Through a unique academic-clinical partnership with Banner Health in Phoenix, Sheila M. Gephart, RN, PhD, assistant professor at the University of Arizona College of Nursing, is refining a first-of-its-kind early recognition score for necrotizing enterocolitis (NEC), a devastating and expensive gastrointestinal disease that affects premature and critically ill babies in neonatal intensive care units (NICUs).
GutCheckNEC is a 10-item risk assessment originally developed by Dr. Gephart using data from nearly 60,000 infants cared for in 284 NICUs across the United States. During her pre-doctoral fellowship funded by the National Institutes of Health National Institute of Nursing Research, Dr. Gephart found that GutCheckNEC successfully predicted neonatal risk for NEC.
Through a new research study supported by Banner Health and the UA College of Nursing Laurence B. Emmons Research Fund, Dr. Gephart and her main clinical partners, Banner Health’s Shelly Fleiner, DNP, RNC-NIC, CCNS, a neonatal clinical nurse specialist, and Karen Johnson, PhD, RN, director of nursing research, are determining how GutCheckNEC can best help clinicians diagnose NEC in real time.
“NEC is a complication where part of the intestine becomes damaged and can die,” said Dr. Gephart, who witnessed this condition firsthand during her years as a neonatal nurse. “Although we don’t know the exact cause of NEC, an immature immune system, feeding and some type of infectious agent all contribute to its development. The most severe form of NEC is when the damage is so extensive that air builds up in the bowel and it ruptures, which can be fatal.”
Dr. Gephart says the biggest challenge with NEC is that symptoms present unexpectedly, and when they do, the diagnosis often is missed or late. However, when neonatal staff members recognize the signs and intervene earlier, they can treat it without surgery, a late intervention that carries a much higher risk of complications and death.
“Surgical NEC is really what we’re trying to avoid, because it’s related to the worst long-term outcomes,” said Dr. Gephart. “We’re looking at mortality rates of up to 50 percent and extremely long hospital stays. Treating surgical NEC also is very expensive, with costs often exceeding $200,000 per infant.”
Dr. Gephart’s ultimate goal is to make GutCheckNEC fully-automated and integrated into electronic health records to alert clinicians as to when NEC is developing.
“It is life-saving work,” said Dr. Gephart. “If you can save just one baby, you preserve a whole family.”
The three clinical sites for the study are:
• Cardon Children’s Medical Center/Banner Desert Medical Center
• Banner Thunderbird Medical Center
• Banner Estrella Medical Center
Faculty at the University of Arizona College of Nursing envision, engage and innovate in education, research and practice to help people of all ages optimize health in the context of major life transitions, illnesses, injuries, symptoms and disabilities. Established in 1957, the college ranks among the top nursing programs in the United States. For more information about the college, please visit its website, www.nursing.arizona.edu