Standardizing the diagnosis of necrotizing enterocolitis in infants with congenital heart disease

Margot Hillyer; Michael Fundora; Feifei Williams; Michelle Gleason; Mary Lukacs; Shannon Hamrick; Jonathan Meisel; Shanelle Clarke; Natalie Korcinsky-Tillman; Nikhil Chanani

doi:10.1038/s41372-024-02112-0

Standardizing the diagnosis of necrotizing enterocolitis in infants with congenital heart disease

J Perinatol. 2024 Sep 12. doi: 10.1038/s41372-024-02112-0. Online ahead of print.

Authors

Margot Hillyer¹, Michael Fundora^{2

3}, Feifei Williams^{2

4}, Michelle Gleason³, Mary Lukacs³, Shannon Hamrick⁵, Jonathan Meisel⁶, Shanelle Clarke^{2

3}, Natalie Korcinsky-Tillman^{3

7}, Nikhil Chanani^{2

3}

Affiliations

¹ Emory University School of Medicine, Department of Pediatrics, Division of Critical Care Medicine, Atlanta, GA, USA. [email protected].
² Emory University School of Medicine, Department of Pediatrics, Division of Cardiology, Atlanta, GA, USA.
³ The Heart Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.
⁴ AdventHealth Medical Group, Division of Pediatric Critical Care Medicine, AdventHealth for Children, Orlando, FL, USA.
⁵ Emory University School of Medicine, Department of Pediatrics, Division of Neonatology, Atlanta, GA, USA.
⁶ Emory University School of Medicine, Department of Pediatrics, Division of General Surgery, Atlanta, GA, USA.
⁷ Children's Healthcare of Atlanta Quality Department, Atlanta, GA, USA.

PMID: 39266665
DOI: 10.1038/s41372-024-02112-0

Abstract

Objective: This quality improvement initiative aimed to standardize the diagnosis of necrotizing enterocolitis (NEC) in infants with congenital heart disease (CHD).

Study design: A multidisciplinary team developed clinical practice guidelines for the diagnosis and treatment of NEC within the Cardiac Intensive Care Unit (CICU). The diagnosis rate of NEC per 100 at-risk admissions was the primary outcome measure. NEC order set usage was employed as a process measure, and the balancing measures monitored were CICU length of stay (LOS) and mortality.

Result: After guideline development and implementation, the diagnosis rate of NEC decreased from 3% to 1%, sustained over three years. The EMR order set enabled guideline integration into daily workflow. No change was noted in CICU LOS or mortality.

Conclusion: Guideline implementation standardized the diagnosis of NEC in infants with CHD. Establishing a standardized definition and subsequent treatment regimen has enabled us to provide more consistent and appropriate care.