In Northwest Argentina, a large maternity hospital provides services for the majority of the inhabitants of one of the poorest and most densely populated provinces. It was noted in a chart review that only 6.3% of the infants born at 27-37 weeks gestation met the 10^th percentile for intrauterine growth at 28 days of life.  Observations of feeding of NICU residents demonstrated a lack of feeding consistency. This data led to the exploration of possible interventions to improve weight gain and nutritional status of the preterm neonates. Due to the suboptimal resources of the facility, it was necessary that any intervention have high efficacy with minimal cost.

Evidence regarding feeding interventions for preterm neonates was reviewed by a team of Argentine and US nurses and neonatologists. Early feedings supplemented with total parenteral nutrition, decreasing NPO days, fortification of breast milk, and greater volume were all considered. After considering the evidence, the team adopted an existing guideline that had been developed in Utah by Intermountain Healthcare and adapted it to local conditions.

Implementation required patience as the team worked across language and culture. However, the language of evidence and best practices aided all team members to find agreement and solve differences.

In comparison to data from pre-implementation chart review, outcomes were evaluated using real-time data collection of infants enrolled in the guideline trial. Successful implementation led to statistically significant improvement in several variables of interest. There was a significant improvement in weight gain, with a decrease in number of days NPO, deaths, and necrotizing enterocolitis.