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Grading the evidence to identify strategies to modify risk for necrotizing enterocolitis
Sheila M Gephart1, Mark A Underwood2, Simone Rosito3
1College of Nursing, University of Arizona, Tucson, AZ, USA. gepharts@email.arizona.edu.
Insights
This study focuses on managing modifiable risks for necrotizing enterocolitis (NEC) in premature infants, offering clinical actions and quality improvement targets. It emphasizes engaging parents to recognize and reduce NEC risk through evidence-based strategies.
Area of Science:
- Neonatal Medicine
- Clinical Pediatrics
- Evidence-Based Medicine
Background:
- Necrotizing enterocolitis (NEC) is a significant concern in premature infants.
- Risk is often attributed to nonmodifiable factors, overlooking actionable clinical interventions.
Purpose of the Study:
- To identify and summarize modifiable risk factors for NEC in premature infants.
- To present evidence-based recommendations for managing these risks.
- To provide quality improvement targets for healthcare teams and engage patient-family advocates.
Main Methods:
- Utilized the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
- Systematically reviewed evidence to balance risks and benefits of interventions.
- Considered strategies across prenatal, intrapartum, and neonatal clinical courses.
Main Results:
- Identified key modifiable risk factors amenable to clinical management.
- Provided graded recommendations based on supporting evidence.
- Outlined strategies for healthcare teams and patient-family advocates.
Conclusions:
- Clinical actions can effectively manage modifiable risks for NEC.
- Evidence-based strategies and parental engagement are crucial for NEC prevention.
- Quality improvement targets can enhance NEC risk reduction in neonatal care.
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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