Quality indicators in nutrition therapy and clinical outcomes in a neonatal intensive care unit

HOLZBACH, Luciana Carla; MOREIRA, Renata Andrade de Medeiros; PEREIRA, Renata Junqueira

doi:10.1590/1678-9865202134e200213

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Sumário

Original • Rev Nutr 34 • 2021 • https://doi.org/10.1590/1678-9865202134e200213 copy

Quality indicators in nutrition therapy and clinical outcomes in a neonatal intensive care unit

Indicadores de qualidade da terapia nutricional e desfechos clínicos em uma unidade de terapia intensiva neonatal

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To associate quality indicators in nutritional therapy and pre-determined clinical outcomes in a neonatal unit.

Methods

A total of 81 premature newborns were monitored regarding the time to initiate nutrition therapy, time to meet energy needs, energy and protein adequacy, cumulative energy deficit, adequacy of the nutritional formula and fasting periods; weight gain, the occurrence of necrotizing enterocolitis, mortality and length of stay in the intensive care unit. The data were analyzed with the Statistical Package for the Social Sciences at 5% significance level.

Results

The time to start enteral nutrition and the calories infused/kg/day were predictors of length of hospital stay F(2.46)=6.148; p=0.004; R²=0.211; as well as the cumulative energy deficit+birth weight+infused calories/kg/day (F=3.52; p<0.001; R²=0.422); cumulative energy deficit+calories infused/kg/day+fasting time for Enteral Nutrition (F=15.041; p<0.001; R²=0.474) were predictors of weight gain. The time to start enteral nutrition, gestational age and birth weight were inversely associated with the occurrence of necrotizing enterocolitis (β=-0.38; β=-0.198; β=-0.002). Early enteral nutrition predisposed to mortality (β=0.33). Gestational age, birth weight and calories infused/kg/day were inversely related to mortality (β=-0.442; β=-0.004; β=-0.08).

Conclusions

Considering the associations between indicators and outcomes, routine monitoring of the time to start enteral nutrition, energy adequacy, energy deficit and fasting time is recommended.

Keywords
Indicators of morbidity and mortality; Necrotizing enterocolitis; Neonatal intensive care units; Nutrition therapy; Premature infant

Variable		Values
Variable		Mean	SD
Gestational age at birth (weeks)^* * Mean and Standard Deviation;		32.16	3.40
Gestational age at outcome (weeks)^* * Mean and Standard Deviation;		34.84	3.65
Weight at birth (g)^* * Mean and Standard Deviation;		1,631.00	653.30
Weight at discharge (g)^* * Mean and Standard Deviation;		1,752.44	637.99
		%	n
Gender
	Male	50.61	41
	Female	49.38	40
Preterm classification^ World Health Organization [4];
	Extreme preterm	13.58	11
	Very preterm	24.69	20
	Moderate preterm	24.69	20
	Late preterm	37.04	30
Weight at birth classification^* ***** World Health Organization [32]; SD: Standard Deviation.		-	-
	Extreme Low Weight	20.98	17
	Very Low Weight	25.92	21
	Low Weight	46.91	38
	Insufficient Weight	4.93	4
	Normal weight	1.23	1
Weight Classification for Gestational Age at Birth
	Low for Gestational Age at Birth	22.22	18
	Adequate for Gestational Age at Birth	75.30	61
	High for Gestational Age at Birth	2.46	2
Weight Classification for Gestational Age at Discharge
	Sm Low all for Gestational Age at Discharge	62.96	51
	Adequate for Gestational Age at Discharge	37.03	30
Prevalence of clinical conditions
	Early sepsis	86.42	70
	Respiratory distress syndrome/ early respiratory distress	81.48	66
	Use of vasoactive drugs	66.67	54
	Invasive Mechanical Ventilation	62.90	51
	Glucose metabolism disorders	23.46	19
	Anemia	18.82	15
	Acute renal failure	18.82	15
	Septic shock	14.81	12

