Management protocol for extremely/very low birth weight infants: impact of waterbed-style nesting combined with continuous breast milk feeding quality improvement on infants’ quality of life and neurobehavioral outcomes

Objective To investigate the clinical efficacy of waterbed-style nests combined with breast milk feeding quality continuous improvement on early growth and neurobehavioral outcomes in extremely/very low birth weight infants, providing theoretical support for clinical practice. Methods A retrospective study enrolled 103 extremely/very low birth weight infants admitted to our hospital from May 2024 to October 2025. Based on electronic medical records, they were divided into a control group ( n = 50, conventional management) and an observation group ( n = 53, water-bed nest combined with continuous improvement of breast milk feeding quality). Clinical outcomes during hospitalization were collected and compared: Short-term physical growth outcomes (weight gain rate, head circumference gain rate, length gain rate, time to regain birth weight, sleep duration), Neurobehavioral development [Neurobehavioral Assessment of the Neonate (NABA)], Serum indicators [total protein (TP), albumin (ALB), prealbumin (PA)], Complication occurrence (feeding intolerance, necrotizing enterocolitis, bronchopulmonary dysplasia, late-onset sepsis). Results The observation group showed significantly higher weight gain, head circumference and length growth rates, and shorter time to regain birth weight (all P < 0.05). Neurobehavioral scores (primitive reflexes, muscle tone, general condition, functional capacity) and serum nutritional markers (TP, ALB, PA) were also higher post-intervention ( P < 0.05). Incidences of feeding intolerance (20.75% vs. 46.00%) and bronchopulmonary dysplasia (5.66% vs. 20.00%) were significantly lower in the observation group ( P < 0.05). No significant differences were found in necrotizing enterocolitis or late-onset sepsis. Conclusion The waterbed-style bird's nest combined with continuous quality improvement in breast milk feeding effectively enhances feeding and nutritional status, promotes early physical growth and neurobehavioral function, and reduces short-term complications such as feeding intolerance and bronchopulmonary dysplasia in infants. Long-term follow-up studies are warranted to determine if these early benefits translate into sustained improvements in quality of life.