Implementation of the Best Evidence: Probiotics in the Neonatal Intensive Care Setting in an Effort to Prevent Necrotizing Enterocolitis in Preterm Infants

Abstract

Necrotizing enterocolitis (NEC) is a devastating and deadly disease that causes inflammation and tissue necrosis of the intestinal tract. Probiotics, live microbial additives that colonize the intestines, are known to protect high-risk premature neonates from developing NEC. Although complex and extensive literature exists recommending the use of probiotics in NEC prevention, many clinicians are resistant to utilizing this therapy. This may be attributed to a lack of current patient specific evidence-based clinical practice guidelines. The aim for this scholarly project was to develop and implement a clinical practice guideline for the use of probiotics in premature infants with birth weights greater than 1,000 grams. Lewin’s Change Theory provides the theoretical framework that underpins this translational research project. An integrative review of literature based upon the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting was utilized. Strength and confidence of the evidence was examined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. This comprehensive approach assisted in guideline development for determining, appropriate treatment populations, contraindications, strain combinations, dosing, administration, preparation, storage, quality assurance methods, clinical monitoring and adverse effects, and family centered involvement in regards to implementing probiotics for prevention of NEC in the neonatal intensive care setting.