NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis
Abstract Background Although decades have focused on unraveling its etiology, necrotizing enterocolitis (NEC) remains a chief threat to the health of premature infants. Both modifiable and non-modifiable risk factors contribute to varying rates of disease across neonatal intensive care units (NICUs)...
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BMC
2017-12-01
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Series: | Maternal Health, Neonatology and Perinatology |
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Online Access: | http://link.springer.com/article/10.1186/s40748-017-0062-0 |
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doaj-09815c74efc141c19735bf6ffe5ae4e5 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sheila M. Gephart Corrine Hanson Christine M. Wetzel Michelle Fleiner Erin Umberger Laura Martin Suma Rao Amit Agrawal Terri Marin Khaver Kirmani Megan Quinn Jenny Quinn Katherine M. Dudding Tanya Clay Jason Sauberan Yael Eskenazi Caroline Porter Amy L. Msowoya Christina Wyles Melissa Avenado-Ruiz Shayla Vo Kristina M. Reber Jennifer Duchon |
spellingShingle |
Sheila M. Gephart Corrine Hanson Christine M. Wetzel Michelle Fleiner Erin Umberger Laura Martin Suma Rao Amit Agrawal Terri Marin Khaver Kirmani Megan Quinn Jenny Quinn Katherine M. Dudding Tanya Clay Jason Sauberan Yael Eskenazi Caroline Porter Amy L. Msowoya Christina Wyles Melissa Avenado-Ruiz Shayla Vo Kristina M. Reber Jennifer Duchon NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis Maternal Health, Neonatology and Perinatology Necrotizing enterocolitis Very low birth weight Prevention Clinical practice guideline Evidence-based practice Neonatal intensive care |
author_facet |
Sheila M. Gephart Corrine Hanson Christine M. Wetzel Michelle Fleiner Erin Umberger Laura Martin Suma Rao Amit Agrawal Terri Marin Khaver Kirmani Megan Quinn Jenny Quinn Katherine M. Dudding Tanya Clay Jason Sauberan Yael Eskenazi Caroline Porter Amy L. Msowoya Christina Wyles Melissa Avenado-Ruiz Shayla Vo Kristina M. Reber Jennifer Duchon |
author_sort |
Sheila M. Gephart |
title |
NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis |
title_short |
NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis |
title_full |
NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis |
title_fullStr |
NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis |
title_full_unstemmed |
NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis |
title_sort |
nec-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis |
publisher |
BMC |
series |
Maternal Health, Neonatology and Perinatology |
issn |
2054-958X |
publishDate |
2017-12-01 |
description |
Abstract Background Although decades have focused on unraveling its etiology, necrotizing enterocolitis (NEC) remains a chief threat to the health of premature infants. Both modifiable and non-modifiable risk factors contribute to varying rates of disease across neonatal intensive care units (NICUs). Purpose The purpose of this paper is to present a scoping review with two new meta-analyses, clinical recommendations, and implementation strategies to prevent and foster timely recognition of NEC. Methods Using the Translating Research into Practice (TRIP) framework, we conducted a stakeholder-engaged scoping review to classify strength of evidence and form implementation recommendations using GRADE criteria across subgroup areas: 1) promoting human milk, 2) feeding protocols and transfusion, 3) timely recognition strategies, and 4) medication stewardship. Sub-groups answered 5 key questions, reviewed 11 position statements and 71 research reports. Meta-analyses with random effects were conducted on effects of standardized feeding protocols and donor human milk derived fortifiers on NEC. Results Quality of evidence ranged from very low (timely recognition) to moderate (feeding protocols, prioritize human milk, limiting antibiotics and antacids). Prioritizing human milk, feeding protocols and avoiding antacids were strongly recommended. Weak recommendations (i.e. “probably do it”) for limiting antibiotics and use of a standard timely recognition approach are presented. Meta-analysis of data from infants weighing <1250 g fed donor human milk based fortifier had reduced odds of NEC compared to those fed cow’s milk based fortifier (OR = 0.36, 95% CI 0.13, 1.00; p = 0.05; 4 studies, N = 1164). Use of standardized feeding protocols for infants <1500 g reduced odds of NEC by 67% (OR = 0.33, 95% CI 0.17, 0.65, p = 0.001; 9 studies; N = 4755 infants). Parents recommended that NEC information be shared early in the NICU stay, when feedings were adjusted, or feeding intolerance occurred via print and video materials to supplement verbal instruction. Discussion Evidence for NEC prevention is of sufficient quality to implement. Implementation that addresses system-level interventions that engage the whole team, including parents, will yield the best impact to prevent NEC and foster its timely recognition. |
