Quality improvement interventions to prevent neonatal necrotizing enterocolitis: a systematic review

Area of Science:

• Neonatal Medicine
• Pediatric Surgery
• Public Health

Background:

• Necrotizing enterocolitis (NEC) is a primary cause of mortality from gastrointestinal disease in preterm neonates.
• Quality improvement bundles aim to reduce NEC incidence in preterm infants, but results in neonatal intensive care units are inconsistent.

Purpose of the Study:

• To evaluate quality improvement interventions (QIIs) designed to prevent or reduce the severity of NEC in preterm infants.
• To identify effective strategies for reducing NEC incidence and severity.

Main Methods:

• A systematic review of multiple databases (PubMed, Embase, Cochrane Library, Web of Science, Wanfang, CNKI, VIP, CBM) and citation searching.
• Inclusion of 13 quality improvement interventions involving 17,961 preterm infants.
• Data extraction by paired reviewers, focusing on NEC incidence and severity reduction.

Main Results:

• Most QIIs incorporated breastfeeding improvement strategies.
• 16 out of 19 interventions demonstrated a significant reduction in NEC incidence post-implementation.
• Interventions were generally of medium to high quality, though study heterogeneity was noted.

Conclusions:

• QIIs can reduce NEC incidence and severity in preterm infants, but effectiveness varies by setting.
• The specific mechanisms and reasons for differential success of QIIs remain unclear.
• This review aids teams in identifying potentially superior practices for NEC reduction.