title: Reducing necrotizing enterocolitis in very low birth weight infants using quality-improvement methods.
abstract: OBJECTIVE
  Owing to a rise in necrotizing enterocolitis (NEC, stage ⩾ 2) among very low birth weight (VLBW, birth weight <1500 g) infants from 4% in 2005 to 2006 to 10% in 2007 to 2008, we developed and implemented quality improvement (QI) initiatives. The objective was to evaluate the impact of QI initiatives on NEC incidence in VLBW infants.
  
  
  METHODS
  In September 2009, we developed an NEC QI multidisciplinary team that conducted literature reviews and reviewed practices from other institutions to develop a feeding protocol, which was implemented in December 2009. The team tracked intervention compliance and occurrence of NEC stage ⩾ 2. In May 2010, we reviewed our nasogastric tube practice and relevant literature to develop a second intervention that reduced nasogastric tube indwelling time. The infants were divided into three groups: baseline (January 2008 to Novovember 2009, n219), QI phase 1 (December 2009 to May 2010, n62) and QI phase 2 (June 2010 to November 2011, n170).
  
  
  RESULTS
  The NEC incidence did not decrease after implementation of the feeding protocol in QI phase 1 (19.4%) but did decline significantly after changing nasogastric tube management in QI phase 2 (2.9%). Multivariable logistic regression analysis demonstrated a significant relationship between QI phase and the incidence of NEC.
  
  
  CONCLUSIONS
  QI initiatives were effective in decreasing NEC incidence in our high human milk-feeding NICU. Nasogastric tube bacterial contamination may have contributed to our peak in NEC incidence.
authors.affiliation: Section of Neonatology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Patel
authors.affiliation: Washington University School of Medicine, St Louis, MO, USA.
authors.forename: S
authors.initials: S
authors.lastname: Trivedi
authors.affiliation: Section of Neonatology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: N P
authors.initials: NP
authors.lastname: Bhandari
authors.affiliation: Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: A
authors.initials: A
authors.lastname: Ruf
authors.affiliation: Section of Neonatology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Scala
authors.affiliation: Section of Neonatology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: G
authors.initials: G
authors.lastname: Witowitch
authors.affiliation: Section of Neonatology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Section of Neonatology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: C
authors.initials: C
authors.lastname: Renschen
authors.affiliation: Section of Neonatology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: P P
authors.initials: PP
authors.lastname: Meier
authors.affiliation: Section of Neonatology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Silvestri
mesh_terms: D002985:Clinical Protocols; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000592:standards; D016015:Logistic Models; D008297:Male; D016730:Program Development; D058996:Quality Improvement / Q000458:organization & administration*