Quality Improvement Efforts Reduce Incidence of Surgical Necrotizing Enterocolitis and Related Deaths

Abstract

Objective The aim of this study was to determine whether a regional quality improvement (QI) initiative decreased incidence and severity of surgical necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants.

Study Design A retrospective review of all VLBW infants who received care at one of the three hospitals involved in a NEC QI initiative from 2011 to 2016. Primary outcome was the number of surgical NEC cases per year. Secondary outcomes included associated outcomes and mortality.

Results Sixty-three infants with either a diagnosis of Stage III NEC (n = 40) or spontaneous intestinal perforation (SIP) (n = 23) were included. The incidence of medical and surgical NEC and the mortality rate of infants with surgical NEC decreased over time. Incidence and mortality of SIP did not significantly change.

Conclusion A regional QI bundle to reduce the overall incidence of NEC also significantly decreased the incidence of surgical NEC and all-cause mortality of infants diagnosed with surgical NEC.

Key Points

• QI reduces surgical necrotizing enterocolitis.

• Reduction in NEC rate improves mortality.

• Human milk does not change SIP incidence.

Keywords

necrotizing enterocolitis - prematurity - quality improvement - very low birth weight

Authors' Contributions

G.G. conceptualized and designed the study, designed the data collection instruments, collected data, performed the initial analyses, was the drafter of the initial paper, and reviewed and revised the paper. K.M. conceptualized and designed the study, designed the data collection instruments, collected data, performed the initial analyses, and reviewed and revised the paper. A.P. collected data and reviewed and revised the paper. T.J. performed the final statistical analyses and reviewed and revised the paper. J.W. and A.N. were involved in the care of the infants described in this study and were involved in reviewing and revising the submitted paper. M.H. and B.P. conceptualized and designed the study and were involved in reviewing and revising the submitted article. All authors approved the final article as submitted and agreed to be accountable for all aspects of the work.

Publikationsverlauf

Eingereicht: 26. März 2020

Angenommen: 30. April 2020

Artikel online veröffentlicht:
08. Juni 2020

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