Promoting readiness for perioperative neonatal and infant enhanced recovery guideline implementation (propel)

The National Institute of Child Health and Human Development awarded Northwestern University $468,777 on June 25, 2026, under the Child Health and Human Development Extramural Research program (CFDA 93.865) to conduct the Promoting Readiness for Perioperative Neonatal and Infant Enhanced Recovery Guideline Implementation (PROPEL) study.

The award funds research to optimize the Enhanced Recovery After Surgery (ERAS) Neonatal Guidelines for perioperative care of neonatal intestinal surgery and to develop implementation and effectiveness measures for their adoption across neonatal surgery sites. The study will conduct a modified Delphi process with an expert panel of clinicians, parents, caregivers, and other stakeholders to refine the ERAS Neonatal Guidelines, addressing barriers to adoption that prior focus groups identified: guideline-specific barriers such as inadequate patient population definition and low acceptability of specific components, and implementation barriers including insufficient provider knowledge and resistance. The research will develop implementation and effectiveness measures using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and identify potential data sources for measurement.

Performance will take place in Chicago, Illinois, with a period of performance through May 31, 2028. This is a Project Grant assistance type. Northwestern University's Sponsored Research Division administers the award.

Abstract

Enhanced recovery protocols (erps) for surgical patients, comprised of evidence-based components (e.g., minimally invasive surgery, early oral feeds after surgery), improve outcomes, such as reduced hospital length of stay, decreased opioid use, and lower costs. In 2020, the enhanced recovery after surgery (eras®) society published eras® neonatal guidelines for perioperative care of neonatal intestinal surgery (eras neonatal guidelines). To date, these guidelines have not been widely adopted. Neonates undergoing surgery represent a fragile patient population that could benefit greatly from the use of an ERP, given their lengthy recovery times and high complication rates. Through focus groups with clinicians and parents/caregivers from six neonatal surgery sites, we identified two types of barriers to adoption of the guidelines: (1) "guideline- specific barriers" including inadequate definition of the eligible patient population and guideline components, and low acceptability of specific components, and (2) "implementation barriers", including lack of knowledge and resistance among providers. Additionally, implementation of erps is found to be complex, particularly in pediatric populations, and often inadequate. Therefore, inclusion of implementation measures in studies of erps is critical. In this study, promoting readiness for perioperative neonatal and infant enhanced recovery guideline implementation (propel), we will first conduct a modified delphi study among an expert panel of clinicians, parents/ caregivers, and other key stakeholders to optimize the eras neonatal guidelines (optimized eras neonatal guidelines). Next, we will develop implementation and effectiveness measures, using the reach, effectiveness, adoption, implementation, and maintenance (RE-aim) framework, and identify potential data sources for these measures. We will also determine acceptability of specific thresholds for implementation (e.g., percent of patients who should receive regional anesthetic blocks as part of a multimodal pain management strategy). Finally, we will conduct a readiness assessment among US sites to understand neonatal surgery program site and individual clinician readiness for implementation of the optimized eras neonatal guidelines. Specifically, we will assess organizational/ cultural readiness, leadership readiness, resource readiness, and trial readiness and rank order sites on their overall readiness for implementation. This developmental pre-implementation work is critically needed to enhance and inform a future multicenter, prospective effectiveness trial of the guidelines. The propel study will accelerate implementation and facilitate conduct of a trial that will be able to evaluate the effect of the optimized neonatal guidelines on a large (and adequate) sample of neonatal patients and assess sustainability of the protocol.