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2024-06-07 SMB dissertation.pdf (20.6 MB)

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Examining the Relationship of Malnutrition In Preterm Infants to Critical Clinical Outcomes

Merlino Barr, Stephanie
http://orcid.org/0000-0002-0125-5684
http://rave.ohiolink.edu/etdc/view?acc_num=case1717781207596245

Abstract Details

2024, Doctor of Philosophy, Case Western Reserve University, Clinical Translational Science.
Nutrition is both a lifesaving and life sustaining intervention in the Neonatal Intensive Care Unit (NICU) that is needed for the appropriate growth and development of premature infants. The importance of nutrition for preterm infants is clear, as providing both the appropriate quantity and quality of nutrition to premature infants has been shown to variably influence infant growth, morbidities, and neurodevelopmental outcomes. Thus, identifying, preventing, and resolving malnutrition are all necessary to provide optimal care to preterm infants. Diagnostic criteria for neonatal malnutrition were proposed in 2018 by field experts, but these criteria have not been validated since publication. The objective of this dissertation was to investigate the validity of the neonatal malnutrition diagnostic tool in preterm infants using a large, single-center cohort from a level III NICU. Validity of the neonatal malnutrition diagnostic tool was assessed in three aims: 1) evaluating how current proposed indicators of malnutrition identify patients in a preterm infant population; 2) analyzing current malnutrition indicators to determine if a causal relationship between malnutrition diagnoses and critical clinical outcomes exists; and 3) exploring novel markers of neonatal malnutrition to determine their predictive power in relation to patient significant clinical outcomes. This work found that inter-indicator reliability of the overall malnutrition diagnostic tool was poor (κ = 0.054 for malnutrition diagnoses in the first two weeks of life, and κ = 0.048 for malnutrition diagnoses in the remainder of the NICU course). Inter-indicator of reliability of individual malnutrition indicators was moderate for between growth-based indicators of malnutrition, but poor when comparing intake-based indicators of malnutrition to growth-based indicators of malnutrition. Intra-indicator reliability was high for different definitions of the weight gain velocity malnutrition indicator (κ > 0.8), but low for the different definitions of linear growth velocity (κ = 0.12). In assessing the predictive validity of a neonatal malnutrition diagnosis on critical clinical outcomes, moderate/severe malnutrition using the weight gain velocity indicator showed a causal relationship with bronchopulmonary dysplasia, time to full oral feeds, and hospital readmission within 30 days of hospital discharge (p<0.05). Growth-related indicators of malnutrition (weight gain velocity, weight z-score, linear growth velocity, length z-score) all had a strong relationship with a longer time to full oral feeds (p < 0.05). Finally, change in mid upper arm z-score, ratio of non-protein energy to grams protein in the first two weeks of life, and fat free mass z-scores were assessed as novel markers of malnutrition. Infants with an adjusted fat free mass z-score less than -1.96 trended in having a prolonged time to full oral feeds (HR: 1.66, 95% CI: 1.07, 2.59), higher rates of rehospitalization or emergency department visits within 30 days of hospital discharge (OR: 2.38, 95% CI: 0.76, 7.46), and severe retinopathy of prematurity (OR: 2.90, 95% CI: 0.90, 9.35). Cumulatively, this work identifies parts of the neonatal malnutrition diagnostic tool that require reassessment with the goal of better defining the neonatal malnutrition framework, with the goal of supporting a future, multi-site validation study.
Thomas E Love (Committee Chair)
Sharon Groh-Wargo (Advisor)
Rosa Hand (Committee Member)
Marc Collin (Committee Member)
632 p.
Nutrition
malnutrition, neonatal malnutrition, neonate, preterm infant, neonatal nutrition, bronchopulmonary dysplasia, retinopathy of prematurity, human milk, neonatal malnutrition, hospital readmission

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Citations

  • Merlino Barr, S. (2024). Examining the Relationship of Malnutrition In Preterm Infants to Critical Clinical Outcomes [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1717781207596245

    APA Style (7th edition)

  • Merlino Barr, Stephanie. Examining the Relationship of Malnutrition In Preterm Infants to Critical Clinical Outcomes. 2024. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1717781207596245.

    MLA Style (8th edition)

  • Merlino Barr, Stephanie. "Examining the Relationship of Malnutrition In Preterm Infants to Critical Clinical Outcomes." Doctoral dissertation, Case Western Reserve University, 2024. http://rave.ohiolink.edu/etdc/view?acc_num=case1717781207596245

    Chicago Manual of Style (17th edition)

case1717781207596245
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© 2024, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.