Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA.
Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
J Perinatol. 2018 Jun;38(6):742-750. doi: 10.1038/s41372-018-0104-0. Epub 2018 Apr 20.
Necrotizing enterocolitis (NEC) is a devastating intestinal disease in premature infants. Local rates of NEC were unacceptably high. We hypothesized that utilizing quality improvement methodology to standardize care and apply evidence-based practices would reduce our rate of NEC.
A multidisciplinary team used the model for improvement to prioritize interventions. Three neonatal intensive care units (NICUs) developed a standardized feeding protocol for very low birth weight (VLBW) infants, and employed strategies to increase the use of human milk, maximize intestinal perfusion, and promote a healthy microbiome.
The primary outcome measure, NEC in VLBW infants, decreased from 0.17 cases/100 VLBW patient days to 0.029, an 83% reduction, while the compliance with a standardized feeding protocol improved.
Through reliable implementation of evidence-based practices, this project reduced the regional rate of NEC by 83%. A key outcome and primary driver of success was standardization across multiple NICUs, resulting in consistent application of best practices and reduction in variation.
坏死性小肠结肠炎（NEC）是早产儿的一种严重肠道疾病。局部 NEC 发生率高得令人无法接受。我们假设，利用质量改进方法来规范护理并应用基于证据的实践将降低我们的 NEC 发生率。
一个多学科团队使用改进模型来确定干预措施的优先级。三个新生儿重症监护病房（NICU）为极低出生体重（VLBW）婴儿制定了标准化的喂养方案，并采取了增加人乳使用量、最大限度地增加肠道灌注和促进健康微生物组的策略。
主要结局指标，即 VLBW 婴儿的 NEC 从 0.17 例/100 VLBW 患者日降至 0.029，减少了 83%，同时标准化喂养方案的依从性也得到了提高。
通过可靠地实施基于证据的实践，本项目将该地区的 NEC 发生率降低了 83%。一个关键的结果和成功的主要驱动因素是多个 NICU 的标准化，从而实现了最佳实践的一致应用和减少了变异。
