부산대학교 도서관

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 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. Keywords: Necrotizing enterocolitis, Very low birth weight, Prevention, Clinical practice guideline, Evidence-based practice, Neonatal intensive care, Infant, Nursing, Parent engagement, Translating Research into Practice Framework, NEC-zero, Practice guidelines, Scoping review
Author(s): Sheila M. Gephart[sup.1] , Corrine Hanson[sup.2] , Christine M. Wetzel[sup.3] , Michelle Fleiner[sup.4] , Erin Umberger[sup.5] , Laura Martin[sup.6] , Suma Rao[sup.7,8,9] , Amit Agrawal[sup.10,11] , Terri Marin[sup.12] , [...]