6395 A service improvement project to develop a nutrition round on the neonatal unit, (NICU) in cardiff

Objectives Cardiff Neonatal Unit (NNU) is a tertiary level centre and the regional centre for surgery and cardiology, caring for babies with complex nutritional needs. Prior to this service development project, the service teams reviewed nutritional intake, growth and feeding on a daily basis. Results of a retrospective audit over 5 months from July to December 2022, to review weight gain in those most at risk of growth failure (see figure 2), showed that babies are falling across 1.4 centiles (SD change in weight ranging from -2.39 to 3.31) during their admission (N=47). In an analysis of the year 2022, for all those weighing less than 1500g (N=41), babies were falling across at least one centile, and those less than 1000g at birth, weight fell at least 1.2 centiles. Considering these results, and the appointment of allied health professionals to the NICU, the following aims were assimilated: Achieve recommended standards of care for neonatal nutrition and TPN management, as per ESPGHAN guidance for enteral nutrition for preterm infants1 and NICE Neonatal parenteral nutrition guidance.2 Form a focussed nutrition round, targeting babies at high risk of growth failure (figure 1). The team should include; neonatologists, trainees, infant feeding experts, pharmacists, dietician and speech and language therapists. Improve growth along growth centiles in babies at risk of growth failure. Methods We developed a process for a weekly MDT nutrition round using a model for improvement and multi-staged approach (see figure 2). Results We have implemented a multi-disciplinary focussed nutrition round to support growth and nutrition for those at greatest risk of nutritional failure on NICU. We will measure success of the new service by recording our activity, prospective data collection of those under review, repeat audit work looking at growth. Conclusion Through working together as an MDT, with a combined collective enthusiasm for nutrition, we have identified additional projects to be undertaken by the team; including development of new guidelines for TPN, metabolic bone disease, adherence to feeding guideline, audit of breast feeding, and QI project into the use of length measurement. Our combined efforts will improve the quality of nutritional care for our patients. References Embleton ND, et al. Enteral nutrition in preterm infants. A position paper from the ESPGHAN committee on nutrition and invited experts. J Pediatr Gastroenterol Nutr 2022. Feb 2023. nice.org.uk/guidance/ng154. Published by NICE, 26 February 2020.