topic |
Necrotizing enterocolitis Very low birth weight Prevention Clinical practice guideline Evidence-based practice Neonatal intensive care |
url |
http://link.springer.com/article/10.1186/s40748-017-0062-0 |
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doaj-09815c74efc141c19735bf6ffe5ae4e52020-11-24T22:17:13ZengBMCMaternal Health, Neonatology and Perinatology2054-958X2017-12-013111410.1186/s40748-017-0062-0NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitisSheila M. Gephart0Corrine Hanson1Christine M. Wetzel2Michelle Fleiner3Erin Umberger4Laura Martin5Suma Rao6Amit Agrawal7Terri Marin8Khaver Kirmani9Megan Quinn10Jenny Quinn11Katherine M. Dudding12Tanya Clay13Jason Sauberan14Yael Eskenazi15Caroline Porter16Amy L. Msowoya17Christina Wyles18Melissa Avenado-Ruiz19Shayla Vo20Kristina M. Reber21Jennifer Duchon22Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of NursingUniversity of Nebraska Medical CenterCarle HospitalBanner Health, Cardon Children’s Medical CenterNEC SocietyGraham’s FoundationBanner Health, Banner University Medical Center-PhoenixBanner Health, Thunderbird Medical CenterAugusta University College of NursingBanner Health, Cardon Children’s Medical CenterRobert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of NursingRobert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of NursingRobert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of NursingHand to HoldNeonatal Research Institute, Sharp Mary Birch Hospital for Women and NewbornsRobert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of NursingRobert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of NursingStetson Hills Family MedicineRobert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of NursingUniversity of Sonora at HermisilloRobert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of NursingNationwide Children’s Hospital and The Ohio State Wexner Medical CenterColumbia UniversityAbstract Background Although decades have focused on unraveling its etiology, necrotizing enterocolitis (NEC) remains a chief threat to the health of premature infants. Both modifiable and non-modifiable risk factors contribute to varying rates of disease across neonatal intensive care units (NICUs). Purpose The purpose of this paper is to present a scoping review with two new meta-analyses, clinical recommendations, and implementation strategies to prevent and foster timely recognition of NEC. Methods Using the Translating Research into Practice (TRIP) framework, we conducted a stakeholder-engaged scoping review to classify strength of evidence and form implementation recommendations using GRADE criteria across subgroup areas: 1) promoting human milk, 2) feeding protocols and transfusion, 3) timely recognition strategies, and 4) medication stewardship. Sub-groups answered 5 key questions, reviewed 11 position statements and 71 research reports. Meta-analyses with random effects were conducted on effects of standardized feeding protocols and donor human milk derived fortifiers on NEC. Results Quality of evidence ranged from very low (timely recognition) to moderate (feeding protocols, prioritize human milk, limiting antibiotics and antacids). Prioritizing human milk, feeding protocols and avoiding antacids were strongly recommended. Weak recommendations (i.e. “probably do it”) for limiting antibiotics and use of a standard timely recognition approach are presented. Meta-analysis of data from infants weighing <1250 g fed donor human milk based fortifier had reduced odds of NEC compared to those fed cow’s milk based fortifier (OR = 0.36, 95% CI 0.13, 1.00; p = 0.05; 4 studies, N = 1164). Use of standardized feeding protocols for infants <1500 g reduced odds of NEC by 67% (OR = 0.33, 95% CI 0.17, 0.65, p = 0.001; 9 studies; N = 4755 infants). Parents recommended that NEC information be shared early in the NICU stay, when feedings were adjusted, or feeding intolerance occurred via print and video materials to supplement verbal instruction. Discussion Evidence for NEC prevention is of sufficient quality to implement. Implementation that addresses system-level interventions that engage the whole team, including parents, will yield the best impact to prevent NEC and foster its timely recognition.http://link.springer.com/article/10.1186/s40748-017-0062-0Necrotizing enterocolitisVery low birth weightPreventionClinical practice guidelineEvidence-based practiceNeonatal intensive care |