---
title: "Nutrition decision making on NICU bedside rounds: mixed-methods analysis in preterm infants"
id: "pubmed-42768100"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42768100"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42768100/"
doi: "10.1038/s41390-026-05502-6"
published_at: "2026-09-22T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Nutrition decision making on NICU bedside rounds: mixed-methods analysis in preterm infants
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42768100
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42768100/)
- **DOI:** [10.1038/s41390-026-05502-6](https://doi.org/10.1038%2Fs41390-026-05502-6)
- **Published At:** 2026-09-22T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The study used a convergent parallel **mixed methods** design to characterize how clinicians make **nutrition** decisions during bedside rounds for **preterm infants** in two neonatal intensive care units (NICUs). Observations of rounds were audio recorded, transcribed, and thematically analyzed while quantitative data were abstracted from the medical record. - Four nutrition-specific themes emerged from analysis of bedside discussions: clinicians prioritize **fluid** discussions over explicit nutrition language; conversations were often vague and reflected **uncertainty**; primary drivers of nutrition plans were **fluid allowance**, feeding tolerance, growth, and metabolism; and distinguishing true growth from **fluid retention** or measurement error was difficult. - The authors report that clinicians frequently use a heuristic of discussing “how much fluid the baby received” as a proxy to approximate energy or protein intake rather than directly assessing nutrition delivered. - This reliance on fluid-focused language and heuristics may contribute to suboptimal nutrition decisions during transition phases and periods of fluid restriction, when distinguishing nutritional adequacy is particularly important. - The study highlights gaps in easily accessible data at the bedside to accurately quantify what nutrition the infant received and how the infant grew in response. - Consent procedures: clinicians gave verbal consent to observation and audio recording; parental consent was not required. Conflicts of interest reported for some authors, including grant support and industry relationships; remaining authors reported no financial conflicts. - The analysis implies multiple direct and indirect drivers influence bedside nutrition decision making and that improving data availability and clarity of nutrition discussion could help address variation in nutrition delivery and growth outcomes for preterm infants.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Food for thought: a mixed methods analysis of nutrition decision making during bedside rounds in the neonatal intensive care unit [Gustave H Falciglia](https://pubmed.ncbi.nlm.nih.gov/?term=Falciglia+GH&cauthor_id=42768100)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#full-view-affiliation-1 "Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. gustave-falciglia@northwestern.edu.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#full-view-affiliation-2 "Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. gustave-falciglia@northwestern.edu."), [Irem Sengul Orgut](https://pubmed.ncbi.nlm.nih.gov/?term=Sengul+Orgut+I&cauthor_id=42768100)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#full-view-affiliation-3 "Department of Information Systems and Supply Chain Management, Quinlan School of Business, Loyola University Chicago, Chicago, IL, USA."), [Karna Murthy](https://pubmed.ncbi.nlm.nih.gov/?term=Murthy+K&cauthor_id=42768100)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#full-view-affiliation-4 "Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#full-view-affiliation-5 "Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#full-view-affiliation-6 "Children's Hospital Neonatal Consortium, Dover, DE, USA."), [Karen Smilowitz](https://pubmed.ncbi.nlm.nih.gov/?term=Smilowitz+K&cauthor_id=42768100)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#full-view-affiliation-7 "Department of Industrial Engineering and Management Sciences, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#full-view-affiliation-8 "Department of Operations, Kellogg School of Management, Northwestern University, Evanston, IL, USA."), [Daniel T Robinson](https://pubmed.ncbi.nlm.nih.gov/?term=Robinson+DT&cauthor_id=42768100)[#](https://pubmed.ncbi.nlm.nih.gov/42768100/#full-view-equal-contrib-explanation "Contributed equally")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#full-view-affiliation-4 "Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#full-view-affiliation-5 "Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA."), [Julie K Johnson](https://pubmed.ncbi.nlm.nih.gov/?term=Johnson+JK&cauthor_id=42768100)[#](https://pubmed.ncbi.nlm.nih.gov/42768100/#full-view-equal-contrib-explanation "Contributed equally")[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#full-view-affiliation-9 "Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.") Affiliations Expand ### Affiliations * 1 Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. gustave-falciglia@northwestern.edu. * 2 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. gustave-falciglia@northwestern.edu. * 3 Department of Information Systems and Supply Chain Management, Quinlan School of Business, Loyola University Chicago, Chicago, IL, USA. * 4 Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. * 5 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. * 6 Children's Hospital Neonatal Consortium, Dover, DE, USA. * 7 Department of Industrial Engineering and Management Sciences, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA. * 8 Department of Operations, Kellogg School of Management, Northwestern University, Evanston, IL, USA. * 9 Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. # Contributed equally. * PMID: **42768100** * DOI: [ 10.1038/s41390-026-05502-6 ](https://doi.org/10.1038/s41390-026-05502-6) Item in Clipboard # Food for thought: a mixed methods analysis of nutrition decision making during bedside rounds in the neonatal intensive care unit Gustave H Falciglia et al. Pediatr Res. 2026. Show details Display options Display options Format Abstract PubMed PMID Pediatr Res Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Pediatr+Res%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Pediatr+Res%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42768100/) . 2026 Sep 22. doi: 10.1038/s41390-026-05502-6. Online ahead of print. ### Authors [Gustave H Falciglia](https://pubmed.ncbi.nlm.nih.gov/?term=Falciglia+GH&cauthor_id=42768100)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#short-view-affiliation-1 "Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. gustave-falciglia@northwestern.edu.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#short-view-affiliation-2 "Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. gustave-falciglia@northwestern.edu."), [Irem Sengul Orgut](https://pubmed.ncbi.nlm.nih.gov/?term=Sengul+Orgut+I&cauthor_id=42768100)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#short-view-affiliation-3 "Department of Information Systems and Supply Chain Management, Quinlan School of Business, Loyola University Chicago, Chicago, IL, USA."), [Karna Murthy](https://pubmed.ncbi.nlm.nih.gov/?term=Murthy+K&cauthor_id=42768100)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#short-view-affiliation-4 "Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#short-view-affiliation-5 "Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#short-view-affiliation-6 "Children's Hospital Neonatal Consortium, Dover, DE, USA."), [Karen Smilowitz](https://pubmed.ncbi.nlm.nih.gov/?term=Smilowitz+K&cauthor_id=42768100)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#short-view-affiliation-7 "Department of Industrial Engineering and Management Sciences, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#short-view-affiliation-8 "Department of Operations, Kellogg School of Management, Northwestern University, Evanston, IL, USA."), [Daniel T Robinson](https://pubmed.ncbi.nlm.nih.gov/?term=Robinson+DT&cauthor_id=42768100)[#](https://pubmed.ncbi.nlm.nih.gov/42768100/#short-view-equal-contrib-explanation "Contributed equally")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#short-view-affiliation-4 "Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#short-view-affiliation-5 "Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA."), [Julie K Johnson](https://pubmed.ncbi.nlm.nih.gov/?term=Johnson+JK&cauthor_id=42768100)[#](https://pubmed.ncbi.nlm.nih.gov/42768100/#short-view-equal-contrib-explanation "Contributed equally")[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42768100/#short-view-affiliation-9 "Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.") ### Affiliations * 1 Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. gustave-falciglia@northwestern.edu. * 2 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. gustave-falciglia@northwestern.edu. * 3 Department of Information Systems and Supply Chain Management, Quinlan School of Business, Loyola University Chicago, Chicago, IL, USA. * 4 Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. * 5 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. * 6 Children's Hospital Neonatal Consortium, Dover, DE, USA. * 7 Department of Industrial Engineering and Management Sciences, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA. * 8 Department of Operations, Kellogg School of Management, Northwestern University, Evanston, IL, USA. * 9 Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. # Contributed equally. * PMID: **42768100** * DOI: [ 10.1038/s41390-026-05502-6 ](https://doi.org/10.1038/s41390-026-05502-6) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Variation in nutrition delivery contributes to poor growth in preterm infants in the neonatal intensive care unit (NICU); however, few studies have examined how clinicians