A quality improvement initiative to reduce necrotizing enterocolitis in high-risk neonates

Stephanie C. Mavis; Maria C. Gallup; Mikael Meyer; Megan M. Misgen; Laura A. Schram; Danielle L. Herzog; Brandi N. Smith; Virginia S. Schuning; Raymond C. Stetson; Jennifer L. Fang

doi:10.1038/s41372-022-01476-5

A quality improvement initiative to reduce necrotizing enterocolitis in high-risk neonates

Stephanie C. Mavis, Maria C. Gallup, Mikael Meyer, Megan M. Misgen, Laura A. Schram, Danielle L. Herzog, Brandi N. Smith, Virginia S. Schuning, Raymond C. Stetson, Jennifer L. Fang

Pediatric and Adolescent Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: Prompted by an acute increase in necrotizing enterocolitis (NEC) rates, we aimed to decrease the rate of stage 2 or greater NEC in infants born at <1500 grams or <30 weeks gestational age from 19.5% to less than 9.7% (a 50% reduction) within 18 months, without adversely affecting central line-associated bloodstream infection (CLABSI) rates. Study design: We utilized Define, Measure, Analyze, Improve, and Control (DMAIC) as our improvement model. Informed by our key driver diagram and root cause analyses, six Plan-Do-Study-Act cycles were completed. Results: 147 infants in the QI initiative had a median gestational age of 28.1 weeks and a median birthweight of 1070 grams. NEC rates decreased from the QI baseline of 19.5% to 6% (p = 0.03). Oral care administration increased, and maximal gavage tube dwell time decreased. Conclusion: NEC rates decreased during this QI initiative through a combination of multidisciplinary interventions aimed at reducing dysbiosis.

Original language	English (US)
Pages (from-to)	97-102
Number of pages	6
Journal	Journal of Perinatology
Volume	43
Issue number	1
DOIs	https://doi.org/10.1038/s41372-022-01476-5
State	Published - Jan 2023

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Obstetrics and Gynecology

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10.1038/s41372-022-01476-5

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title = "A quality improvement initiative to reduce necrotizing enterocolitis in high-risk neonates",

abstract = "Objective: Prompted by an acute increase in necrotizing enterocolitis (NEC) rates, we aimed to decrease the rate of stage 2 or greater NEC in infants born at <1500 grams or <30 weeks gestational age from 19.5% to less than 9.7% (a 50% reduction) within 18 months, without adversely affecting central line-associated bloodstream infection (CLABSI) rates. Study design: We utilized Define, Measure, Analyze, Improve, and Control (DMAIC) as our improvement model. Informed by our key driver diagram and root cause analyses, six Plan-Do-Study-Act cycles were completed. Results: 147 infants in the QI initiative had a median gestational age of 28.1 weeks and a median birthweight of 1070 grams. NEC rates decreased from the QI baseline of 19.5% to 6% (p = 0.03). Oral care administration increased, and maximal gavage tube dwell time decreased. Conclusion: NEC rates decreased during this QI initiative through a combination of multidisciplinary interventions aimed at reducing dysbiosis.",

author = "Mavis, {Stephanie C.} and Gallup, {Maria C.} and Mikael Meyer and Misgen, {Megan M.} and Schram, {Laura A.} and Herzog, {Danielle L.} and Smith, {Brandi N.} and Schuning, {Virginia S.} and Stetson, {Raymond C.} and Fang, {Jennifer L.}",

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doi = "10.1038/s41372-022-01476-5",

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AU - Gallup, Maria C.

AU - Meyer, Mikael

AU - Misgen, Megan M.

AU - Schram, Laura A.

AU - Herzog, Danielle L.

AU - Smith, Brandi N.

AU - Schuning, Virginia S.

AU - Stetson, Raymond C.

AU - Fang, Jennifer L.

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N2 - Objective: Prompted by an acute increase in necrotizing enterocolitis (NEC) rates, we aimed to decrease the rate of stage 2 or greater NEC in infants born at <1500 grams or <30 weeks gestational age from 19.5% to less than 9.7% (a 50% reduction) within 18 months, without adversely affecting central line-associated bloodstream infection (CLABSI) rates. Study design: We utilized Define, Measure, Analyze, Improve, and Control (DMAIC) as our improvement model. Informed by our key driver diagram and root cause analyses, six Plan-Do-Study-Act cycles were completed. Results: 147 infants in the QI initiative had a median gestational age of 28.1 weeks and a median birthweight of 1070 grams. NEC rates decreased from the QI baseline of 19.5% to 6% (p = 0.03). Oral care administration increased, and maximal gavage tube dwell time decreased. Conclusion: NEC rates decreased during this QI initiative through a combination of multidisciplinary interventions aimed at reducing dysbiosis.

AB - Objective: Prompted by an acute increase in necrotizing enterocolitis (NEC) rates, we aimed to decrease the rate of stage 2 or greater NEC in infants born at <1500 grams or <30 weeks gestational age from 19.5% to less than 9.7% (a 50% reduction) within 18 months, without adversely affecting central line-associated bloodstream infection (CLABSI) rates. Study design: We utilized Define, Measure, Analyze, Improve, and Control (DMAIC) as our improvement model. Informed by our key driver diagram and root cause analyses, six Plan-Do-Study-Act cycles were completed. Results: 147 infants in the QI initiative had a median gestational age of 28.1 weeks and a median birthweight of 1070 grams. NEC rates decreased from the QI baseline of 19.5% to 6% (p = 0.03). Oral care administration increased, and maximal gavage tube dwell time decreased. Conclusion: NEC rates decreased during this QI initiative through a combination of multidisciplinary interventions aimed at reducing dysbiosis.

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A quality improvement initiative to reduce necrotizing enterocolitis in high-risk neonates

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