{"title":"质量改进干预预防新生儿坏死性小肠结肠炎：系统综述。","authors":"Xueli Zhang, Mingqiu Chen, Yanfei Zhang, Jieer Zhou, Tingyan Wei, Zhangbin Yu, Yuqin Yan, Zhangxing Wang","doi":"10.3389/fped.2025.1519029","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Neonatal necrotizing enterocolitis (NEC) is the leading cause of death due to gastrointestinal disease in preterm neonates. Quality improvement bundles could reduce the incidence of NEC in preterm infants, but their replication in neonatal intensive care units has had inconsistent outcomes.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>PubMed, Embase, Cochrane Library, Web of Science, Wanfang Database, China National Knowledge Infrastructure (CNKI), VIP Chinese Journal Service Platform (VIP), Chinese BioMedical Literature Database (CBM), and citations of selected articles were searched. QIIs that reduced the incidence or severity of NEC in preterm infants were the primary outcome. Paired reviewers independently extracted data from selected studies.</p><p><strong>Results: </strong>In total, 13 quality improvement interventions involving 17,961 infants were included. Nearly all of the QIIs included improving breastfeeding rates. Moreover, 16 of the 19 QIIs resulted in a significant reduction in the incidence of NEC after their implementation. Application of the quality criteria of the quality improvement showed that all the interventions were considered to be of medium to high quality, with the lowest score being 8 and 13 of the interventions having scores more than 10. The studies had heterogeneity with significant variations in intervention characteristics, implementation units, personnel, sample size, time, and outcomes.</p><p><strong>Conclusion: </strong>QIIs resulted in reductions in the incidence and severity of NEC in preterm infants in some but not all settings. The specific interventions and quality improvement methods that were responsible for those reductions and why they were successful in some settings but not others are unclear. This systematic review can assist teams in identifying potentially better practices for reducing NEC.</p><p><strong>Systematic reviews registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD42024601939, PROSPERO (CRD42024601939).</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1519029"},"PeriodicalIF":2.1000,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12141217/pdf/","citationCount":"0","resultStr":"{\"title\":\"Quality improvement interventions to prevent neonatal necrotizing enterocolitis: a systematic review.\",\"authors\":\"Xueli Zhang, Mingqiu Chen, Yanfei Zhang, Jieer Zhou, Tingyan Wei, Zhangbin Yu, Yuqin Yan, Zhangxing Wang\",\"doi\":\"10.3389/fped.2025.1519029\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Neonatal necrotizing enterocolitis (NEC) is the leading cause of death due to gastrointestinal disease in preterm neonates. Quality improvement bundles could reduce the incidence of NEC in preterm infants, but their replication in neonatal intensive care units has had inconsistent outcomes.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>PubMed, Embase, Cochrane Library, Web of Science, Wanfang Database, China National Knowledge Infrastructure (CNKI), VIP Chinese Journal Service Platform (VIP), Chinese BioMedical Literature Database (CBM), and citations of selected articles were searched. QIIs that reduced the incidence or severity of NEC in preterm infants were the primary outcome. Paired reviewers independently extracted data from selected studies.</p><p><strong>Results: </strong>In total, 13 quality improvement interventions involving 17,961 infants were included. Nearly all of the QIIs included improving breastfeeding rates. Moreover, 16 of the 19 QIIs resulted in a significant reduction in the incidence of NEC after their implementation. Application of the quality criteria of the quality improvement showed that all the interventions were considered to be of medium to high quality, with the lowest score being 8 and 13 of the interventions having scores more than 10. The studies had heterogeneity with significant variations in intervention characteristics, implementation units, personnel, sample size, time, and outcomes.