467 - From NICU to Home: Evaluating the Impact of a Nutrition-Focused Follow-Up Clinic on Preterm Infant Growth

Publication Number: 4458.467

Rutvi Shah-Jani, University of Wisconsin School of Medicine and Public Health, Verona, WI, United States; Sally Norlin, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Michael R.. Lasarev, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Whitley Hulse, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States

Background: Adequate growth in preterm infants is essential for optimal neurodevelopmental and metabolic outcomes. Despite advances in neonatal nutrition, extrauterine growth restriction remains common, affecting 30-70% of preterm infants. The Great Results After Discharge (GRAD) Clinic was established in 2019 to provide individualized nutritional assessments and fortification guidance to optimize growth trajectories during the transition from the NICU to home.

Objective: To evaluate the impact of a specialized post-NICU nutrition clinic on growth outcomes and fortification strategies among preterm infants.

Design/Methods: A retrospective cohort study included 200 infants discharged from a Level III NICU between June 2019 and October 2023: 100 who attended at least one GRAD clinic visit and 100 matched controls (gestational age and sex). Eligible infants had a primary care provider within the University of Wisconsin or UnityPoint-Meriter systems. Data collected via REDCap included demographics, medical history, nutrition, and anthropometric measurements from birth through 12 months corrected age. Continuous and categorical variables were compared using paired t-tests/Wilcoxon signed-rank and McNemar's/Stuart-Maxwell tests. Time-to-event outcomes were analyzed using Cox regression with cluster-robust standard errors, and longitudinal weight Z-scores modeled using linear mixed-effects models. Analyses were performed in R (v4.4.1).

Results: Cohorts were comparable in mean gestational age (32 ± 3.1 weeks), sex (51% male), and the distribution of small vs appropriate vs large-for-gestational-age infants. There was no difference in intraventricular hemorrhage, necrotizing enterocolitis, or bronchopulmonary dysplasia rates. GRAD infants were more often discharged on fortified feeds (74% vs 60%, p = 0.035) and had fortification reduced earlier (median 16 vs 27 days, p = 0.002). Fortification level significantly influenced weight trajectories in both groups (controls p = 0.008; GRAD p < 0.001). GRAD infants demonstrated a sharper and earlier decline in weight Z-score by 3-4 months postmenstrual age (PMA) compared to controls (−0.78 vs −0.44; 95% CI: 0.075-0.61, p = 0.012), with similar catch-up growth trajectories by one-year PMA.

Conclusion(s): Participation in a post-discharge nutrition clinic facilitates individualized feeding strategies but may be associated with earlier fortification weaning and transient growth faltering. Prolonging fortification duration and improving coordination between inpatient and outpatient settings could enhance growth trajectories after NICU discharge during a critical period of brain development.

Comparing change in weight Z-score between GRAD and control infants post-NICU discharge.