Process Bundle to decrease Necrotizing Enterocolitis (NEC)

Purpose:
A bundle of strategies was developed to decrease the incidence of NEC in neonates between the gestational ages of 23 weeks and 30.6 weeks.

Significance:
NEC is an inflammatory bowel disease seen in both term and preterm infants. NEC is associated with increased hospital costs, longer lengths of stay and a mortality rate of approximately 30%.There are 2 types of NEC: medical NEC and surgical NEC. Surgical NEC has significantly higher hospital costs

Strategy and Implementation:
A process bundle comprised of 3 separate strategies was designed based on a review of the latest evidentiary literature and hospital-specific data including current practices in the NICU: 1) New feeding guidelines including early feeding initiation, standardized feeding advancement , standardized approach to gastric residuals and exclusive use of either mother's or donor breast milk, 2) dilution of hypertonic medications and feeding additives and 3) blood transfusion guidelines that include length of time of the transfusion and amount of transfusions, reduction of enteric caloric density on day of transfusion to 20 kcal/oz and volume to 100ml/kg/day and resumption of pre-transfusion caloric density and volume regimen 24 hours after transfusion initiated.

Evaluation:
Currently four babies have been part of the new NEC process bundle implementation. We have had no cases of NEC but are very early in the implementation phase. Changes to NICU policies and procedures were made to support the bundle.

Implications for Practice:
The exclusive use of breast milk for an infant requires attention from staff to available amounts of breast milk. If a mother plans to use formula at home, the infant will need to be transitioned to formula one week prior to discharge to assure tolerance and weight gain.