What is NEC-Zero?

NEC-Zero is an intervention that is delivered in the Neonatal Intensive Care Unit to prevent and improve timely recognition of necrotizing enterocolitis, known as NEC. The intervention “NEC-Zero” is being tested and reflects a common goal to reduce NEC “to zero” incidence. Technology will support the intervention.

Who is funding the project?

The Agency for Healthcare Research and Quality and the Robert Wood Johnson Foundation are funding the study. Banner Health is a key collaborator and Banner Health NICUs will be study sites.

Who is the target population for NEC-Zero?

Babies targeted to receive NEC-Zero are those born weighing under 1500 grams (or < 3.3 pounds).

What clinical practices are included in NEC-Zero?

The intervention integrates parent engagement and includes five practices:

  1. Strategies to promote babies being fed human milk, especially their mom’s milk
  2. Using a tool to support timely recognition called GutCheckNEC with a structured communication tool when clinical worsening is suspected
  3. Limiting the length of time antibiotics are given right after a baby is born
  4. Promoting adherence to a unit-agreed on standardized feeding protocol

What research supports NEC-Zero?

  • Cotten, C. M., Taylor, S., Stoll, B., Goldberg, R. N., Hansen, N. I., Sanchez, P. J., . . . Benjamin, D. K., Jr. (2009). Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics, 123(1), 58-66. doi:10.1542/peds.2007-3423
  • Gephart, S.M., Hanson, C., Wetzel, C., Fleiner, M., Umberger, E.,  Martin, L., Rao, S., Agrawal, A., Marin, T., Kirmani, K., Quinn, M., Quinn, J., Dudding, K.,  Clay, T., Sauberan, J., Eskenazi, Y., Porter, C., Msowoya, A., Wyles, C., Avenado-Ruiz, M., Vo, S., Reber, C., and Duchon, J. (2017). NEC-Zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis.  Maternal Health, Neonatology and Perinatology. 3(23). https://doi.org/10.1186/s40748-017-0062-0
  • Gephart, S. M., Spitzer, A. R., Effken, J. A., Dodd, E., Halpern, M., & McGrath, J. M. (2014). Discrimination of GutCheck(NEC): a clinical risk index for necrotizing enterocolitis. J Perinatol, 34(6), 468-475. doi:10.1038/jp.2014.37
  • Gephart, S. M., Wetzel, C., & Krisman, B. (2014). Prevention and early recognition of necrotizing enterocolitis: a tale of 2 tools--eNEC and GutCheckNEC. Adv Neonatal Care, 14(3), 201-210; quiz 211-202. doi:10.1097/anc.0000000000000063
  • Jasani, B., & Patole, S. (2017). Standardized feeding regimen for reducing necrotizing enterocolitis in preterm infants: an updated systematic review. J Perinatol, 37(7), 827-833. doi:10.1038/jp.2017.37
  • Samuels, N., van de Graaf, R. A., de Jonge, R. C. J., Reiss, I. K. M., & Vermeulen, M. J. (2017). Risk factors for necrotizing enterocolitis in neonates: a systematic review of prognostic studies. BMC Pediatr, 17(1), 105. doi:10.1186/s12887-017-0847-3
  • Gephart, S. M., Newnam, K., Wyles, C., Bethel, C., Porter, C., Quinn, M. C., Canvasser, J., Umberger, E., & Titler, M. (2020, Jan 1). Development of the NEC-Zero Toolkit: Supporting Reliable Implementation of Necrotizing Enterocolitis Prevention and Recognition. Neonatal Netw, 39(1), 6-15. https://doi.org/10.1891/0730-0832.39.1.6
  • Quinn, J. M., Gephart, S. M., & Davis, M. P. (2019, Dec). External Facilitation as an Evidence-Based Practice Implementation Strategy During an Antibiotic Stewardship Collaborative in Neonatal Intensive Care Units. Worldviews Evid Based Nurs, 16(6), 454-461. https://doi.org/10.1111/wvn.12413