一项旨在规范患有医学坏死性小肠结肠炎患者抗生素治疗和喂养实践的质量改进计划。
A quality improvement initiative standardizing the antibiotic treatment and feeding practices in patients with medical necrotizing enterocolitis.
机构信息
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.
出版信息
J Perinatol. 2024 Apr;44(4):587-593. doi: 10.1038/s41372-023-01797-z. Epub 2023 Oct 20.
OBJECTIVE
Evaluate the impact of a multidisciplinary guideline standardizing antibiotic duration and enteral feeding practices following medical necrotizing enterocolitis (mNEC).
STUDY DESIGN
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).
RESULTS
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%.
CONCLUSION
Implementation of a mNEC QI package reduced antibiotic duration, time to full feeds, central line use and CL days.
目的
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。
研究设计
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）。
结果
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%。
结论
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。
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