Pediatrics: A QI Initiative to Reduce Necrotizing Enterocolitis in Very Preterm Infants

SOURCE: Belal N. Alshaikh, Thomas D.R. Sproat, Christel Wood, Jill-Marie Spence, Megan Knauff, Claire Hamilton, Meagan Roy; A Quality Improvement Initiative to Reduce Necrotizing Enterocolitis in Very Preterm Infants. Pediatrics 2023; e2023061273. DOI: 10.1542/peds.2023-061273


To reduce the incidence of necrotizing enterocolitis (NEC) among very preterm infants in the Calgary Health Region to ≤2% within 2 years.


A multidisciplinary team developed key drivers for NEC. Targeted interventions included strategies to increase mothers’ own milk (MOM), improve compliance with feeding regimens, standardize management of feeding intolerance, prevent intestinal microbial aberrations, and feed conservatively during blood transfusion and the treatment of patent ductus arteriosus. The outcome measure was NEC (≥ stage 2). Changes in NEC rates were examined among racial and ethnic groups. Process measures included MOM feeding at discharge, the difference between actual and expected time to reach full feeds, lowest hemoglobin, and the duration of empirical antibiotics. Growth, the rate of blood transfusion, and the duration of parenteral nutrition were balancing measures. The preintervention, intervention, and sustainment periods were January 2013 to June 2016, July 2016 to December 2018, and December 2018 to December 2021, respectively.


We included 2787 infants born at ≤32 weeks’ gestation (1105 preintervention, 763 during intervention, and 919 in sustainment). NEC decreased from 5.6% to 1.9%. Process measures indicated increased MOM feeding at discharge, improved compliance with feeding regimens, increased lowest hemoglobin levels, and shorter durations of empirical antibiotics. Balancing measures revealed improved weight Z-scores, shorter durations on parenteral nutrition, and increased rates of blood transfusion.


Quality improvement initiatives to increase MOM, improve compliance with feeding regimens, feed conservatively during blood transfusion and treatment of patent ductus arteriosus, and prevent intestinal microbial aberrations were associated with reduced NEC.