Grading the evidence to identify strategies to modify risk for necrotizing enterocolitis

Abstract

Although risk for necrotizing enterocolitis (NEC) is often presented from the perspective of a premature infant’s vulnerability to nonmodifiable risk factors, in this paper we describe the evidence and present recommendations to manage modifiable risks that are amenable to clinical actions. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, we present recommendations in the context of their supporting evidence in a way that balances risks (e.g. potential harm, cost) and benefits. Across the prenatal, intrapartum, early and late clinical course, strategies to limit NEC risk in premature infants are presented. Our goal is to summarize modifiable NEC risk factors, grade the evidence to offer quality improvement (QI) targets for healthcare teams and offer a patient-family advocate’s perspective on how to engage parents to recognize and reduce NEC risk.

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Acknowledgements

Publication of this article was sponsored by the Necrotizing Enterocolitis (NEC) Society, Patient-Centered Outcomes Research Institute, and National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development. S.M.G. received training support from the Agency for Healthcare Research and Quality (K08HS022908). Content is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ.

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Correspondence to Sheila M. Gephart.

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S.M.G. has received lecture fees from Prolacta Bioscience and Mead Johnson. M.A.U. has received grant support from Evolve Bioscience, honoraria and travel support from Abbott and is on the scientific advisory board for Avexegen. J.H.K. received grant support from Mallinckrodt and Fresenius-Kabi, received consultant or advisor fees from Evolve Bioscience, Medela, Alcresta, Ferring, received lecture fees from Mead Johnson Nutrition, Abbott Nutrition, owns shares in Pediasolutions, Nicolette and Astarte Medical, served as expert witness, and holds a patent for a newborn heart rate device. M.S.C. has received consulting fees or advisor fees from Sigma Tau Pharmaceuticals and lecture fees from Mead Johnson Nutrition. S.R. declares no competing financial interests.

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Gephart, S.M., Underwood, M.A., Rosito, S. et al. Grading the evidence to identify strategies to modify risk for necrotizing enterocolitis. Pediatr Res 88, 41–47 (2020). https://doi.org/10.1038/s41390-020-1079-z

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