develop nutrition plans. The aim of this research is to describe the nutrition decision-making process during rounds for preterm infants in the NICU. **Methods:** We conducted a convergent parallel mixed methods study of bedside rounds on preterm infants at two NICUs. Qualitative data were collected by observing rounds which were recorded, transcribed, and analyzed thematically. Quantitative data were abstracted from the medical record. Data were merged to analyze characteristics of discussion of infant nutrition. **Results:** Four nutrition-specific themes characterized discussion during rounds for preterm infants: 1) nutrition is important but fluid is prioritized, and discussion of nutrition occurs in the language of fluid; 2) discussions reflect uncertainty and lack specificity; 3) fluid allowance, feeding tolerance, growth and metabolism are primary drivers of nutrition plans; and 4) distinguishing whether measured weights indicate growth versus fluid retention or measurement error is challenging. **Conclusion:** Multiple direct and indirect drivers influence nutrition decisions. Clinicians answer questions about nutrition by discussing fluid. This may lead to suboptimal solutions during the transition phase of nutrition and periods of fluid restriction. **Impact:** In the neonatal intensive care unit, nutrition-specific concerns of fluid allowance, feeding intolerance, growth and metabolism are drivers of the nutrition decision-making process for infants and involve several tradeoffs. Rather than discussing "how much nutrition the baby received," clinicians commonly used a heuristic to more easily approximate energy or protein intake by discussing "how much fluid the baby received." Distinguishing actual growth from measurement error and fluid retention is challenging. Clinicians lack easily accessible data to accurately assess what nutrition the infant received and how the infant grew in response. © 2026. The Author(s). [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Competing interests: Gustave H. Falciglia has received a Small Business Technology Transfer grant (STTR) with Medical Predictive Science Corporation (MPSC) from the National Institutes of Health to study nutrition and growth. He does not have a financial relationship with MPSC outside the grant. Karna Murthy is a board member and Chair of the CHNC, 501(c)(3) non-profit organization. Daniel Robinson currently receives grant support from Abbott and served as a speaker for Baxter (relationship ended). None of the remaining authors have any financial conflicts of interest or disclosures. Consent: Prior to each observation, we provided each clinician participating on rounds with an information sheet approved by the Lurie Children’s Hospital Institutional Review Board describing the study. Each clinician individually and independently provided verbal consent to being observed and audio recorded during rounds. Parental consent was not required. ## References 1. 1. Ehrenkranz, R. A. et al. Early nutrition mediates the influence of severity of illness on extremely LBW infants. Pediatr. Res. 69, 522–529 (2011). - [DOI](https://doi.org/10.1203/pdr.0b013e318217f4f1) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/21378596/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/3090495/) 2. 1. Sjöström, E. S. et al. Nutrient intakes independently affect growth in extremely preterm infants: results from a population-based study. Acta Paediatr. 102, 1067–1074 (2013). 3. 1. deRegnier, R. A., Guilbert, T. W., Mills, M. M. & Georgieff, M. K. Growth failure and altered body composition are established by one month of age in infants with bronchopulmonary dysplasia. J. Nutr. 126, 168–175 (1996). - [DOI](https://doi.org/10.1093/jn/126.1.168) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/8558298/) 4. 1. Horbar, J. D. et al. Weight growth velocity and postnatal growth failure in infants 501 to 1500 grams: 2000-2013. Pediatrics 136, e84–e92 (2015). - [DOI](https://doi.org/10.1542/peds.2015-0129) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/26101360/) 5. 1. Sjöström, E. S. et al. Low energy intake during the first 4 weeks of life increases the risk for severe retinopathy of prematurity in extremely preterm infants. Arch. Dis. Child. Fetal Neonatal Ed. 101, F108–F113 (2016). - [DOI](https://doi.org/10.1136/archdischild-2014-306816) Show all 55 references [x] Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM **Send To** * [Clipboard](https://pubmed.ncbi.nlm.nih.gov/42768100/) * [Email](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42768100%2F%23open-email-panel) * [Save](https://pubmed.ncbi.nlm.nih.gov/42768100/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42768100%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42768100%2F%23open-collections-panel) * [Citation Manager](https://pubmed.ncbi.nlm.nih.gov/42768100/) [x] NCBI Literature Resources [MeSH](https://www.ncbi.nlm.nih.gov/mesh/) [PMC](https://www.ncbi.nlm.nih.gov/
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