Prevention and early recognition of necrotizing enterocolitis: A tale of 2 tools-eNEC and GutCheck ^NEC

BACKGROUND AND SIGNIFICANCE: Risk for neonatal necrotizing enterocolitis (NEC) is complex, reflecting its multifactorial pathogenesis. PURPOSE: To improve risk awareness and facilitate communication among neonatal caregivers, especially nurses, 2 tools were developed. DESIGN: GutCheck NEC was derived and validated as part of a formal research study over 3 phases, evidence synthesis, expert consensus building, and statistical modeling. The Wetzel/Krisman tool, eNEC, was developed and tested as part of a quality improvement initiative in a single clinical setting using evidence synthesis, review by internal expert clinicians, and implementation and evaluation of its use by direct line neonatal staff. Refinement of both tools is under way to evaluate their effect on clinical decision making, early identification of NEC and surgical NEC. METHODS AND MAIN OUTCOMES: Clinicians can take an active role to reduce NEC in their units by focusing on modifiable risk factors such as adoption of standardized feeding protocols, preferential feeding of human milk, and antibiotic and histamine blocker stewardship. RESULTS: Feeding during transfusion remains controversial, but judicious use of transfusions, adoption of transfusion guidelines, and withholding feeding during transfusion are feasible measures with potential benefit to prevent NEC and confer little risk.