{
  "abstract": "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.",
  "authors": [
    {
      "affiliations": [
        "Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia",
        "King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia"
      ],
      "name": "Lina Alsherbini"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia",
        "King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia"
      ],
      "name": "Mohanned Alrahili"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia"
      ],
      "name": "Sabreen Asiry"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia",
        "King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia"
      ],
      "name": "Talal Aljarbou"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia",
        "King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia"
      ],
      "name": "Manal Alshareef"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia",
        "King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia"
      ],
      "name": "Alanoud Alluwaymi"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia",
        "King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia"
      ],
      "name": "Amjad Altofail"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia",
        "King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia"
      ],
      "name": "Amirah Altamimi"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia"
      ],
      "name": "Ashwag Alsubaie"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia"
      ],
      "name": "Tarek El Aallem"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia",
        "King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia",
        "College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia"
      ],
      "name": "Saif Alsaif"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia",
        "King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia",
        "College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia"
      ],
      "name": "Kamal Ali"
    }
  ],
  "title": "Standardised neonatal nutrition care bundle and growth velocity in infants <32 weeks: a single-centre pre-quality/post-quality improvement study",
  "uid": "979c311d-da3b-53d2-8925-e881ec8ca65b"
}