Development of the NEC-Zero Toolkit: Supporting Reliable Implementation of Necrotizing Enterocolitis Prevention and Recognition

Neonatal Netw. 2020 Jan 1;39(1):6-15. doi: 10.1891/0730-0832.39.1.6.


The goal of the NEC-Zero project is to reduce the burden of necrotizing enterocolitis (NEC) by increasing access to evidence-based tools to help clinicians and parents integrate evidence into daily care. It involves (a) human milk feeding with prioritized mother's own milk; (b) use of a unit-adopted standardized feeding protocol; (c) a unit-adopted strategy for timely recognition that integrates risk awareness and a structured communication tool when symptoms develop; and (d) stewardship of empiric antibiotics and avoidance of antacids. A toolkit for caregivers and parents was developed to make implementation consistent. For clinicians the toolkit includes: the GutCheckNEC risk score, a structured communication tool, the "Avoiding NEC" checklist, and the NEC-Zero website. For parents, NEC-Zero tools include the website, three educational brochures in English and Spanish, and a collaborative care video produced with the NEC Society. This article describes the toolkit and how it has been accessed and used.

Keywords: family engagement; necrotizing enterocolitis; neonatal intensive care; quality improvement toolkit.

Publication types

  • Review

MeSH terms

  • Checklist / methods*
  • Early Diagnosis
  • Enterocolitis, Necrotizing / prevention & control*
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Infant, Premature, Diseases / diagnosis
  • Infant, Premature, Diseases / prevention & control*
  • Infant, Very Low Birth Weight
  • Intensive Care Units, Neonatal / organization & administration
  • Male
  • Patient Advocacy
  • Quality Improvement*
  • Risk Factors