Optimal policies for nutrition administration to very low birth weight infants

Abstract

Very low birth weight (VLBW) infants (birth weight 1500 grams) are at risk of postnatal growth restriction. Understanding how nutrition is associated with growth and how these associations vary based on infant characteristics and comorbidities is important to reduce postnatal growth restriction. We propose a three‐step analytical framework: (i) We use unsupervised Clustering techniques to identify subgroups within a cohort of VLBW infants based on infant characteristics, diagnoses, and treatments. (ii) For each cluster, we use Multilevel Modeling to explore the associations between calorie or protein intake and growth velocity (GV) for varying time windows. (iii) We build Mixed‐Integer Programming Models to achieve simple rule‐based policies that physicians can use to classify infants into one of the identified subgroups. We use electronic health records from VLBW infants at Lurie Children's Hospital in Chicago, IL, born between 2011 and 2014. We find that clustering separates infants into two clusters, with Cluster 1 having smaller infants with more comorbidities than Cluster 2. Initial clustering on only sex and birth weight provides results similar to clustering on later‐life diagnoses and treatments. Multilevel models with Clustering provide better model fit than models without clustering. For Cluster 1, there is a significant association between GV and protein but not calories. For Cluster 2, both protein and calories are individually associated with growth. We develop accurate and sparse scoring systems to help clinicians identify infants at higher risk of growth restriction and consider nutrition regimens accordingly.