Actual and Potential Impact of a Home Nasogastric Tube Feeding Program for Infants Whose Neonatal Intensive Care Unit Discharge Is Affected by Delayed Oral Feedings

Abstract

Objective To compare healthcare use and parent health-related quality of life (HRQL) in 3 groups of infants whose neonatal intensive care unit (NICU) discharge was delayed by oral feedings.Study design This was a prospective, single-center cohort of infants in the NICU from September 2018 to March 2020. After enrollment, weekly chart review determined eligibility for home nasogastric (NG) feeds based on predetermined criteria. Actual discharge feeding decisions were at clinical discretion. At 3 months' postdischarge, we compared acute healthcare use and parental HRQL, measured by the PedsQL Family Impact Module, among infants who were NG eligible but discharged with all oral feeds, discharged with NG feeds, and discharged with gastrostomy (G) tubes. We calculated NICU days saved by home NG discharges.Results Among 180 infants, 80 were orally fed, 35 used NG, and 65 used G tubes. Compared with infants who had NG-tube feedings, infants who had G-tube feedings had more gastrointestinal or tube-related readmissions and emergency encounters (unadjusted OR 3.97, 95% CI 1.3-12.7, P = .02), and orally-fed infants showed no difference in use (unadjusted OR 0.41, 95% CI 0.1-1.7, P = .225). Multivariable adjustment did not change these comparisons. Parent HRQL at 3 months did not differ between groups. Infants discharged home with NG tubes saved 1574 NICU days.Conclusions NICU discharge with NG feeds is associated with reduced NICU stay without increased postdischarge healthcare use or decreased parent HRQL, whereas G-tube feeding was associated with increased postdischarge healthcare use.

Clinical Outcomes of Neonatal Intensive Care Unit Graduates with Bridled Nasogastric Feeding Tubes

“…13 Seventy-five percent of study participants discharged with a bridled NGT did not require GT placement, which is consistent with rates of progression to full oral feeds reported among similar cohorts. [4][5][6][7] The typical duration of 1 month of bridled NGT use observed in our study also paralleled that of previously published intervals for both taped and bridled NGT AHF among infants. [4][5][6] We noted that brief trials of taped NGT AHF and ad lib feeds without any tube were employed by providers in several infants to ascertain whether their oral intake would improve without a bridle prior to committing to surgery.…”

“…[4][5][6][7] The typical duration of 1 month of bridled NGT use observed in our study also paralleled that of previously published intervals for both taped and bridled NGT AHF among infants. [4][5][6] We noted that brief trials of taped NGT AHF and ad lib feeds without any tube were employed by providers in several infants to ascertain whether their oral intake would improve without a bridle prior to committing to surgery. These practices accounted for the discrepancy between bridled NGT AHF duration and time to GT after NICU discharge; however, those infants all subsequently underwent GT placement for continued tube feeding support.…”

“…We demonstrated that bridles can be successfully inserted in most infants with a wide variety of surgical histories and medical diagnoses, including prematurity. Four bridles were removed during postplacement monitoring in the NICU, which differed from findings published by Lagatta et al 5 One bridle was removed because the infant was deemed by the medical team as not yet eligible for discharge and returned to standard inpatient taped NGT securement. Three of the four removed bridles were due to skin irritation prior to NICU discharge.…”

“…Duration of AHF in infancy is variable and often not expected to be lifelong. [3][4][5][6][7] GT placement exposes the infant to surgical and anesthetic risks for an anticipated temporary device. Complications of GTs are well described and range from simple dislodgement and site cellulitis to more severe issues such as bowel obstruction and gastrocutaneous fistula requiring reoperation.…”

“…Even so, infants with GTs experience more frequent emergency department (ED) visits for tube-related issues, such as dislodgement, than infants with NGTs when the two routes of AHF are compared. [3][4][5][6] Either AHF device adds complexity to the daily routine, further contributing to challenges and frustrations faced by families. 1 Identifying the optimal AHF choice for an infant, either taped NGT or GT, can be challenging and complex.…”