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Reducing necrotizing enterocolitis in very low birth weight infants using quality-improvement methods.

Patel AL, Trivedi S, Bhandari NP, Ruf A, Scala CM, Witowitch G, Chen Y, Renschen C, Meier PP, Silvestri JM - J Perinatol (2014)

Bottom Line: The infants were divided into three groups: baseline (January 2008 to Novovember 2009, n219), QI phase 1 (December 2009 to May 2010, n62) and QI phase 2 (June 2010 to November 2011, n170).Multivariable logistic regression analysis demonstrated a significant relationship between QI phase and the incidence of NEC.QI initiatives were effective in decreasing NEC incidence in our high human milk-feeding NICU.

View Article: PubMed Central - PubMed

Affiliation: Section of Neonatology, Rush University Medical Center, Chicago, IL, USA.

ABSTRACT

Objective: Owing to a rise in necrotizing enterocolitis (NEC, stage ⩾ 2) among very low birth weight (VLBW, birth weight <1500 g) infants from 4% in 2005 to 2006 to 10% in 2007 to 2008, we developed and implemented quality improvement (QI) initiatives. The objective was to evaluate the impact of QI initiatives on NEC incidence in VLBW infants.

Study design: In September 2009, we developed an NEC QI multidisciplinary team that conducted literature reviews and reviewed practices from other institutions to develop a feeding protocol, which was implemented in December 2009. The team tracked intervention compliance and occurrence of NEC stage ⩾ 2. In May 2010, we reviewed our nasogastric tube practice and relevant literature to develop a second intervention that reduced nasogastric tube indwelling time. The infants were divided into three groups: baseline (January 2008 to Novovember 2009, n219), QI phase 1 (December 2009 to May 2010, n62) and QI phase 2 (June 2010 to November 2011, n170).

Result: The NEC incidence did not decrease after implementation of the feeding protocol in QI phase 1 (19.4%) but did decline significantly after changing nasogastric tube management in QI phase 2 (2.9%). Multivariable logistic regression analysis demonstrated a significant relationship between QI phase and the incidence of NEC.

Conclusion: QI initiatives were effective in decreasing NEC incidence in our high human milk-feeding NICU. Nasogastric tube bacterial contamination may have contributed to our peak in NEC incidence.

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Related in: MedlinePlus

Initial (version 1) and Final feeding protocols (version 8) used for feeding advancement in VLBW infants
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Figure 1: Initial (version 1) and Final feeding protocols (version 8) used for feeding advancement in VLBW infants

Mentions: Parental education about hygienic handling and cleaning of breast pumps was expanded to include a demonstration and provision of dishwashing soap and a basin for each mother. These changes were accompanied by a revision in the feeding protocol to emphasize feeding initiation with colostrum by DOL 2 due to concerns of gut atrophy and increased permeability with prolonged NPO status.57,58 Rapid in-services were conducted for NICU nurses during May 2010 to institute the practice changes of 1) reducing NG tube indwelling time to a maximum of 7 days, identifying “Tube Tuesdays” as the weekly time to replace NG tubes, and 2) changing the extension tubing between each feeding. The NG tube handling changes, parental education reinforcement and increased emphasis on earlier feedings of colostrum were implemented by early June 2010. We continued to revise the feeding protocol (Figure 1) in order to achieve full enteral feedings sooner, thus decreasing the durations of TPN and central catheter use. Through increased dietician participation in daily rounds we aggressively adjusted feeding volumes to maintain growth targets.


Reducing necrotizing enterocolitis in very low birth weight infants using quality-improvement methods.

Patel AL, Trivedi S, Bhandari NP, Ruf A, Scala CM, Witowitch G, Chen Y, Renschen C, Meier PP, Silvestri JM - J Perinatol (2014)

Initial (version 1) and Final feeding protocols (version 8) used for feeding advancement in VLBW infants
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4216600&req=5

Figure 1: Initial (version 1) and Final feeding protocols (version 8) used for feeding advancement in VLBW infants
Mentions: Parental education about hygienic handling and cleaning of breast pumps was expanded to include a demonstration and provision of dishwashing soap and a basin for each mother. These changes were accompanied by a revision in the feeding protocol to emphasize feeding initiation with colostrum by DOL 2 due to concerns of gut atrophy and increased permeability with prolonged NPO status.57,58 Rapid in-services were conducted for NICU nurses during May 2010 to institute the practice changes of 1) reducing NG tube indwelling time to a maximum of 7 days, identifying “Tube Tuesdays” as the weekly time to replace NG tubes, and 2) changing the extension tubing between each feeding. The NG tube handling changes, parental education reinforcement and increased emphasis on earlier feedings of colostrum were implemented by early June 2010. We continued to revise the feeding protocol (Figure 1) in order to achieve full enteral feedings sooner, thus decreasing the durations of TPN and central catheter use. Through increased dietician participation in daily rounds we aggressively adjusted feeding volumes to maintain growth targets.

Bottom Line: The infants were divided into three groups: baseline (January 2008 to Novovember 2009, n219), QI phase 1 (December 2009 to May 2010, n62) and QI phase 2 (June 2010 to November 2011, n170).Multivariable logistic regression analysis demonstrated a significant relationship between QI phase and the incidence of NEC.QI initiatives were effective in decreasing NEC incidence in our high human milk-feeding NICU.

View Article: PubMed Central - PubMed

Affiliation: Section of Neonatology, Rush University Medical Center, Chicago, IL, USA.

ABSTRACT

Objective: Owing to a rise in necrotizing enterocolitis (NEC, stage ⩾ 2) among very low birth weight (VLBW, birth weight <1500 g) infants from 4% in 2005 to 2006 to 10% in 2007 to 2008, we developed and implemented quality improvement (QI) initiatives. The objective was to evaluate the impact of QI initiatives on NEC incidence in VLBW infants.

Study design: In September 2009, we developed an NEC QI multidisciplinary team that conducted literature reviews and reviewed practices from other institutions to develop a feeding protocol, which was implemented in December 2009. The team tracked intervention compliance and occurrence of NEC stage ⩾ 2. In May 2010, we reviewed our nasogastric tube practice and relevant literature to develop a second intervention that reduced nasogastric tube indwelling time. The infants were divided into three groups: baseline (January 2008 to Novovember 2009, n219), QI phase 1 (December 2009 to May 2010, n62) and QI phase 2 (June 2010 to November 2011, n170).

Result: The NEC incidence did not decrease after implementation of the feeding protocol in QI phase 1 (19.4%) but did decline significantly after changing nasogastric tube management in QI phase 2 (2.9%). Multivariable logistic regression analysis demonstrated a significant relationship between QI phase and the incidence of NEC.

Conclusion: QI initiatives were effective in decreasing NEC incidence in our high human milk-feeding NICU. Nasogastric tube bacterial contamination may have contributed to our peak in NEC incidence.

Show MeSH
Related in: MedlinePlus