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  • Quality Improvement Article
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A quality improvement initiative to standardize time to initiation of enteral feeds after non-surgical necrotizing enterocolitis using a consensus-based guideline

Journal of Perinatology volume 42, pages 522–527 (2022)Cite this article

Subjects

Abstract

Background

Recent evidence demonstrates that earlier feeding may be beneficial after non-surgical necrotizing enterocolitis (NEC). We aimed to decrease time to reach full enteral feeds by 20% post-NEC by standardizing time to reinitiate feeds.

Methods

We implemented a consensus-based guideline for earlier feeding post-NEC. Outcome measures included days to initiate enteral feeds and reach full enteral feeds. Central venous line days and length of stay were also evaluated. Balancing measures were NEC recurrence and post-NEC stricture. Statistical analysis used process control methodology and standard comparison statistical testing.

Results

Average days infants with Stage II NEC began feeding decreased from 9.4 to 5.1 days and average days to reach full feeds was decreased by 35% from 24.0 to 15.7 days. We observed no change in our balancing measures.

Conclusion

A multidisciplinary consensus-based NEC earlier feeding guideline decreased time to reach full enteral feeds and reduced central line days without adverse events.

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Fig. 1: These factors were used to develop a post-NEC refeeding guideline to decrease time to full enteral feeds after NEC.
Fig. 2: XmR control charts demonstrating feeding data.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, South Carolina; Children’s Hospital Kansas City, Kansas City, MO, USA

    Ekta U. Patel

  2. Medical University of South Carolina, Charleston, SC, USA

    William T. Head

  3. Department of Surgery, Division of Pediatric Surgery, Medical University of South Carolina, Charleston, SC, USA

    Allison Rohrer & Aaron P. Lesher

  4. Department of Pediatrics, Division of Neonatology, Case Western Reserve University and UH Rainbow Babies and Children’s Hospital, Cleveland, OH, USA

    Rita M. Ryan

Authors
  1. Ekta U. Patel
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  2. William T. Head
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  3. Allison Rohrer
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  4. Rita M. Ryan
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  5. Aaron P. Lesher
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Contributions

EUP conducted a literature search, helped with the study design, performed the data collection, contributed to the data analysis and data interpretation, helped write the manuscript, and performed critical revisions. WTH conducted a literature search, helped write the manuscript, and performed critical revisions. AR helped with the study design, contributed to the data analysis and interpretation, and performed critical revisions. RMR helped with the study design, contributed to the data analysis and interpretation, and performed critical revisions. APL helped with the study design, contributed to the data analysis and interpretation, and performed critical revisions.

Corresponding author

Correspondence to Ekta U. Patel.

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The authors declare no competing interests.

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Patel, E.U., Head, W.T., Rohrer, A. et al. A quality improvement initiative to standardize time to initiation of enteral feeds after non-surgical necrotizing enterocolitis using a consensus-based guideline. J Perinatol 42, 522–527 (2022). https://doi.org/10.1038/s41372-022-01324-6

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  • DOI: https://doi.org/10.1038/s41372-022-01324-6

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