SYSTEMATIC REVIEW article
Front. Pediatr.
Sec. Neonatology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1519029
Quality Improvement Interventions to Prevent Neonatal Necrotizing Enterocolitis:A Systematic Review
Provisionally accepted
Xueli Zhang1
Mingqiu Chen1Yanfei Zhang1Jieer Zhou2Tingyan Wei2
Yu Zhangbing3Yuqin Yan3*Zhangxing Wang2*- 1518109,Guangdong, China, Department of Pediatrics, People's Hospital of Longhua, Shenzhen, Shenzhen, China
- 2518109,Guangdong, China., Department of Pediatrics, People's Hospital of Longhua, Shenzhen, Shenzhen, China
- 3Department of Neonatology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China, Shenzhen, China
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Background:Neonatal necrotizing enterocolitis(NEC) is the leading cause of death due to gastrointestinal disease in preterm neonates.Quality improvement(QI) bundles could reduce the incidence of NEC in preterm infants, but their replication in neonatal intensive care units(NICU) has had inconsistent outcomes.Objective:Quality improvement may reduce the incidence and severity of NEC in preterm infants. We evaluated quality improvement interventions (QIIs) that sought to prevent or reduce the severity of NEC.Methods: PubMed, Embase, Cochrane Library, Web of Science, Wanfang Database, China National Knowledge Infrastructure (CNKI), VIP, and CBM, and citations of selected articles were searched. QIIs that had reducing incidence or severity of NEC in preterm infants as the primary outcome. Paired reviewers independently extracted data from selected studies.Results:Thirteen quality improvement interventions involving 17961 infants were included. Sixteen of the 19 QIIs reported a significant reduction in the incidence of NEC after implementation of quality improvements. Quality Criteria of the Quality Improvement showed that all interventions were considered to be of medium to high quality, with the lowest score being 8 and 13 reporting scores more than 10. Studies had heterogeneity with significant variations in intervention characteristics, implementation units, personnel, sample size, time, and outcomes.Conclusion:QIIs demonstrated reductions in the incidence and severity of NEC in preterm infants in some but not all settings. Which specific interventions and quality improvement methods were responsible for those reductions and why they were successful in some settings but not others are not clear. This systematic review can assist teams in identifying potentially better practices for reducing NEC.
Keywords: quality improvement1, necrotizing enterocolitis2, preterm infants3, low birth weight infants4, Meta-analysis5
Received: 29 Oct 2024; Accepted: 01 May 2025.
Copyright: © 2025 Zhang, Chen, Zhang, Zhou, Wei, Zhangbing, Yan and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yuqin Yan, Department of Neonatology, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong, China, Shenzhen, China
Zhangxing Wang, 518109,Guangdong, China., Department of Pediatrics, People's Hospital of Longhua, Shenzhen, Shenzhen, China
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