OBJECTIVE To reduce the incidence of necrotizing enterocolitis (NEC) among very preterm infants in the Calgary Health Region to ≤2% within 2 years. METHODS 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. RESULTS We included 2787 infants born at ≤326/7 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. CONCLUSIONS 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.

中文翻译：

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减少极早产儿坏死性小肠结肠炎的质量改进计划。

目标 在 2 年内将卡尔加里卫生区极早产儿的坏死性小肠结肠炎 (NEC) 发病率降低至 ≤2%。方法 多学科团队为 NEC 开发了关键驱动因素。有针对性的干预措施包括增加母乳（MOM）、提高喂养方案依从性、规范喂养不耐受管理、预防肠道微生物畸变以及在输血和动脉导管未闭治疗期间保守喂养等策略。结果测量为 NEC（≥ 2 期）。研究了种族和族裔群体中 NEC 率的变化。过程测量包括出院时 MOM 喂养、实际和预期达到完全喂养时间之间的差异、最低血红蛋白以及经验性抗生素的持续时间。生长、输血率和肠外营养持续时间是平衡措施。预干预期、干预期和维持期分别为2013年1月至2016年6月、2016年7月至2018年12月、2018年12月至2021年12月。结果 我们纳入了 2787 名妊娠≤326/7 周出生的婴儿（1105 名干预前婴儿、763 名干预期间婴儿和 919 名维持婴儿）。NEC从5.6%下降至1.9%。过程测量表明出院时 MOM 喂养增加，喂养方案依从性提高，最低血红蛋白水平增加，经验性抗生素持续时间缩短。平衡措施显示体重 Z 评分有所改善、肠外营养持续时间缩短以及输血率增加。结论 提高 MOM、提高喂养方案依从性、输血和动脉导管未闭治疗期间保守喂养以及预防肠道微生物畸变等质量改进举措与减少 NEC 相关。