6 Things About Being A Registered Dietitian For The NICU & Pediatrics

Insights from Connecticut Children’s Registered Dietitians: Enhancing NICU and Pediatric Nutrition

In recognition of Nutrition Awareness Month, I had the pleasure of interviewing two Registered Dietitians at Connecticut Children’s about their clinical nutrition program in the Milk Room, NICU, and Pediatrics floors. Thank you to Jennifer Zarrilli, MS, RD, CD-N, and AnnMarie Spizzoucco, RD, CD-N, for the insightful and candid interview!

1. What do you wish providers and staff knew about what you do?

JZ: The work of a dietitian goes beyond healthy eating. We are deeply involved with the medical team, making suggestions for medical nutrition therapy to treat chronic diseases. Some diseases have specific nutrition therapy as the treatment. We also prescribe parenteral nutrition and tube feedings that keep children alive. Many people don’t realize that, as nutritionists, we do these things alongside promoting health throughout a child's life to ensure proper growth and development, as well as disease management.

AS: As NICU dietitians, we play an integral role in the interdisciplinary team. We round with the teams daily and provide nutrition recommendations. We assess patient growth, which significantly impacts neurodevelopmental outcomes. We work closely with nurses and lactation consultants to assess when patients are ready to start oral feedings and develop the best plan. We’re involved in developing a discharge plan and following some of our patients in the NICU follow-up clinic.

2. Now that you’ve had a milk room for over a year, what advice do you have for other hospitals looking to implement one?

AS: I am very excited about the milk room. As a NICU dietitian for over 15 years, this has been a goal since I started. We know it increases our safety standards. It is crucial to verify you are feeding the right milk to the right baby and preparing the milk with aseptic techniques. I love the barcode scanning system. We give labels to moms to scan the milk at home, and when they bring milk back, we verify and validate using the correct milk for the correct baby. We also scan our fortifiers to ensure we are not adding an incorrect fortifier. This is vital for babies with allergies or intolerances to prevent any adverse reactions.

JZ: Having our own room has helped us reduce waste, especially using the Keriton systems. We can see how many near misses of feeding expired milk or formula there were. The scanning system prevents expired or wrong feeds. We have great communication with our nurses and milk techs. The nursing team appreciates the work the milk techs do. We can provide fortification for smaller volumes, meeting the needs of the sickest infants.

3. What metrics do you use to measure the success of your nutrition program?

JZ: Every month, we review our budget and expenses, the number of patients seen outpatient, inpatient assessments, and if we screen every patient within 24 hours. We look at near misses, allergy misses, high priority recommendations, chart audits, and patient satisfaction surveys.

AS: We focus on first feed and decreasing feeding time to less than 12 hours, seeing success so far. I use Klassify to track moms pumping and help those facing challenges. We conduct safety reviews for expired milk to educate staff on managing volumes during preparation.

4. What have been some of the successes of the formula room?

JZ: Keriton was a huge success for the formula room. We wanted two-person verification for the correct formula for the correct patient. Space is a limitation, but the barcoding system was a success. We are open later into the evening, ensuring patients admitted late get the formula they need. Dietitians are more engaged in ensuring orders are correct and building relationships with techs.

5. What are some of the biggest challenges facing NICU nutrition management?

AS: Our biggest challenge is tolerance. I promote moms' milk and donor human milk, as babies tolerate it better. We can advance and fortify feedings to ensure optimal growth. The biggest opportunity is basing fortifications on analyzed breastmilk.

6. What are some of the biggest challenges facing pediatric nutrition management?

JZ: We are fighting for Medicaid coverage for outpatient visits. Nutrition is not covered in Connecticut by Medicaid services. We are working on legislation to get that passed. Without it, children on Medicaid services lack access, putting them at a disadvantage. There could be better access to dietitians, whether in schools or hospital-based clinics.

Bios

Jennifer Zarrilli, MS, RD, CD-N, is the Clinical Nutrition Manager at Connecticut Children’s. She graduated with a BS in nutrition from the University of Connecticut in 2008 and an MS in nutrition from the University of Saint Joseph in 2019. She has been a pediatric dietitian for about 13 years, entirely at Connecticut Children’s.

AnnMarie Spizzoucco, RD, CD-N, is a Registered Dietitian with 15 years of experience in a Level IV NICU at Connecticut Children’s Medical Center. She supports the Milk Room by developing policies, competencies, and workflows related to breastmilk and formula preparation, distribution, and storage. AnnMarie serves on multiple multidisciplinary teams involving NICU Research, Lactation, and Nutrition Support.

Planning a milk or formula room? Contact us.