Expert Consensus Building using e-Delphi for Necrotizing Enterocolitis Risk Assessment

Objective: To confirm content validity of GutCheck^NEC, a risk index for necrotizing enterocolitis (NEC) and to determine the level of agreement among experts about NEC risk factors in premature infants. Design: Electronic Delphi method (e-Delphi). Setting: Online electronic surveys and e-mail communication supported by an interactive study website. Participants: Nurses and physicians (N = 35) from four countries and across the United States who rated themselves as at least moderately expert about NEC risk. Methods: e-Delphi involved three rounds of surveys and qualitative thematic analysis of experts' comments. Surveys continued until criteria for consensus and/or stability were met. Results: Of 64 initial items, 43 were retained representing 33 risk factors (final GutCheck^NEC Content Validity Index [CVI] = .77). Two broad themes about NEC risk emerged from 242 comments: the impact of individual physiologic vulnerability and variation in neonatal intensive care unit (NICU) clinicians' practices. Controversy arose over the impact of treatments on NEC, including probiotics, packed red blood cell (PRBC) transfusions, and patent ductus arteriosus (PDA) management using indomethacin. Conclusion: GutCheck^NEC achieved borderline content validity for a new scale. The e-Delphi process yielded a broad perspective on areas in which experts share and lack consensus on NEC risk. Future testing is underway to reduce the number of risk items to the most parsimonious set for a clinically useful risk tool and test reliability.