(123) Global Collaborations to Improve Newborn Nutrition: Implementation of a Who-aligned Feeding Protocol for Preterm & Low Birth Weight Neonates at a Tertiary Hospital in Nigeria

Background: Preterm neonates have higher energy requirements than term infants due to ongoing metabolic demands during the neonatal period. Optimal nutrition during this critical window promotes weight gain, reduces complications, and supports improved long-term neuro-developmental outcomes. The World Health Organization (WHO) has developed evidence-based guidelines for the feeding of preterm and low-birthweight (LBW) infants in low- and middle-income countries (LMICs). Despite these recommendations, substantial implementation gaps persist across many neonatal intensive care units (NICUs) in LMICs and result in delayed initiation of enteral feeds, prolonged reliance on intravenous (IV) fluids, inconsistent advancement of feeding volumes and ultimately affect neonatal outcomes.
At Jos University Teaching Hospital (JUTH) in Nigeria, inconsistent feeding practices, delayed initiation of enteral feeds, and prolonged use of intravenous (IV) fluids were contributing to poor weight gain and suboptimal outcomes for preterm and low-birthweight infants. These challenges underscored the urgent need for targeted quality improvement (QI) interventions to support early and consistent nutritional management in this vulnerable population.

Objectives: 1. To implement a unit-specific feeding protocol aligned with WHO and national guidelines.
2. To identify key behavioral and systemic factors influencing protocol adherence using the Theoretical Domains Framework (TDF).
3. To evaluate the early impacts of protocol implementation on feeding practices and clinical documentation.

Design/Methods: A QI project was conducted in the Special Care Baby Unit at JUTH to implement a unit-specific feeding protocol for preterm and LBW neonates. Baseline data were collected retrospectively through chart review to determine the current time to initiation of enteral feed, days on IV fluids and median time to full enteral feeds. life. A unit-specific feeding guideline aligned with WHO and national guidelines, was designed and implemented in March 2025. Printed guidelines were made available at each bedside with ongoing re-education of clinical staff on improved documentation in the electronic medical record system for evaluation of outcomes.
Implementation science was applied to assess change behavior affecting protocol adherence with selection of eight domains from the Theoretical Domains Framework. Project outcomes evaluation is currently in process.

Results:

Conclusions: