Expert consensus to weight an adherence score for audit and feedback of practices that prevent necrotizing enterocolitis in very low birth weight infants

Sheila M Gephart, Christina Wyles, Jennifer Canvasser

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Objective Necrotizing enterocolitis (NEC) is a catastrophic abdominal complication threatening the life of premature infants, but adoption of prevention and early recognition practices differs as do NEC rates in Neonatal Intensive Care Units (NICUs). The purpose of this research was to validate and weight an evidence-based adherence score (aka NEC-Zero Adherence Score) to prevent and foster timely recognition of NEC. Study design An electronic Delphi (e-Delphi) approach was used to identify consensus. NEC experts were recruited via the NEC Society and surveyed until consensus and stability criteria for the Delphi were met (≥ 70% consensus and mean responses changed < 15% between rounds). Results Expert panelists (n = 22) were experienced (M = 17.6, SD 11 years) and predominately physicians (68%) or neonatal nurse practitioners (18%). Consensus (> 70% by item) supported a 10 point score. Points were distributed across 1) an exclusive human milk diet (5 points), 2) standardized feeding protocols (3 points), 3) antibiotic stewardship (1 point), and 4) a unit-specified approach to early recognition (1 point). Withholding feeding during transfusion was controversial (M = 0.50, SD 0.73) and met consensus criteria to drop from the score. Conclusions Holding feeding during transfusion was dropped from the score. Relationships between the score and unit NEC rates as well as its utility for use in audit and feedback should be studied in the future.

Original languageEnglish (US)
Pages (from-to)182-188
Number of pages7
JournalApplied Nursing Research
Volume39
DOIs
StatePublished - Feb 1 2018

Keywords

  • E-Delphi
  • Early recognition
  • Feeding protocol
  • Guideline adherence
  • Human milk
  • NEC score
  • Necrotizing enterocolitis
  • Prevention
  • Very low birth weight

ASJC Scopus subject areas

  • Nursing(all)

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