</p><p><strong>Conclusion: </strong>QIIs resulted in reductions in the incidence and severity of NEC in preterm infants in some but not all settings. The specific interventions and quality improvement methods that were responsible for those reductions and why they were successful in some settings but not others are unclear. This systematic review can assist teams in identifying potentially better practices for reducing NEC.</p><p><strong>Systematic reviews registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD42024601939, PROSPERO (CRD42024601939).</p>\",\"PeriodicalId\":12637,\"journal\":{\"name\":\"Frontiers in Pediatrics\",\"volume\":\"13 \",\"pages\":\"1519029\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-05-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12141217/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Frontiers in Pediatrics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3389/fped.2025.1519029\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Pediatrics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fped.2025.1519029","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
摘要
背景：新生儿坏死性小肠结肠炎（NEC）是导致早产儿胃肠道疾病死亡的主要原因。质量改进包可以降低早产儿NEC的发病率，但在新生儿重症监护病房的复制结果不一致。目的：提高质量可降低早产儿NEC的发病率和严重程度。我们评估了旨在预防或减轻NEC严重程度的质量改进干预措施（QIIs）。方法：检索PubMed、Embase、Cochrane图书馆、Web of Science、万方数据库、中国知网（CNKI）、VIP中文期刊服务平台（VIP）、中国生物医学文献数据库（CBM），并检索选定文章的引文。qi降低了早产儿NEC的发生率或严重程度是主要结局。配对审稿人独立地从选定的研究中提取数据。结果：共纳入13项质量改善干预措施，涉及17961例婴幼儿。几乎所有的qii都包括提高母乳喂养率。此外，19个qii中有16个在实施后导致NEC发病率显著降低。质量改进质量标准的应用表明，所有干预措施均为中高质量，最低得分为8分，10分以上的干预措施有13项。这些研究具有异质性，在干预特征、实施单位、人员、样本量、时间和结果方面存在显著差异。结论：在一些但不是所有的情况下，QIIs导致早产儿NEC的发病率和严重程度降低。导致这些减少的具体干预措施和质量改进方法，以及为什么它们在某些情况下成功而在其他情况下不成功，目前尚不清楚。这种系统的审查可以帮助团队确定潜在的减少NEC的更好的实践。系统综述注册：https://www.crd.york.ac.uk/PROSPERO/view/CRD42024601939, PROSPERO （CRD42024601939）。
Quality improvement interventions to prevent neonatal necrotizing enterocolitis: a systematic review.
Background: Neonatal necrotizing enterocolitis (NEC) is the leading cause of death due to gastrointestinal disease in preterm neonates. Quality improvement bundles could reduce the incidence of NEC in preterm infants, but their replication in neonatal intensive care units 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 Chinese Journal Service Platform (VIP), Chinese BioMedical Literature Database (CBM), and citations of selected articles were searched. QIIs that reduced the incidence or severity of NEC in preterm infants were the primary outcome. Paired reviewers independently extracted data from selected studies.
Results: In total, 13 quality improvement interventions involving 17,961 infants were included. Nearly all of the QIIs included improving breastfeeding rates. Moreover, 16 of the 19 QIIs resulted in a significant reduction in the incidence of NEC after their implementation. Application of the quality criteria of the quality improvement showed that all the interventions were considered to be of medium to high quality, with the lowest score being 8 and 13 of the interventions having scores more than 10. The studies had heterogeneity with significant variations in intervention characteristics, implementation units, personnel, sample size, time, and outcomes.
Conclusion: QIIs resulted in reductions in the incidence and severity of NEC in preterm infants in some but not all settings. The specific interventions and quality improvement methods that were responsible for those reductions and why they were successful in some settings but not others are unclear. This systematic review can assist teams in identifying potentially better practices for reducing NEC.
期刊介绍：
Frontiers in Pediatrics (Impact Factor 2.33) publishes rigorously peer-reviewed research broadly across the field, from basic to clinical research that meets ongoing challenges in pediatric patient care and child health. Field Chief Editors Arjan Te Pas at Leiden University and Michael L. Moritz at the Children''s Hospital of Pittsburgh are supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.
Frontiers in Pediatrics also features Research Topics, Frontiers special theme-focused issues managed by Guest Associate Editors, addressing important areas in pediatrics. In this fashion, Frontiers serves as an outlet to publish the broadest aspects of pediatrics in both basic and clinical research, including high-quality reviews, case reports, editorials and commentaries related to all aspects of pediatrics.
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