Management protocol for extremely/very low birth weight infants: impact of waterbed-style nesting combined with continuous breast milk feeding quality improvement on infants’ quality of life and neurobehavioral outcomes

Objective To investigate the clinical efficacy of waterbed-style nests combined with breast milk feeding quality continuous improvement on early growth and neurobehavioral outcomes in extremely/very low birth weight infants, providing theoretical support for clinical practice. Methods A retrospective study enrolled 103 extremely/very low birth weight infants admitted to our hospital from May 2024 to October 2025. Based on electronic medical records, they were divided into a control group ( n = 50, conventional management) and an observation group ( n = 53, water-bed nest combined with continuous improvement of breast milk feeding quality). Clinical outcomes during hospitalization were collected and compared: Short-term physical growth outcomes (weight gain rate, head circumference gain rate, length gain rate, time to regain birth weight, sleep duration), Neurobehavioral development Neurobehavioral Assessment of the Neonate (NABA), Serum indicators total protein (TP), albumin (ALB), prealbumin (PA), Complication occurrence (feeding intolerance, necrotizing enterocolitis, bronchopulmonary dysplasia, late-onset sepsis). Results The observation group showed significantly higher weight gain, head circumference and length growth rates, and shorter time to regain birth weight (all P 0.05). Neurobehavioral scores (primitive reflexes, muscle tone, general condition, functional capacity) and serum nutritional markers (TP, ALB, PA) were also higher post-intervention ( P 0.05). Incidences of feeding intolerance (20.75% vs. 46.00%) and bronchopulmonary dysplasia (5.66% vs. 20.00%) were significantly lower in the observation group ( P 0.05). No significant differences were found in necrotizing enterocolitis or late-onset sepsis. Conclusion The waterbed-style bird's nest combined with continuous quality improvement in breast milk feeding effectively enhances feeding and nutritional status, promotes early physical growth and neurobehavioral function, and reduces short-term complications such as feeding intolerance and bronchopulmonary dysplasia in infants. Long-term follow-up studies are warranted to determine if these early benefits translate into sustained improvements in quality of life.