An Interdisciplinary Approach to Reducing NEC While Optimizing Growth: A 20-Year Journey

Area of Science:

• Neonatal care
• Quality improvement science
• Pediatric nutrition

Background:

• Necrotizing enterocolitis (NEC) and postnatal growth restriction are major challenges in premature infant care.
• These conditions lead to significant short- and long-term morbidities.

Purpose of the Study:

• To address rising necrotizing enterocolitis (NEC) rates in a neonatal intensive care unit (NICU).
• To concurrently improve NEC rates and postnatal growth outcomes in premature infants.

Main Methods:

• Implemented interdisciplinary quality improvement (QI) initiatives over two decades.
• Utilized a standardized tool for NEC case review and continuous outcome tracking.
• Focused QI efforts initially on nutrition and growth, later addressing NEC and growth concurrently.

Main Results:

• Achieved a significant reduction in NEC rates from 16.2% to 0% for inborn infants between 2007 and 2018.
• An exclusive human milk diet was identified as crucial for NEC reduction.
• Jointly addressing NEC and nutrition improved growth outcomes without negatively impacting NEC rates.

Conclusions:

• Historical data and evolving scientific understanding can guide local QI efforts in neonatal care.
• Continued efforts are needed to optimize lactation support in the NICU.
• Further research is required on the impact of care practices (medication osmolality, probiotics, respiratory support) on gastrointestinal inflammation.