Pediatrics World Conference 2026

Abstract

Background. Necrotizing enterocolitis (NEC) remains a major gastrointestinal emergency of prematurity, with substantial mortality, prolonged hospitalization and potential long-term neurodevelopmental morbidity. Very preterm and very-low-birth-weight infants are particularly vulnerable. We evaluated whether a sustained, multidisciplinary NEC-prevention quality-improvement programme could reduce NEC incidence in a high-volume tertiary NICU.

Methods. A four-year quality-improvement initiative was conducted in the level III NICU of Al Qassimi Women’s and Children’s Hospital from January 2021 to December 2024. Infants born at ≤32 weeks’ gestation and/or weighing ≤1.5 kg were included. Monthly data were captured using a focused audit tool and reviewed against progressively lower annual targets. A multidisciplinary NEC-prevention care bundle was implemented and reinforced throughout the study period. Core measures included standardized enteral feeding practices, early trophic feeding with mother’s milk, avoidance of prolonged antibiotic exposure, kangaroo care, appropriate feed supplementation, cautious feeding around blood transfusion, early parenteral nutrition, infection-outbreak control, and continuous staff education and protocol monitoring.

Results. Over the four years, 493 eligible preterm infants were evaluated. NEC occurred in 23 of 105 infants in 2021 (21.9%), 25 of 135 in 2022 (18.5%), 9 of 104 in 2023 (8.7%) and 12 of 149 in 2024 (8.1%). NEC incidence therefore declined from 21.9% to 8.1% over the programme period, an absolute reduction of about 14 percentage points and a relative reduction of approximately 63%. The unit met its progressively lower annual NEC-reduction targets, alongside sustained implementation of the prevention bundle, multidisciplinary education, feeding-protocol surveillance and infection-control measures.

Conclusion. A sustained multidisciplinary NEC-prevention bundle was associated with a marked reduction in NEC incidence among very preterm and very-low-birth-weight infants in this tertiary NICU. The decrease from 21.9% to 8.1% over four years supports continuous audit, standardized feeding practices, infection prevention, staff education and iterative quality improvement as practical strategies for reducing the burden of NEC. This model may offer a reproducible framework for NICUs seeking sustained improvement in NEC prevention.