Location
Virtual
Start Date
1-3-2024 8:00 AM
End Date
1-3-2024 3:30 PM
Keywords:
alaska; pamc
Description
Background:
Extrauterine Growth Restriction (EUGR) has been defined as infant weight-for-age z-score (WAZ) of less than -1.28 standard deviations (SD), at discharge or 36–40 weeks (about 9 months) postmenstrual age. In 2018, the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition published indicators of neonatal malnutrition, including a decline in WAZ over time. Mild, moderate, and severe neonatal malnutrition is defined as a WAZ decline of 0.8-1.2 SD; >1.2-2 SD; >2 SD, respectively, and it is unclear how widely revised neonatal malnutrition indicators are being used.
Purpose/aim:
To investigate the sensitivity and specificity of neonatal malnutrition indicators compared to the EUGR definition among infants discharged from a NICUfrom 2016-2021
Methods/Approach:
This quality improvement project utilized quantitative data from infants discharged from the NICU from 2016-2021, excluding infants with major congenital anomalies and infants with non-viable WAZ (n=1483). The Statistical Package for the Social Sciences (SPSS) was utilized for data analysis. Infants were classified as meeting the EUGR definition if their WAZ at discharge was less than -1.28. Infants were classified as having at least mild neonatal malnutrition if their birth to discharge WAZ declined by ≥0.8; at least moderate neonatal malnutrition if their WAZ declined by >1.2; and severe neonatal malnutrition if their WAZ declined by >2. Sensitivity, specificity, and percent agreement of the mild, moderate, and severe thresholds of neonatal malnutrition were calculated in reference to EUGR.
Results:
Compared to EUGR, the sensitivity (percent of infants meeting the EUGR definition who also meet the neonatal malnutrition definition) of mild, moderate, and severe neonatal malnutrition was 60%, 24.1%, and 3.5%, respectively. The specificity (percent of infants not meeting the EUGR definition who also do not meet the neonatal malnutrition definition) of mild, moderate, and severe neonatal malnutrition was 46.7%, 81%, and 96.5%. Severe neonatal malnutrition had the highest percent agreement (percent of infants where both indicators are concordant), at 71%.
Conclusion:
Decline in WAZ as an indicator of neonatal malnutrition has low sensitivity and specificity when compared to the EUGR definition. Clinical judgement is important when evaluating infants’ growth and nutritional status. A limitation of this analysis is that it does not identify the indicator that is more accurate or more closely associated with infant health outcomes; for these analyses, EUGR was chosen as the reference because it is the historical standard. Future research should address this knowledge gap.
Implications for practice:
This project contributes to the current understanding of indicators of neonatal malnutrition and highlights an important research priority. Clinicians’ judgement remains invaluable for evaluation and treatment, yet standardized definitions of growth failure may be used in clinical settings, for example for quality improvement. These results suggest that EUGR and revised indicators have poor agreement, highlighting the importance of (1) future research to understand which indicator is more closely associated with health outcomes and/or clinical judgement, and (2) consistent adoption of updated indicators.
Recommended Citation
Baty, Madison; Faerber, Emily; and Sirois, Cayenne, "COMPARISON OF DATA ON PRETERM NEONATAL GROWTH MEASURES IN THE NEONATAL INTENSIVE CARE UNIT" (2024). Providence Nursing Research Conference 2023 – Present. 15.
https://digitalcommons.providence.org/prov_rn_conf_annual/2024/posters/15
Clinical Institute
Women & Children
Department
Nursing
Department
Perinatology/Neonatology
COMPARISON OF DATA ON PRETERM NEONATAL GROWTH MEASURES IN THE NEONATAL INTENSIVE CARE UNIT
Virtual
Background:
Extrauterine Growth Restriction (EUGR) has been defined as infant weight-for-age z-score (WAZ) of less than -1.28 standard deviations (SD), at discharge or 36–40 weeks (about 9 months) postmenstrual age. In 2018, the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition published indicators of neonatal malnutrition, including a decline in WAZ over time. Mild, moderate, and severe neonatal malnutrition is defined as a WAZ decline of 0.8-1.2 SD; >1.2-2 SD; >2 SD, respectively, and it is unclear how widely revised neonatal malnutrition indicators are being used.
Purpose/aim:
To investigate the sensitivity and specificity of neonatal malnutrition indicators compared to the EUGR definition among infants discharged from a NICUfrom 2016-2021
Methods/Approach:
This quality improvement project utilized quantitative data from infants discharged from the NICU from 2016-2021, excluding infants with major congenital anomalies and infants with non-viable WAZ (n=1483). The Statistical Package for the Social Sciences (SPSS) was utilized for data analysis. Infants were classified as meeting the EUGR definition if their WAZ at discharge was less than -1.28. Infants were classified as having at least mild neonatal malnutrition if their birth to discharge WAZ declined by ≥0.8; at least moderate neonatal malnutrition if their WAZ declined by >1.2; and severe neonatal malnutrition if their WAZ declined by >2. Sensitivity, specificity, and percent agreement of the mild, moderate, and severe thresholds of neonatal malnutrition were calculated in reference to EUGR.
Results:
Compared to EUGR, the sensitivity (percent of infants meeting the EUGR definition who also meet the neonatal malnutrition definition) of mild, moderate, and severe neonatal malnutrition was 60%, 24.1%, and 3.5%, respectively. The specificity (percent of infants not meeting the EUGR definition who also do not meet the neonatal malnutrition definition) of mild, moderate, and severe neonatal malnutrition was 46.7%, 81%, and 96.5%. Severe neonatal malnutrition had the highest percent agreement (percent of infants where both indicators are concordant), at 71%.
Conclusion:
Decline in WAZ as an indicator of neonatal malnutrition has low sensitivity and specificity when compared to the EUGR definition. Clinical judgement is important when evaluating infants’ growth and nutritional status. A limitation of this analysis is that it does not identify the indicator that is more accurate or more closely associated with infant health outcomes; for these analyses, EUGR was chosen as the reference because it is the historical standard. Future research should address this knowledge gap.
Implications for practice:
This project contributes to the current understanding of indicators of neonatal malnutrition and highlights an important research priority. Clinicians’ judgement remains invaluable for evaluation and treatment, yet standardized definitions of growth failure may be used in clinical settings, for example for quality improvement. These results suggest that EUGR and revised indicators have poor agreement, highlighting the importance of (1) future research to understand which indicator is more closely associated with health outcomes and/or clinical judgement, and (2) consistent adoption of updated indicators.
