Standardised neonatal nutrition care bundle and growth velocity in infants <32 weeks: a single-centre pre-quality/post-quality improvement study

Objective To test whether a unit-level nutrition care bundle that accelerates enteral feed and optimises early caloric delivery improves in-hospital growth in preterm infants. Design Single-centre pre–post observational study. Setting Tertiary neonatal intensive care unit. Participants Infants born at less than 32 weeks’ gestation admitted during two epochs: baseline (1 January 2023–30 April 2024) and post-quality improvement (QI) (1 May 2024–31 August 2025). Complete cases were analysed for each endpoint (growth velocity (GV) cohort: pre n=163, post n=149). Intervention A multicomponent nutrition care bundle promoting earlier initiation and advancement of enteral feeds, protocolised fortification and higher early energy delivery. Main outcome measures Primary outcome was infant-level average GV (g/kg/day) calculated from weekly GV from week 3 onwards. Secondary outcomes included week-specific GV, change in weight Z-score from birth to discharge (Δ weight Z), discharge anthropometry, feeding process measures (time to full feeds, week 1 calories) and safety outcomes (feeding intolerance and necrotising enterocolitis). Results Average GV increased from 12.52±2.49 pre-QI to 15.50±2.30 g/kg/day post-QI (mean difference+2.98, 95% CI 2.45 to 3.52; p<0.001). Weekly GV was higher post-QI across weeks 3–12, with the largest difference at week 8 (+4.31 g/kg/day, 95% CI 2.34 to 6.27; p<0.001). Δ weight Z was less negative post-QI (−1.21±0.75 vs −1.43±0.81; difference+0.22, 95% CI 0.05 to 0.39; p=0.012). Discharge weight was higher post-QI (+152 g, 95% CI 13 to 290; p=0.033), while discharge length and head circumference Z-scores were similar between epochs. Time to full feeds decreased by 6.05 days (95% CI −11.77 to −0.33), and mean week 1 caloric intake increased by 11.38 kcal/kg/day (95% CI 6.16 to 16.60). Feeding intolerance and necrotising enterocolitis rates did not differ between periods. Conclusions Implementation of a care bundle was associated with improved GV and earlier feeding milestones without increased feeding intolerance or necrotising enterocolitis.