Investigating Variations of Respiratory, Nutritional, and Feeding Management of Moderate and Late Preterm Infants in Alberta

Abstract

Background: Moderate and late preterm infants (MLPI), born between 32-36 weeks’ gestation, are underrepresented in research, with limited evidence-based guidelines for optimal respiratory, nutritional, and feeding management. This contributes to inconsistent practices and outcomes between neonatal intensive care units (NICUs). Objective: The objective of this study is to investigate the prevalence and variation in respiratory, nutritional, and feeding management and outcomes among MLPI between 12 NICUs in Alberta. Study Design: A retrospective cohort study of 2210 MLPI born between May 1, 2023, and April 30, 2024, and had a primary admission to one of 12 participating NICUs in Alberta (10 Level II, 2 Level III). Demographics, clinical management, and outcomes were abstracted from electronic medical records. Descriptive statistics summarized patient characteristics and clinical outcomes. Adjusted mixed-effect modeling was used to investigate variation of respiratory, nutritional, and feeding management between NICUs. Results: Among 2210 eligible MLPI, 44.3% were female, 16.7% were small for gestational age, and 25.4% were born from multiple pregnancies. Of the infants, 56.8% were diagnosed with respiratory distress syndrome or transient tachypnea of the newborn, 23.8% with apnea of prematurity, and 58% received respiratory support prior to discharge home or death, whichever came first. The median (interquartile range) time until first enteral feed was 4.5 (1.45-12.2) hours, with most infants initially tube fed (57.0%), followed by bottle (35.3%), and breast (4.7%). There were significant differences between NICU sites in respiratory management including caffeine administration, mechanical ventilation usage, and duration of respiratory management. Variations were also found in nutritional and feeding management including, breastmilk at discharge, exclusive breastmilk at discharge, duration until first enteral feed, and post-natal days at achieving full oral feeds. Conclusion: Study findings help address the lack of population-based data on MLPI by presenting demographic characteristics, and the prevalence of respiratory, nutritional, and feeding management. Variations in respiratory, nutritional, and feeding management, emphasize the importance of establishing evidence informed clinical practice guidelines to improve health outcomes and reduce length of stay for MLPI. There is an urgent need to create a national quality improvement collaborative that include all level II NICUs in Canada.