Institutional members access full text with Ovid®

Share this article on:

Prevention and Early Recognition of Necrotizing Enterocolitis: A Tale of 2 Tools—eNEC and GutCheckNEC

Gephart, Sheila M. PhD, RN; Wetzel, Christine MSN, RN, IBCLC; Krisman, Brittany BSN, RN

Section Editor(s): Dowling, Donna

doi: 10.1097/ANC.0000000000000063
Original Research

BACKGROUND AND SIGNIFICANCE: Risk for neonatal necrotizing enterocolitis (NEC) is complex, reflecting its multifactorial pathogenesis.

PURPOSE: To improve risk awareness and facilitate communication among neonatal caregivers, especially nurses, 2 tools were developed.

DESIGN: GutCheckNEC was derived and validated as part of a formal research study over 3 phases, evidence synthesis, expert consensus building, and statistical modeling. The Wetzel/Krisman tool, eNEC, was developed and tested as part of a quality improvement initiative in a single clinical setting using evidence synthesis, review by internal expert clinicians, and implementation and evaluation of its use by direct line neonatal staff. Refinement of both tools is under way to evaluate their effect on clinical decision making, early identification of NEC and surgical NEC.

METHODS AND MAIN OUTCOMES: Clinicians can take an active role to reduce NEC in their units by focusing on modifiable risk factors such as adoption of standardized feeding protocols, preferential feeding of human milk, and antibiotic and histamine blocker stewardship.

RESULTS: Feeding during transfusion remains controversial, but judicious use of transfusions, adoption of transfusion guidelines, and withholding feeding during transfusion are feasible measures with potential benefit to prevent NEC and confer little risk.

College of Nursing, University of Arizona, Tucson (Dr Gephart), and Carle Foundation Hospital, Urbana, Illinois (Mss Wetzel and Krisman).

Correspondence: Sheila M. Gephart, PhD, RN, College of Nursing, University of Arizona, PO Box 210203, Tucson, AZ 85721 (

Derivation and validation of GutCheckNEC were supported by the National Institute of Nursing Research (F31NR012333-A1) and the Friends of Yuma. Content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health.

Data were obtained from the Pediatrix Medical Group.

The authors declare no conflict of interest.

© 2014 by The National Association of Neonatal Nurses