Abstract
Objective: Evaluate the impact of a care bundle on the incidence of necrotizing enterocolitis (NEC) in the neonatal intensive care unit. Study Design: Retrospective, single-center, population comparison of patients diagnosed with NEC before and after implementing an NEC care bundle utilizing standardized feeding protocol, donor milk program, transfusion protocol, early antibiotic protocol, and restricted indomethacin use. Result: Incidence of NEC fell from 1.92 to 0.83% (P <0.0001). Incidence of NEC in the 23-27 weeks gestation group decreased from 14.21 to 6.09% (P = 0.0009). In the 28-30 weeks gestation group, NEC incidence decreased from 5.56 to 2.10% (P = 0.0096). Significant reduction of recurrent NEC and transfusion-associated NEC was observed. Conclusion: Implementation of an NEC care bundle reduced NEC incidence, with the greatest impact seen in the most vulnerable preterm and very preterm infants.
Highlights
Necrotizing enterocolitis (NEC) remains a devastating disease of the premature infant
In a recent review by Battersby et al, NEC occurred in 5-7% of infants born < 35 weeks gestation and in 5-22% of preterm infants with birth weight < 1000 grams.(2 )Incidence of recurrent NEC has been reported to be 6-10%.(3,4) NEC delays the establishment of full enteral nutrition, leads to poor growth, and increases the length of hospital stay with a concomitant increase in hospital costs
There was a 56.8% reduction in overall incidence of NEC in the Post-Bundle group compared to the Pre-Bundle group in our neonatal intensive care unit (NICU)
Summary
Necrotizing enterocolitis (NEC) remains a devastating disease of the premature infant. When encountered in the neonatal intensive care unit (NICU), NEC carries a mortality rate of up to 44%, with significant long-term morbidity in survivors.(1 )The incidence of NEC is highly variable and is dependent on gestational age and birth weight. In a recent review by Battersby et al, NEC occurred in 5-7% of infants born < 35 weeks gestation and in 5-22% of preterm infants with birth weight < 1000 grams.(2 )Incidence of recurrent NEC has been reported to be 6-10%.(3,4) NEC delays the establishment of full enteral nutrition, leads to poor growth, and increases the length of hospital stay with a concomitant increase in hospital costs. Providing optimal nutritional support to premature infants is vital to their survival, growth, and long-term neurodevelopmental outcomes. Various prevention strategies have been reported in attempts to limit its occurrence.[8,9,10,11,12,13,14,15,16,17] Of the prevention strategies studied, establishing a standardized feeding protocol and exclusive human milk feeds appears to have the greatest impact on decreasing the Readers can follow
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