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VOLUME 3 , ISSUE 2 ( April-June, 2024 ) > List of Articles


A Clinical Care Bundle to Prevent Necrotizing Enterocolitis

The LAYA Group of the Global Newborn Society, Nitasha Bagga

Keywords : Care bundle, Human milk oligosaccharides, Intestinal injury, Intestinal failure, Institute of Health Care Improvement, Mother's own milk, NEC Newborn, Neonate, Preterm

Citation Information : The LAYA Group of the Global Newborn Society, Bagga N. A Clinical Care Bundle to Prevent Necrotizing Enterocolitis. 2024; 3 (2):70-82.

DOI: 10.5005/jp-journals-11002-0094

License: CC BY-NC 4.0

Published Online: 21-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Necrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality in very-low-birth-weight (VLBW) infants all over the world. Even thought the incidence of NEC has decreased over the past decade, it continues to affect 5–7% of premature infants born ≤ 32–33 weeks. The disconcerting part is that the incidence of NEC has not changed despite continuous efforts to understand its etiopathogenesis. Because of limited information about the cause of this disease, our group has increasingly focused on developing a clinical care bundle to treat these patients. As we know, a bundle is a structured attempt to improve the care of patients with a specific nosological entity, to improve outcomes. The team adopts a small number of, usually 3–5 evidence-based, proven practices which when performed reliably and consistently, have been shown to improve patient outcomes. In this article, we have focused on the use of human milk, including mother's own, that from donors, and of oral colostrum; standardized feeding practices; prevention of intestinal dysbiosis with antibiotic stewardship and use of probiotics; avoiding certain medications, such as histamine receptor blockers; adequate management of anemia; and antenatal use of corticosteroids. In these efforts, we have combined information from our own peer-reviewed clinical and preclinical studies with an extensive review of the literature from the databases PubMed, EMBASE, and Scopus.

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