A recent study conducted at Ann & Robert H. Lurie Children’s Hospital reveals important insights about the determination of dosing weights for very low birth weight (VLBW) infants within the neonatal intensive care unit (NICU). This research highlights the significant variability among dosing weights used for medication and nutrition ordering, as well as the factors influencing these calculations.
Dosing weight (DW), often assigned during clinical rounds, directly impacts the nutritional and medical needs of critically ill infants. The study examined 115 infants over 4,643 days, with researchers recommending using measured weight (MW) instead of dosing weight once the infants have regained their birth weight (BW) to prevent nutrient deficits.
The median birth weight of the infants studied was found to be 1060 grams, with the majority of them taking around 10 days to regain this weight following birth. Notably, the research indicated, after regaining BW, the dosing weight was typically 4.2% lower than the measured weight. Such discrepancies were linked to factors such as increasing creatinine levels and fluid output, which may signal renal function and help identify infants suffering from fluid overload.
Dr. Gustave Falciglia, one of the study's authors, explains the practical challenges. “Dosing weights in the NICU appear to fall... under three categories: BW prior to regaining BW, practical weight... and ‘dry’ weight adjusting for fluid overload states,” he commented. This indicates varying practices among clinicians and emphasizes the need for standardized guidelines.
While the study stressed the importance of assigning appropriate dosing weights to VLBW infants, it also identified non-clinical factors like the day of the week as influencing the frequency of changes made to these weights. “Dosing weight changes are more frequent on Mondays and Fridays, likely linked to variations in staffing and workload,” added Falciglia.
Further, the results showed high incidence rates of hyponatremia among the infants, with approximately 77% exhibiting sodium levels below 135 mEq/L. This information underlines the necessity for careful fluid and sodium management during the early postnatal period to mitigate complications associated with imbalances.
The authors urge practitioners to shift their focus to using the measured weights for nutritional calculations once birth weight is achieved. “We recommend using measured weight to avoid... 4% daily loss in nutrition intake once BW is regained,” noted the researchers, emphasizing how such practices could positively influence the growth and development of VLBW infants.
This study's findings point to the broader impact of precise dosing weight management on treatment outcomes and calls for increased awareness and research to guide clinical decisions effectively. It highlights the necessity for standardized protocols and clinical decision support systems aimed at reducing nutrient deficits and improving nutritional outcomes for preterm infants.
With the study shedding light on these important factors, attention to the nuances of dosing weight assignments is more necessary than ever to advance care practices and optimize outcomes for vulnerable populations like VLBW infants.