Dietitian Involvement in the Neonatal Intensive Care Unit: More Is Better
Abstract
Objective
Describe the level of registered dietitian (RD) involvement in neonatal intensive care units (NICUs) and associations with NICU nutrition practices.
Design
Questionnaires were mailed to 820 NICUs in the United States with two follow-up mailings to nonresponders. Abbreviated phone surveys were conducted with a random sample of 10% of nonresponders. A nutrition care score was devised based on a sum of 10 survey questions (range 0 to 10) to summarize the intensity of reported practices.
Subjects/Setting
Directors of NICUs in the United States and RDs associated with them.
Statistical Analyses
χ2, analysis of variance, Bonferroni and Duncan multiple range tests, regression.
Results
Respondents from 417 (54%) of the 772 NICUs eligible for the study provided completed questionnaires. Among NICUs responding, 76% involved RDs in care (41% employed full- or part-time RDs, 35% employed consult RDs), and 24% had no RD. NICUs with full- or part-time RDs provided fewer kilocalories and more protein parenterally, and more kilocalories and protein enterally. NICUs with less RD involvement were more likely to provide full-term infant feedings (eg, unfortified breast milk, full-term formula) to very-low-birth-weight infants. Mean nutrition care score varied with RD involvement from 4.6±1.7 (mean±standard deviation) for NICUs with a consult RD and 4.7±1.4 for NICUs employing no RD to 5.6±1.7 for NICUs with a full- or part-time RD (overall P<.001).
Conclusions
More involvement of RDs in NICUs increased the intensity of important aspects of nutrition care that may improve outcomes of very-low-birth-weight infants in NICUs. These findings highlight the importance of RDs as NICU team members.
Address correspondence to: Irene E. Olsen, PhD, RD, Assistant Professor, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, Center for Epidemiology & Biostatistics and Division of Neonatology, Cincinnati Children’s Hospital Medical Center (MLC 5041), 3333 Burnet Ave, Cincinnati, OH 45229.
ABSTRACT
Dietitian Involvement in the Neonatal Intensive Care Unit: More Is Better