal growth restriction, defined as discharge weight <10th percentile for postmenstrual age, among preterm infants cared for in New York State Regional Perinatal Centers. Study design: The quality improvement cohort consisted of infants <31 weeks of gestation admitted to a New York State Regional Perinatal Center within 48 hours of birth who survived to hospital discharge. Using quality improvement principles from the Institute for Healthcare Improvement and experience derived from successfully reducing central line–associated blood stream infections statewide, the New York State Perinatal Quality Collaborative sought to improve neonatal growth by adopting better nutritional practices identified through literature review and collaborative learning. New York State Regional Perinatal Center neonatologists were surveyed to characterize practice changes during the project. The primary outcome—the incidence of postnatal growth restriction—was compared across the study period from baseline (2010) to the final (2013) years of the project. Secondary outcomes included differences in z-score between birth and discharge weights and head circumferences. Results: We achieved a 19% reduction, from 32.6% to 26.3%, in postnatal growth restriction before hospital discharge. Reductions in the difference in z-score between birth and discharge weights were significant, and differences in z-score between birth and discharge head circumference approached significance. In survey data, regional perinatal center neonatologists targeted change in initiation of feedings, earlier breast milk fortification, and evaluation of feeding tolerance. Conclusions: Statewide collaborative quality improvement can achieve significant improvement in neonatal growth outcomes that, in other studies, have been associated with improved neurodevelopment in later infancy.

Original languageEnglish (US)
Pages (from-to)82-89.e2
JournalJournal of Pediatrics
StatePublished - Jun 2018


  • extrauterine growth restriction
  • infant growth
  • infant, extremely low birth weight
  • infant, extremely low gestational age
  • infant, low birth weight
  • infant, newborn
  • infant, premature
  • neonatal intensive care
  • neonatal nutrition
  • neurodevelopmental morbidity
  • neurodevelopmental outcome
  • quality improvement
  • total parenteral nutrition

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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