NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis.

Autor: Gephart SM; Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA., Hanson C; University of Nebraska Medical Center, Omaha, NE USA., Wetzel CM; Carle Hospital, Urbana, IL USA., Fleiner M; Banner Health, Cardon Children's Medical Center, Mesa, AZ USA., Umberger E; NEC Society, Fresno, CA USA., Martin L; Graham's Foundation, Canton, GA USA., Rao S; Banner Health, Banner University Medical Center-Phoenix, Phoenix, AZ USA.; Phoenix Perinatal Associates, Mesa, AZ USA.; Clinical Assistant Professor and Vice-Chair, Department of Pediatrics, The University of Arizona, Tucson, AZ USA., Agrawal A; Banner Health, Thunderbird Medical Center, Glendale, AZ USA.; Envision Physician Services, Lawrenceville, GA USA., Marin T; Augusta University College of Nursing, Athens, GA USA., Kirmani K; Banner Health, Cardon Children's Medical Center, Mesa, AZ USA.; Phoenix Perinatal Associates, Mesa, AZ USA., Quinn M; Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA.; Banner Health, Cardon Children's Medical Center, Mesa, AZ USA., Quinn J; Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA.; NorthBay Medical Center, Fairfield, CA USA., Dudding KM; Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA., Clay T; Hand to Hold, Dallas, TX USA., Sauberan J; Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA USA., Eskenazi Y; Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA., Porter C; Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA., Msowoya AL; Stetson Hills Family Medicine, Glendale, AZ USA., Wyles C; Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA., Avenado-Ruiz M; University of Sonora at Hermisillo, Hermosillo, Mexico., Vo S; Robert Wood Johnson Foundation Nurse Faculty Scholar, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 USA., Reber KM; Nationwide Children's Hospital and The Ohio State Wexner Medical Center, Columbus, OH USA., Duchon J; Columbia University, New York, NY USA.
Jazyk: angličtina
Zdroj: Maternal health, neonatology and perinatology [Matern Health Neonatol Perinatol] 2017 Dec 18; Vol. 3, pp. 23. Date of Electronic Publication: 2017 Dec 18 (Print Publication: 2017).
DOI: 10.1186/s40748-017-0062-0
Abstrakt: 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.
Competing Interests: This project was deemed not research. Results present a review with expert assessment of recommendations and implementation strategies. All experts participated without coersion.All authors give consent for publication and assure that the paper is not in review by another journal nor have they been published before.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Databáze: MEDLINE
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