Creation of a Standard Model for Tube Feeding at Neonatal Intensive Care Unit Discharge

Abstract

Background Feeding dysfunction is a common consequence of prematurity and illness in neonates, often requiring supplemental nasogastric (NG) or gastrostomy (GT) feeding tubes. A standardized approach to the discharge of infants receiving home enteral nutrition (HEN) is currently lacking. Methods The Home Enteral Feeding Transitions (HEFT) program was developed to identify patients eligible for HEN and create a standard discharge process. A structured tool helped determine discharge timing and route, and a dedicated outpatient clinic was created for infants discharged on HEN. Demographic, inpatient, and outpatient data were prospectively collected and compared with a historical cohort. Results A total of 232 infants discharged from our neonatal intensive care unit (NICU) over 9 months met inclusion criteria. Ninety‐eight (42%) were discharged with HEN, 68 NG and 30 GT, compared with 134 (58%) receiving full oral feeds. This represented a 10% increase in HEN utilization (P = 0.003) compared with our historical control group. Median HEN length of stay was 31.5 days compared with our historical average of 41 days (P = 0.23). Frequency of emergency department visits and admissions because of HEN was unchanged postintervention. Parents were satisfied (8.6/10), and 98% said they would choose HEN again. The median time to NG discontinuation after discharge was 13.5 days, with an estimated cost savings of $2163 per NICU day. Conclusion Our program is the first of which we know to use a standard care‐process model to guide the decision‐making and utilization of HEN at NICU discharge. HEFT shows that HEN at NICU discharge can be safe and effective, with high parental satisfaction.

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

“…1 When describing home NG discharge criteria, previous studies describe physiologic stability and provider consensus that the infant is appropriate for discharge. 11,14 By testing a set of explicit NG criteria apart from the clinical team, we found that one-third of infants enrolled in our study could have been home NG eligible. In practice, most infants discharged with NG tubes were discharged about a week after they met discharge criteria, likely due to a combination of provider hesitancy or unfamiliarity with a novel program, coordinating discharge care needs, and continued progress with Shown are readmissions, emergency department encounters, and parent HRQL by 3 months after discharge, by discharge feeding type.…”

“…9 More programs are now reporting positive experiences with home NG programs. [9][10][11][12]19 Our study adds to this growing literature by comparing outcomes for infants discharged with G tubes and NG tubes to a unique reference group of infants who could have been discharged with home NG feeds but who instead remained in the NICU until achieving full oral feeding. Another unique feature of our study was the inclusion of patient-reported outcomes.…”

“…[3][4][5][6][7] Recently there has been interest in the use of home nasogastric (NG)-tube feedings for neonates, with retrospective studies describing lower rates of readmission and tube-related complications compared with infants with G tubes. [8][9][10][11][12] A home NG program may be an option for hospitals managing their NICU census, or for families who would prefer to attempt oral skill development at home before committing their infant to a surgical procedure. Although oral feeding impacts NICU discharge timing, it is unknown how many infants could be candidates for home NG feedings.…”

Discharging Medically Complex Infants with Supplemental Nasogastric Tube Feeds: Impact on Neonatal Intensive Care Unit Length of Stay and Prevention of Gastrostomy Tubes

“…6 Some neonatal intensive care units (NICUs) discharge infants with supplemental nasogastric tube (NGT) feeds as an alternative to GT placement, but there are limited data published and few centers have organized protocols. [7][8][9] Previous studies have shown that discharge of stable premature infants with supplemental NGT can decrease length of stay without complications. [7][8][9] The American Academy of Pediatrics also recommends consideration of discharge with supplemental gavage feeds when inability to achieve full oral feeds is the only factor keeping the infant in the hospital.…”

“…[7][8][9] Previous studies have shown that discharge of stable premature infants with supplemental NGT can decrease length of stay without complications. [7][8][9] The American Academy of Pediatrics also recommends consideration of discharge with supplemental gavage feeds when inability to achieve full oral feeds is the only factor keeping the infant in the hospital. 10 Other studies have shown that infants discharged home with supplemental NGT compared with GT feeds have fewer emergency room visits and complications.…”