Gephart Sheila M, Quinn Megan C
Community and Health Systems Science Division, College of Nursing, The University of Arizona, Tucson (Dr Gephart and Ms Quinn); and Cardon Children's Medical Center, Banner Health Network Neonatal Intensive Care Unit, Mesa, Arizona (Ms Quinn).
Adv Neonatal Care. 2019 Aug;19(4):321-332. doi: 10.1097/ANC.0000000000000592.
Applying quality improvement methods has reduced necrotizing enterocolitis (NEC) in some neonatal intensive care units (NICUs) by 40% to 90%.
This study was conducted to (1) examine relationships between adoption of prevention practices using the NEC-Zero adherence score and NEC rates, and (2) describe implementation strategies NICUs use to prevent NEC.
A descriptive cross-sectional correlational study was completed among US quality improvement-focused NICUs. Relationships of the NEC-Zero adherence score to NEC rates were examined. Subgroup analyses explored relationships of a human milk adherence subscore and differences between high NEC rate (≥8%) and low NEC rate (≤2%) NICUs.
NICUs (N = 76) ranged in size from 18 to 114 beds. The mean adherence score was 7.3 (standard deviation = 1.7; range, 3-10). The 10-point adherence score was not related to the NEC rate. The human milk subscore related to lower NEC rates (Rho = -0.26, P = .049), as was colostrum for oral care (Rho = -0.27, P = .032). The units that used a feeding protocol showed higher NEC rates (Rho = 0.27, P = .03), although very few addressed the use of effective implementation strategies to track adherence or to ensure consistency among clinicians. The units that used colostrum for oral care were more likely to adopt strategies to limit inappropriate antibiotic exposure (Rho = 0.34, P = .003).
Broader use of evidence-based implementation strategies could bolster delivery of NEC prevention practices. Maternal lactation support is paramount.
Future studies are needed to identify how individual clinicians deliver prevention practices, to find the extent to which this relates to overall delivery of prevention, and to study effects of bundles on NEC outcomes.
应用质量改进方法已使一些新生儿重症监护病房（NICU）的坏死性小肠结肠炎（NEC）发病率降低了40%至90%。
本研究旨在（1）使用NEC-零依从性评分来检验预防措施的采用与NEC发病率之间的关系，以及（2）描述NICU用于预防NEC的实施策略。
在美国以质量改进为重点的NICU中完成了一项描述性横断面相关性研究。检验了NEC-零依从性评分与NEC发病率之间的关系。亚组分析探讨了母乳依从性子评分的关系以及高NEC发病率（≥8%）和低NEC发病率（≤2%）的NICU之间的差异。
NICU（N = 76）的规模从18张床位到114张床位不等。平均依从性评分为7.3（标准差 = 1.7；范围为3 - 10）。10分的依从性评分与NEC发病率无关。母乳子评分与较低的NEC发病率相关（Rho = -0.26，P = .049），用于口腔护理的初乳也是如此（Rho = -0.27，P = .032）。采用喂养方案的病房显示出较高的NEC发病率（Rho = 0.27，P = .03），尽管很少有病房采用有效的实施策略来跟踪依从性或确保临床医生之间的一致性。使用初乳进行口腔护理的病房更有可能采用限制不适当抗生素暴露的策略（Rho = 0.34，P = .003）。
更广泛地使用基于证据的实施策略可以加强NEC预防措施的实施。产妇泌乳支持至关重要。
未来需要开展研究，以确定个体临床医生如何实施预防措施，了解这与预防措施的总体实施程度之间的关系，并研究综合措施对NEC结局的影响。