Variables	Length of hospital stay			Weight gain
Variables	F	R2	p ^* * ANOVA;	F	R2	p ^* * ANOVA;
Gestational age (weeks)	1.216	0.024	0.276	02.923	0.043	0.092
Birth weight (g)	0.049	0.001	0.826	04.206	0.064	0.045
Time to start PN (hours)	0.083	0.002	0.775^ Significant at a statistical level; EN: Enteral Nutrition; F: F- test; PN: Parenteral Nutritition; R2: R-Squared.	2.011	0.032	0.161
Time to start of EN (hours)	7.392	0.120	0.009	02.019	0.030	0.160
Infused calories/day (Kcal)	3.189	0.058	0.080^ Significant at a statistical level; EN: Enteral Nutrition; F: F- test; PN: Parenteral Nutritition; R2: R-Squared.	01.173	0.018	0.283^ Significant at a statistical level; EN: Enteral Nutrition; F: F- test; PN: Parenteral Nutritition; R2: R-Squared.
Infused calories by body weight (Kcal)	7.763	0.142	0.008	06.270	0.088	0.015
Adequacy of infused calories (%)	1.185	0.021	0.281^ Significant at a statistical level; EN: Enteral Nutrition; F: F- test; PN: Parenteral Nutritition; R2: R-Squared.	01.027	0.016	0.315^ Significant at a statistical level; EN: Enteral Nutrition; F: F- test; PN: Parenteral Nutritition; R2: R-Squared.
Cumulative Energy Deficit (Kcal)	9.369	0.148	0.003	15.495	0.217	0.000
Infused protein (g/day)	0.881	0.016	0.352	00.146	0.002	0.704
Infused protein according to body weight (g)	0.282	0.005	0.598	01.650	0.025	0.204
Adequacy of the infused protein (%)	0.173	0.003	0.679	01.654	0.025	0.203
Infused PN volume (mL)	0.008	0.000	0.931	00.853	0.015	0.360
Adequacy of the volume of PN infused (%)	0.262	0.007	0.612	00.210	0.004	0.649
Infused EN volume (mL)	1.359	0.031	0.250	02.998	0.048	0.089
Adequacy of the infused EN volume (%)	6.979	0.149	0.012^ Significant at a statistical level; EN: Enteral Nutrition; F: F- test; PN: Parenteral Nutritition; R2: R-Squared.	00.429	0.007	0.515
Total of EN fasting time (hours)	1.708	0.036	0.198	08.709	0.129	0.005^ Significant at a statistical level; EN: Enteral Nutrition; F: F- test; PN: Parenteral Nutritition; R2: R-Squared.
Total of PN fasting time (hours)	0.042	0.001	0.839	00.983	0.018	0.326

Variable/Indicator	NEC			Mortality
Variable/Indicator	X²	p	R²_Naglekerke	X²	p	R²_Naglekerke
Gestational age (weeks)	14.752	0.039^* * Significant at a statistical level; EN: Enteral Nutrition; NEC: Necrotizing Enterolocolitis; PN: Parenteral Nutrition.	0.089	7.357	0.000^* * Significant at a statistical level; EN: Enteral Nutrition; NEC: Necrotizing Enterolocolitis; PN: Parenteral Nutrition.	0.410
Birth weight (g)	16.034	0.042^* * Significant at a statistical level; EN: Enteral Nutrition; NEC: Necrotizing Enterolocolitis; PN: Parenteral Nutrition.	0.171	18.878	0.016^* * Significant at a statistical level; EN: Enteral Nutrition; NEC: Necrotizing Enterolocolitis; PN: Parenteral Nutrition.	0.511
Time to start of PN (hours)	11.347	0.183	0.002	10.098	0.258	0.021
Time to start of EN (hours)	15.006	0.049^* * Significant at a statistical level; EN: Enteral Nutrition; NEC: Necrotizing Enterolocolitis; PN: Parenteral Nutrition.	0.105	7.540	0.001^* * Significant at a statistical level; EN: Enteral Nutrition; NEC: Necrotizing Enterolocolitis; PN: Parenteral Nutrition.	0.203
Prescribed calories (Kcal/kg/day)	4.839	0.775	0.027	-	-	-
Calories infused per kg of weight (Kcal/Kg/dia)	8.163	0.418	0.026	27.008	0.000^* * Significant at a statistical level; EN: Enteral Nutrition; NEC: Necrotizing Enterolocolitis; PN: Parenteral Nutrition.	0.442

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[1] Correspondence to: R.J. PEREIRA. E-mail: renatajunqueira@uft.edu.br.