Prevention of Necrotizing Enterocolitis (NEC) in Very Preterm Infants: NEC-Free NICU project
Friday, February 14, 2020
1:45 PM – 2:00 PM
Location: Max Bell - MB251
Introduction: Preterm infants with NEC had an estimated mortality rate of 15-30% and an average of 22-60 additional hospital days. Efforts to reduce the incidence of NEC are directed at reducing exposure to risk factors and promoting interventions that protect the gut. Our previous QI initiative to provide exclusive mother’s own milk (MOM) to preterm infants less than 33 weeks resulted in a reduction in NEC incidence from 8.9 % before 2010 to 4.7% in 2010-2015. The objective of the NEC-Free NICU project was to further reduce the incidence of NEC to <2%.
Methods: A quality improvement (QI) initiative using the Plan-Do-Study-Act (PDSA) methodology in 2 level III and 3 level II NICUs in Calgary. We established a multidisciplinary QI team that included medical and nursing staff, clinical pharmacists, lactation consultants and dietitians. The group reviewed evidenced-based research and clinical practices that support putative NEC prevention strategies. We established a strategic aim, key driver interventions, and designed changes as outlined in Figure 1.
Results: A total of 456 preterm infants born less than 33 weeks gestation in the sustain (Jan 01, 2017 to Dec 31, 2018) period compared to 741 born in the baseline period (Jan 01, 2013 to Oct 16, 2016). The specific best practices utilized by the clinical team included the promotion of early use of expressed MOM and strategies to prevent intestinal dysbiosis. The time of first expressed MOM feed decreased after the introduction of antenatal lactation consult from 20.4±9.1 to 13.7±8.7 hours; p-value <0.01. Incidence of NEC was significantly lower in the sustain period (1.3 vs. 4.6%; p=0.002 and adjusted OR=0.03; 95%CI: 0.16-0.55). We observed a trend towards lower incidence of surgical NEC.
Conclusion: QI initiatives utilizing an early use of MOM milk and strategies to prevent intestinal dysbiosis were associated with a significant reduction in the incidence of NEC.