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Reducing necrotizing enterocolitis in very low birth weight infants using quality-improvement methods

Abstract

Objective:

Owing to a rise in necrotizing enterocolitis (NEC, stage 2) among very low birth weight (VLBW, birth weight <1500 g) infants from 4% in 2005 to 2006 to 10% in 2007 to 2008, we developed and implemented quality improvement (QI) initiatives. The objective was to evaluate the impact of QI initiatives on NEC incidence in VLBW infants.

Study Design:

In September 2009, we developed an NEC QI multidisciplinary team that conducted literature reviews and reviewed practices from other institutions to develop a feeding protocol, which was implemented in December 2009. The team tracked intervention compliance and occurrence of NEC stage 2. In May 2010, we reviewed our nasogastric tube practice and relevant literature to develop a second intervention that reduced nasogastric tube indwelling time. The infants were divided into three groups: baseline (January 2008 to Novovember 2009, n219), QI phase 1 (December 2009 to May 2010, n62) and QI phase 2 (June 2010 to November 2011, n170).

Result:

The NEC incidence did not decrease after implementation of the feeding protocol in QI phase 1 (19.4%) but did decline significantly after changing nasogastric tube management in QI phase 2 (2.9%). Multivariable logistic regression analysis demonstrated a significant relationship between QI phase and the incidence of NEC.

Conclusion:

QI initiatives were effective in decreasing NEC incidence in our high human milk-feeding NICU. Nasogastric tube bacterial contamination may have contributed to our peak in NEC incidence.

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Acknowledgements

This study was partially funded by NIH Grant NR010009.

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Correspondence to A L Patel.

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Drs Patel and Meier have been funded by the NIH. The remaining authors declare no conflict of interest.

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Patel, A., Trivedi, S., Bhandari, N. et al. Reducing necrotizing enterocolitis in very low birth weight infants using quality-improvement methods. J Perinatol 34, 850–857 (2014). https://doi.org/10.1038/jp.2014.123

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