Implementation of a Standardized Feeding Protocol to Decrease the Risk of Necrotizing Enterocolitis in the NICU

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George, Kathryn
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Purpose. The purpose of this quality improvement project is to minimize provider variability and modifiable risk factors associated with necrotizing enterocolitis [NEC] through the implementation of an evidence-based standardized feeding protocol in the NICU.|Significance. Premature infants, particularly those weighing <1500 grams at birth of born <32 weeks gestation, are at an increased risk for developing NEC, the leading cause of gastrointestinal-related death in neonates. The utilization of a standardized feeding protocol in the NICU has been shown to reduce the incidence rate of NEC.|Sample/Setting. An evidence-based, unit-specific standardized feeding protocol was implemented at a level III, 36-bed non-surgical NICU in Omaha, Nebraska. Babies born ≥ 23 weeks and <34 weeks were included in this project. In total, 60 neonates were selected using convenience sampling for retrospective chart review. Neonates were excluded from participation in the presence of congenital heart defects, gastrointestinal anomalies, or any other diagnosed congenital or genetic malformation.|Methods. This was a quality improvement study. All qualifying neonates born <34 weeks had a copy of the applicable protocol (ELBW, VLBW, or LBW) placed on their chart for use while updating the plan of care as it related to feeding. Protocol-dependent variables from the pre- and post-implementation neonates were compared using means and standard deviations. Annual incidence of NEC was additionally compared.|Results. Comparison of protocol-dependent variables in pre- and post-implementation neonates demonstrated a 44% reduction in time to feeding initiation with fortification to 24 kcal/oz occurring 3 days sooner in the post-implementation cohorts. Full feeds were achieved 2 days earlier and discontinuation of central line access in the ELBW cohort occurred 2.6 days sooner. The standard deviation of all variables were minimized in the post-implementation ELBW and VLBW cohorts, representing decreased variation in practice among providers. The overall incidence of necrotizing enterocolitis decreased following implementation.|Discussion. The implementation of a standardized feeding protocol can increase consistency among providers in the initiation, advancement, and fortification of enteral feeds, which has been shown to decrease the incidence rate of NEC.
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