A Quality Improvement Initiative to Reduce Necrotizing Enterocolitis in Very Preterm Infants

Area of Science:

• Neonatalogy
• Pediatric Surgery
• Quality Improvement Science

Background:

• Necrotizing enterocolitis (NEC) poses a significant threat to very preterm infants.
• Reducing NEC incidence is a critical goal in neonatal intensive care.

Purpose of the Study:

• To decrease the incidence of NEC in very preterm infants to ≤2% within two years.
• To evaluate the effectiveness of targeted quality improvement interventions.

Main Methods:

• A multidisciplinary team implemented interventions including increased mothers' own milk (MOM) and standardized feeding protocols.
• Key strategies involved managing feeding intolerance, preventing microbial aberrations, and conservative feeding during transfusions/patent ductus arteriosus treatment.
• NEC rates (≥ stage 2) were monitored alongside process and balancing measures from January 2013 to December 2021.

Main Results:

• NEC incidence decreased from 5.6% to 1.9% among 2787 infants born at ≤326/7 weeks' gestation.
• Process measures showed increased MOM feeding, better feeding regimen compliance, higher hemoglobin levels, and reduced antibiotic duration.
• Balancing measures indicated improved weight Z-scores, shorter parenteral nutrition duration, and increased blood transfusion rates.

Conclusions:

• Quality improvement initiatives targeting maternal milk, feeding regimens, and conservative care strategies are effective in reducing NEC.
• These interventions are associated with improved clinical outcomes in very preterm infants.