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Relationship of Necrotizing Enterocolitis Rates to Adoption of Prevention Practices in US Neonatal Intensive Care Units

Gephart, Sheila M. PhD, RN; Quinn, Megan C. BSN, RN

Section Editor(s): Dowling, Donna PhD, RN; Thibeau, Shelley PhD, RNC-NIC;

doi: 10.1097/ANC.0000000000000592
Original Research: PDF Only

Background: Applying quality improvement methods has reduced necrotizing enterocolitis (NEC) in some neonatal intensive care units (NICUs) by 40% to 90%.

Purpose: This study was conducted to (1) examine relationships between adoption of prevention practices using the NEC-Zero adherence score and NEC rates, and (2) describe implementation strategies NICUs use to prevent NEC.

Methods: A descriptive cross-sectional correlational study was completed among US quality improvement–focused NICUs. Relationships of the NEC-Zero adherence score to NEC rates were examined. Subgroup analyses explored relationships of a human milk adherence subscore and differences between high NEC rate (≥8%) and low NEC rate (≤2%) NICUs.

Results: NICUs (N = 76) ranged in size from 18 to 114 beds. The mean adherence score was 7.3 (standard deviation = 1.7; range, 3-10). The 10-point adherence score was not related to the NEC rate. The human milk subscore related to lower NEC rates (Rho =−0.26, P = .049), as was colostrum for oral care (Rho =−0.27, P = .032). The units that used a feeding protocol showed higher NEC rates (Rho = 0.27, P = .03), although very few addressed the use of effective implementation strategies to track adherence or to ensure consistency among clinicians. The units that used colostrum for oral care were more likely to adopt strategies to limit inappropriate antibiotic exposure (Rho = 0.34, P = .003).

Implications for Practice: Broader use of evidence-based implementation strategies could bolster delivery of NEC prevention practices. Maternal lactation support is paramount.

Implications for Research: Future studies are needed to identify how individual clinicians deliver prevention practices, to find the extent to which this relates to overall delivery of prevention, and to study effects of bundles on NEC outcomes.

Community and Health Systems Science Division, College of Nursing, The University of Arizona, Tucson (Dr Gephart and Ms Quinn); and Cardon Children's Medical Center, Banner Health Network Neonatal Intensive Care Unit, Mesa, Arizona (Ms Quinn).

Correspondence: Sheila M. Gephart, PhD, RN, Community and Health Systems Science Division, College of Nursing, The University of Arizona, PO Box 210203, Tucson, AZ 85721 (

Dr Gephart acknowledges that this project was funded by the Robert Wood Johnson Foundation Nurse Faculty Scholars Program (72114). She also received training support from the Agency for Healthcare Research and Quality (K08HS022908) and the Pacific Southwest Region of the National Network of Libraries of Medicine. The authors thank the NEC-Zero study team, including Ms Christina Wyles, Mr Anthony Tolentino, Mr Scott Robert Johnson, and Ms Caroline Porter, for their role in the larger NEC-Zero project and for reviewing the manuscript.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the Robert Wood Johnson Foundation, Agency for Healthcare Research and Quality, or the National Network of Libraries of Medicine.

Dr Gephart is a member of the Editorial Board of Advances in Neonatal Care and was not involved in the review or decision for the manuscript. The other authors declare no conflicts of interest.

© 2019 by The National Association of Neonatal Nurses