Department of Pediatrics, Division of Newborn Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA.
Department of Pediatrics, Washington University School of Medicine, St. Louis, USA.
J Perinatol. 2024 Apr;44(4):587-593. doi: 10.1038/s41372-023-01797-z. Epub 2023 Oct 20.
Evaluate the impact of a multidisciplinary guideline standardizing antibiotic duration and enteral feeding practices following medical necrotizing enterocolitis (mNEC).
For preterm infants with Bell Stage 2 A mNEC and negative blood culture, antibiotic treatment was standardized to 7 days. Trophic feeds of unfortified human milk began 72 h after resolution of pneumatosis. Feeds were advanced by 20 cc/kg/day starting on the last day of antibiotics. Primary outcomes were antibiotic days and days to full feeds, defined as 120 cc/kg/day of enteral nutrition. Secondary outcomes included central line days and length of stay (LOS).
Antibiotic duration decreased 23%. Time to start trophic feeds and time to full feeds decreased 33 and 16% respectively. Central line use dropped (98 to 72% of infants) and central line days were reduced by 59%.
Implementation of a mNEC QI package reduced antibiotic duration, time to full feeds, central line use and CL days.
评估多学科指南规范医疗相关性坏死性小肠结肠炎（mNEC）后抗生素使用时间和肠内喂养实践的影响。
对于 Bell 分期 2A 期 mNEC 且血培养阴性的早产儿，将抗生素治疗标准化为 7 天。在气腹缓解后 72 小时开始给予未强化人乳的滋养性喂养。从最后一天的抗生素开始，每天增加 20cc/kg 的喂养量。主要结局指标为抗生素使用天数和达到全肠内营养（即 120cc/kg/天）的天数。次要结局指标包括中心静脉置管天数和住院时间（LOS）。
抗生素使用时间减少了 23%。开始给予滋养性喂养的时间和达到全肠内营养的时间分别减少了 33%和 16%。中心静脉置管使用率下降（从 98%降至 72%的婴儿），中心静脉置管天数减少了 59%。
实施 mNEC QI 方案可减少抗生素使用时间、达到全肠内营养的时间、中心静脉置管使用率和置管天数。
