Neonatal ICUs Lack Resources to Monitor Infant Nutritional Intake

By Will Boggs MD

December 13, 2019

NEW YORK (Reuters Health) - Many neonatal intensive-care units (NICUs) in the U.S. lack clinical-decision support (CDS) to calculate and monitor caloric intake for critically ill infants, according to a survey.

"I hear about nutrition intake less often than I hear about fluid intake," Dr. Gustave H. Falciglia of Northwestern University, Feinberg School of Medicine, and Ann and Robert H. Lurie Children's Hospital of Chicago, told Reuters Health by email. "Having dietitians on rounds has helped with this problem; however, we are performing these calculations manually or retyping data already within the electronic health record (EHR)."

CDS provides real-time support to clinicians during order entry and has been shown to improve the quality and safety of nutrition of preterm infants in the NICU.

Dr. Falciglia and colleagues surveyed clinicians at 34 NICUs participating in the Children's Hospital's Neonatal Consortium (CHNC) to determine the availability of CDS to calculate nutrition and fluids received in the prior 24 hours and to estimate projected nutrition and fluids that an infant should receive in the subsequent 24 hours.

Only 32% of NICUs had CDS to determine enteral calories received and only 29% had CDS to determine parenteral calories received, whereas 82% had CDS to determine enteral and parenteral fluids received, the researchers report in the Journal of Perinatology.

Similarly, only 24% of NICUs had CDS to project enteral fluids or calories, whereas 79% had CDS to project parenteral calories and 68% had CDS to project parenteral fluids.

Even among NICUs with CDS, the majority did not have an automated CDS for nutrition received. Clinicians had to retype data from the EHR into a calculator within the same EHR or into a calculator separate from the EHR.

Only one surveyed NICU had an automated CDS that calculates both enteral and parenteral calories received.

"Clinicians and parents should work together to define and prioritize healthcare goals for infants in the NICU and then ensure that meaningful data exist to support these goals," Dr. Falciglia said. "I believe that delivering adequate nutrition and optimizing growth is important for every critically ill infant in the NICU."

"Automating nutrition data will require changes to how the EHR captures data (e.g., less reliance on free-text instructions in feeding orders); however, the first step is to define what we are trying to achieve," he said. "If we can use automated data to drive quality initiatives or use data to improve our understanding between growth and nutrition, then we may significantly improve the care of critically ill infants."

The study had no funding.

SOURCE: Journal of Perinatology, online December 9, 2019.