Standardised reporting framework for nutrition and growth in preterm nutrition studies: A Delphi study

In 2020, over 13.4 million babies globally (>10% of all live births) were born preterm (1) . Nutrition during the neonatal period plays a crucial role in supporting optimal growth, brain development, and reducing the risk of metabolic diseases later in life (2) . Current guidelines on nutrition for preterm infants contain inconsistent recommendations (3) , most of which are based on very low certainty of evidence. Challenges in formulating recommendations for nutrition in preterm infants partly arise from inconsistent reporting of outcomes in nutrition intervention studies (4) . We aimed to develop a standardised reporting framework for measures of nutrition intake and growth outcomes in preterm nutrition studies. Measures of nutrition intake and growth outcomes were identified in a scoping review, curated, and presented in two real-time Delphi surveys to participants from three stakeholder groups with experience in preterm infants, nutrition, and growth: healthcare consumer; healthcare professional, and researcher. The first survey was to identify measures deemed critical for reporting in a minimum reporting set; the second on how to report these measures. Questions were rated for their importance on a 9-point Likert scale. Items were considered for inclusion when ≥80% of all participants scored the item as 7–9 (critical for inclusion) and <15% scored as 1–3, or when ≥80% of healthcare consumers scored the item as 7–9. The standardised reporting framework was finalised during three online consensus meetings, where stakeholders were given the opportunity to discuss and then vote on the importance of each item. Items receiving ≥80% “critical for inclusion” votes from all attendees or from consumers were included. We recruited 313 participants from 32 countries for survey 1, and 121 participants from 26 countries for survey 2. The proportions of stakeholder groups in both surveys were similar: 12% consumers; 73-77% healthcare professionals, and 11-15% researchers. Eight measures are included in the final standardised reporting framework: (1) the type of milk the baby receives; (2) the type of supplement to milk that a baby receives; (3) the nutrition that the baby actually receives; (4) the time period over which the measurement of the nutrition that the baby actually receives was made; (5) baby’s weight; (6) baby’s length/height; (7) baby’s head circumference; and (8) the time point at which, or the time interval over which, the measurement of size or growth was made. These eight measures are accompanied by 22 recommended measurement methodologies. This standardised reporting framework should be used in the development of future study protocols, evidence syntheses, and nutrition guidelines for preterm infants. Widespread adoption of this framework in preterm nutrition studies would improve the design of studies, the comparability of research findings, thereby facilitating reliable evidence synthesis, and potentially could support the development of evidence-based clinical guidelines and practice.