Chandran Suresh, Anand Amudha Jayanthi, Rajadurai Victor Samuel, Seyed Ehsan Saffari, Khoo Poh Choo, Chua Mei Chien
Department of Neonatology, KK Women's and Children's Hospital, Singapore.
Duke-NUS Medical School, Singapore.
JPEN J Parenter Enteral Nutr. 2021 Sep;45(7):1408-1416. doi: 10.1002/jpen.2058. Epub 2020 Dec 31.
Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in preterm infants. Survivors may suffer both short- and long-term morbidities. Current evidence suggests that the incidence of NEC can be reduced by standardizing the care delivery in addressing key risk factors including an altered gut microbiome, use of formula milk, hyperosmolar feeds, and unrestricted use of high-risk medications METHODS: Since 2014, the department has a workgroup who analyzed all cases of NEC within a month of diagnosis to identify preventable risk factors. Existing evidence-based quality improvement strategies were revised and new ones were implemented sequentially over the next 4 years. These strategies include (1) a standardized feeding protocol, (2) early initiation of enteral feeding using human milk, (3) optimization of the osmolality of preterm milk feeds using standardized dilution guidelines for additives, and (4) promotion of healthy microbiome by use of probiotics, early oral care with colostrum and by restricting high-risk medications and prolonged use of empirical antibiotics RESULTS: Baseline characteristics of the patients including sex, gestational age, and birth weight were similar during the study period. After implementing the evidence-based practices successively over 4 years, the incidence of NEC in very- low birth-weight (VLBW) infants dropped from 7% in 2014 to 0% (P < .001) in 2018. The duration of parenteral nutrition, use of central line, and days to full feeds were also reduced significantly (P < .05) CONCLUSION: Adopting evidence-based best practices resulted in a significant decrease in the incidence of NEC and improved the nutrition outcomes in VLBW infants.
坏死性小肠结肠炎（NEC）是早产儿最常见的胃肠道急症。幸存者可能会遭受短期和长期的发病情况。目前的证据表明，通过规范护理措施来应对关键风险因素，包括肠道微生物群改变、使用配方奶、高渗喂养以及无限制使用高风险药物等，可以降低NEC的发病率。方法：自2014年以来，该科室成立了一个工作组，对诊断后一个月内的所有NEC病例进行分析，以确定可预防的风险因素。在接下来的4年里，对现有的循证质量改进策略进行了修订，并依次实施了新的策略。这些策略包括：（1）标准化喂养方案；（2）尽早开始使用母乳进行肠内喂养；（3）根据添加剂的标准化稀释指南优化早产奶喂养的渗透压；（4）通过使用益生菌、用初乳进行早期口腔护理以及限制高风险药物和长期使用经验性抗生素来促进健康的微生物群。结果：在研究期间，患者的基线特征（包括性别、胎龄和出生体重）相似。在连续4年实施循证实践后，极低出生体重（VLBW）婴儿的NEC发病率从2014年的7%降至2018年的0%（P <.001）。肠外营养的持续时间、中心静脉导管的使用以及完全经口喂养的天数也显著减少（P <.05）。结论：采用循证最佳实践可显著降低VLBW婴儿的NEC发病率，并改善其营养结局。
