Implementation of a scoring tool and treatment algorithm for necrotising enterocolitis in the CHD population: a novel quality improvement approach

Patients with CHD have an increased risk of necrotising enterocolitis, leading to higher mortality compared to infants without necrotising enterocolitis. Current definitions and treatment recommendations are based on premature infants and accepted criteria for diagnosing or treating necrotising enterocolitis in infants with CHD are lacking. We performed a quality improvement project to develop and implement a diagnostic scoring tool and treatment algorithm for necrotising enterocolitis in infants with CHD, aiming to enhance early diagnosis, categorise disease severity, and expedite safe return to enteral feeding. The scoring tool and algorithm were implemented in children with CHD under six months of age with clinical suspicion of necrotising enterocolitis. Outcome measures included days of nil per os (NPO), duration of antibiotic treatment, time on total parenteral nutrition, and time to full enteral feeding after diagnosis. Balancing measures included progression to surgical necrotising enterocolitis, vasoactive-inotropic score, length of stay, and mortality. Twenty-seven patients were included (14 preintervention and 13 postintervention) and 39 episodes of necrotising enterocolitis were analysed (19 preintervention and 20 postintervention). In the postintervention group, patients were NPO for fewer days (2 vs. 7 days, p = 0.004), had a shorter duration of antibiotic treatment (3 vs. 7 days, p = 0.02), received total parenteral nutrition for fewer days (0 vs. 20 days, p = 0.01), and returned to full feeds more quickly (8 versus 18 days, p = 0.013) without increased progression to surgical necrotising enterocolitis (3 versus 0, p = 0.11). Implementation of a novel necrotising enterocolitis scoring tool and treatment algorithm reduced NPO days, antibiotic duration, and time to full feeds without increasing surgical necrotising enterocolitis in infants with CHD.