Effective Tube Weaning and Predictive Clinical Characteristics of NICU Patients With Feeding Dysfunction

Abstract

BackgroundThe present study evaluated the effectiveness of a multidisciplinary earlier discharge model for neonates receiving home enteral nutrition (HEN).MethodsA retrospective data review and analysis was performed on 183 patients discharged out of the neonatal intensive care unit (NICU) receiving partial oral feeds (PO) and partial HEN from September 2016 to March 2018. These patients were followed in a multidisciplinary clinic led by a pediatric gastroenterologist, a neonatal feeding therapist, and a pediatric dietitian. Demographics and data were recorded for patients at discharge, and then chart reviews were performed for additional data.ResultsOf 182 patients, 121 (67%) weaned off HEN with a median time to full PO at 79 days (interquartile range [IQR] 15, 247) and had median PO intake of 20% (0, 43) at time of discharge. When comparing patients who gained 100% PO vs patients who did not wean off HEN, the weaned group consisted of 88% nasogastric tubes, with median time off feeds at 27 days (IQR 8, 79) and median PO intake of 29% (11, 50) at discharge. Only 13% of the cohort had an emergency room or hospital admission, which corresponds to 1.6 and 0.8 events, respectively, per 500 tube days specifically due to HEN complications.ConclusionsOur study supports that NICU patients with feeding dysfunction can effectively and safely discharge home earlier while receiving HEN. Our data suggest that a dedicated outpatient clinic can facilitate effective tube weaning in a majority of neonates with complex medical diseases with low rates of adverse events.

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

“…day (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). Infants who progressed to full oral feeds gained 24 g/day (17-29) and infants who eventually received a GT gained 28 g/day (22-37) in the first month (►Table 5).…”

“…Other studies have had success in helping infants attain full oral feeds taking as little as 30% of their daily feed volume by mouth at discharge. 18 Further studies being added to the literature and further comparison and analysis of patients who are or are not successful in attaining full oral feeds would likely further elucidate factors that decrease length of stay and avoid GTs. Social consideration also played an important role in selecting families who had been consistent in their daily communication and interaction with the team (even if not able to be at bedside daily), showed ability to orally feed the child well, desired breastfeeding, would follow-up consistently in clinic, and agreed that NGT was not a long-term management plan.…”

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

“…We found that infants discharged with home NG feedings had a median time to achieving full oral feeds of 29 days; this timeline is similar to other programs. 8,12 As centers like ours shift to more liberal use of home NG at discharge, we will need to maintain responsive outpatient follow-up and support for parents and clinicians caring for these infants in the community setting. Since beginning our home NG program, our institution has increased our ac-cess to enteral feeding providers 24/7 for troubleshooting, hoping to centralize tube-related care and reduce the number of emergency room visits for NG-or G tube-related issues.…”

“…[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.…”

Feeding outcomes in post-discharge feeding clinic for infants following cardiac surgery

“…Influence on the approach to infant tube weaning was not spared from the well-meaning advice families may receive from other family members, websites, internet groups, and social media that may affect adherence to research supported tube weaning. 18,39,[41][42][43][44][45] This study was limited by several factors. This study was retrospective and the pre-clinic data were confounded by manual chart review of cardiology visit notes with high reporting variability and difficulty discerning amount of weight gain or loss with the 100% oral feeding with the pre-clinic cohort.…”