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A quality improvement initiative standardizing the antibiotic treatment and feeding practices in patients with medical necrotizing enterocolitis

Journal of Perinatology volume 44, pages 587–593 (2024)Cite this article

Subjects

Abstract

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.

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Fig. 1: Driver diagram.
Fig. 2: UPMC newborn medicine clinical consensus guideline for the management of bell stage 2 A medical NEC in preterm infants.
Fig. 3: Statistical process control (Xbar-S) chart for the average duration of antibiotic therapy.
Fig. 4: Statistical process control (Xbar-S) charts for post-mNEC feeding.
Fig. 5: Statistical process control (Xbar-S) charts for the secondary outcomes, average days of central line use and length of stay.

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Acknowledgements

This study was approved by the Quality Improvement Review Committee of the University of Pittsburgh (QRC#1732). Patient privacy and confidentiality were maintained by keeping data in a password-protected file on a HIPAA compliant computer. No identifying information was used in the statistical analysis. The data that support the findings of this study are not openly available due to reasons of privacy and sensitivity and may be available from the corresponding author upon reasonable request after review by the University of Pittsburgh Data Use Committee. There is no internal or external funding for this quality improvement project.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Newborn Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA

    Zoya Mahmood, Brighid O’Donnell, Beverly S. Brozanski, Kalyani Vats, Jennifer Kloesz, Laura E. Jackson, Abeer Azzuqa & Toby Debra Yanowitz

  2. Department of Pediatrics, Washington University School of Medicine, St. Louis, USA

    Beverly S. Brozanski

  3. Division of Neonatology, Akron Children’s Hospital, Akron, USA

    Laura E. Jackson

  4. Department of Pharmacy, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, USA

    Jennifer Shenk & Melinda Miller

  5. Department of Pharmacy, Magee Womens Hospital of UPMC, Pittsburgh, USA

    Mary Beth Pasqualicchio

  6. Neonatal Dietitian, UPMC Children’s Hospital of Pittsburgh and Medical University of South Carolina, Pittsburgh, USA

    Haley Schmidt

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  1. Zoya Mahmood
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Contributions

Data acquisition: ZM, KV, JK, LJ, JS, MM, MBP, HS. Data acquisition/analysis: BO’D, AA. Conception/Design/analysis: BB. Conception/Design/data acquisition/analysis: TDY*. Drafted manuscript: ZM. revised manuscript: BO’D, BB, KV, JK, LJ, JS, MM, MBP, HS, AA, TDY*. Approved final version: ZM, BO’D, BB, KV, JK, LJ, JS, MM, MBP, HS, AA, TDY*. Agreed to be accountable for entire work: ZM, BO’D, BB, KV, JK, LJ, JS, MM, MBP, HS, AA, TDY*. *TDY, the corresponding author, additionally confirms that she has full access to the data in the quality improvement project and has the final responsibility for the decision to submit for publication.

Corresponding author

Correspondence to Toby Debra Yanowitz.

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The authors declare no competing interests.

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Mahmood, Z., O’Donnell, B., Brozanski, B.S. et al. A quality improvement initiative standardizing the antibiotic treatment and feeding practices in patients with medical necrotizing enterocolitis. J Perinatol 44, 587–593 (2024). https://doi.org/10.1038/s41372-023-01797-z

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