104 - Multiple interventions as part of Necrotizing Enterocolitis Quality Improvement Effort

Necrotizing Enterocolitis (NEC), characterized by ischemic necrosis of the intestinal mucosa, is a potentially devastating disease in preterm infants. Most cases of NEC occur in infants < 32 weeks gestation and/or 1500 grams at birth. The incidence of NEC increases as both gestational age and birth weight decrease. NEC has a substantial mortality rate (20-30%) and associated morbidity rate for survivors despite earlier intervention and aggressive treatment (such as surgery when indicated). Multiple studies have been conducted to find methods of earlier detection and prevention of NEC.

Objective: To perform a quality improvement initiative to decrease the incidence of NEC in low birth weight (LBW) infants (infants born < 2500 grams), and reduce the mortality and morbidity rate associated with the disease.

Design/Methods:

Seven interventions, each a separate PDSA cycle, were implemented in an inner city tertiary hospital level IIIB NICU between 1st quarter 2018 and 4th quarter 2020 aimed to reduce the rate of medical and surgical NEC. The interventions were Feeding Protocol #1 and #2, Infant-Driven Feeding Protocol, NEC Order Set, GutCheck score, SMOF Lipids, Probiotics, Vitamin Guidelines, and introduction of Pasteurized Donor Human Milk (PDHM). A Chart review of pre- and post-intervention data from January 2016- December 2021 was then conducted. The number and rate of NEC, surgical NEC cases, and mortality due to NEC in LBW infants were documented each quarter. These rates were then compared for statistical significance at each of the seven time frames based on implemented interventions.

Results:

From January 2016 - December 2021 51 charts of neonates with NEC were reviewed. Overall, there was no change in the rate of NEC in LBW patients (p=0.62), surgical NEC (p=0.83), or rate of mortality due to NEC (p=0.61). A Kruskall Wallis analysis with post hoc testing was done by comparing the rate of NEC by LBW patients between each timeframe. The mean rate of NEC-related parameters for many of the variables decreased as interventions such as infant-driven feeding and feeding protocol were implemented, without reaching statistical significance.

Conclusion(s):

Although, there was no statistically significant change in the incidence of NEC in our NICU after specific interventions, the overall mean decreased, indicating potential clinical significance.