Effect of a Quality Improvement Project to Use Exclusive Mother's Own Milk on Rate of Necrotizing Enterocolitis in Preterm Infants
Bibliographic record
Abstract
OBJECTIVE: Mother's own milk (MOM) remains the key strategy to prevent necrotizing enterocolitis (NEC) in preterm infants. We developed and implemented quality improvement (QI) initiatives to improve rate of using MOM in preterm infants of <32 weeks of gestation. The objective was to evaluate the impact of this QI project on NEC incidence in this population. STUDY DESIGN: In November 2009, we established a QI multidisciplinary team that reviewed literature and practices of other institutions to promote exclusive use of MOM in preterm infants of <32 weeks of gestation. The team developed practice changes that were implemented in February 2010. We tracked use of MOM and occurrence of NEC stage ≥ 2 from January 2009 until March 2012 when donor human milk was introduced. The subjects were divided into three groups: baseline (year 2009; n = 189), intervention phase (year 2010; n = 202), and sustain phase (January 2011-March 2012; n = 254). Clinical outcomes of the baseline and sustain phases were compared. RESULTS: Exclusive use of MOM improved significantly from 60.8% to 73.6% at time of first feed (p = 0.004) without any delay in feed introduction (median [interquartile range], 40 [26, 75.5] hours versus 43.5 [24, 69] hours; p = 0.96). There was a nonsignificant increase in exclusive use of MOM at time of full feed (from 79.5% to 85.2%; p = 0.11); however; use of any MOM increased significantly from 80.4% to 91.3% (p < 0.001) at discharge. Time to reach full feed and length of stay remained similar between the baseline and sustain periods. On regression analysis, risk of NEC decreased significantly in the sustain period (odds ratio = 0.32; 95% confidence interval, 0.11-0.93). CONCLUSIONS: QI initiatives were effective in increasing use of exclusive MOM at time of first feed and of any MOM at time of discharge and in reducing NEC incidence in our neonatal intensive care unit.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".