Quality Initiative Reduces Necrotizing Enterocolitis by 83 Percent
Published April 20, 2018 | Journal of Perinatology
A standardized feeding protocol for very low birth weight (VLBW) infants that increased use of human milk, maximized intestinal perfusion, and promoted a healthy microbiome, led to dramatic reductions in necrotizing enterocolitis (NEC) cases at three neonatal intensive care units (NICUs) in Ohio.
The study, led by Amy Nathan, MD, and Heather Kaplan, MD, MSCE, reports that a five-year effort to reduce NEC in VLBW infants resulted in a decrease from 0.17 cases per 100 patient days to 0.029, an 83 percent reduction in incidence.
NEC is a devastating disease that damages intestinal mucosa, primarily in premature infants. In cases requiring surgery (35 percent of all cases), mortality exceeds 50 percent.
After reviewing local data, investigators learned that regional NEC rates exceeded national averages. Theorizing that the higher rates reflected inconsistent practices, they recruited three NICUs to participate in a quality improvement process from 2010 to 2015.
A multidisciplinary team conducted failure mode and effects analyses, and refined key drivers to prioritize interventions. Each NEC case received a root cause analysis.
Key improvements included extending the use of donor milk from two to four weeks; creating a decision tree to reduce antibiotic use; and dropping other unnecessary practices.
Overall, 49 NEC cases were avoided, both saving lives and eliminating $5.7 million in care costs.
“A major strength of this project is generalizability, as three different NICUs participated, each with a unique patient population and local context/microsystem,” the co-authors say. “The interventions applied are practical and transferrable to other groups, and with the exception of a donor milk program, are not costly to the hospital. We believe that all components of our bundle of care are important in reducing NEC.”
