Implementation of a probiotic protocol to reduce rates of necrotizing enterocolitis



To utilize a probiotic protocol to achieve a 50% reduction in rates of necrotizing enterocolitis (NEC) ≥ Bell Stage 2 within 2 years of protocol implementation.

Study design

Literature review guided probiotic selection and protocol design. A driver diagram identified key drivers to achieve our aim. A U chart followed monthly NEC ≥ Bell Stage 2 per 100 patient days and per monthly admissions. The process measure was protocol compliance and the balancing measure was probiotic sepsis.


NEC ≥ Bell Stage 2 decreased from 0.14 to 0.04 per 100 patient days in infants < 33 weeks gestation or <1500 g, or a yearly rate of 7–2%. Protocol compliance was 98% and there were no cases of probiotic sepsis.


Implementation of a probiotic protocol was associated with a decrease in rates of NEC.

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Author contributions

MKS was involved in probiotic protocol implementation, compliance tracking, data collection and analysis, and manuscript preparation. PHG assisted in data analysis and manuscript revision. MN was involved in data extraction from the EMR. BAY developed the probiotic protocol, monitored compliance, and reviewed the manuscript.

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Correspondence to Mehtab K. Sekhon.

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