Factors Associated With Success and Failure of Weaning Children From Prolonged Enteral Nutrition

Abstract

Objectives:The aims of the present study were to assess the efficacy of a tube weaning program, and to identify factors associated with success and failure. Methods: This was a retrospective cohort study including all pediatric patients on enteral nutrition (EN) for !6 months for whom at least 1 attempt of weaning was performed in a single tertiary referral center from 2012 to 2017, with a minimum follow-up of 6 months after EN discontinuation. Weaning program was individualized to each child. Weaning success was defined a priori. Factors associated with success were investigated using multivariate analysis. Results: Ninety-four patients were enrolled, in whom a total of 114 attempts of weaning were performed at a median age of 51 AE 40 months. Success was achieved in 80 attempts (success rate of 70%). One hundred three (92%) weaning attempts were performed at home with a follow-up in the outpatient clinic, mostly (74%) by a progressive (>1 month) reduction of tube feeding. Patients who required psychological support during weaning had more failures than patients who did not (odds ratio ¼ 5.7, 95% confidence interval [1.2-27.0], P ¼ 0.03). The presence of impaired oral feeding skills at the time of EN discontinuation was also predictive of failure (odds ratio ¼ 6.2, 95% confidence interval [0.05-0.5], P ¼ 0.005). Conclusions: Our progressive, mostly outpatient-based, patient-tailored program of weaning from EN is effective for tube-dependent children. Children who need psychological support during weaning and those who present impaired oral feeding skills represent a subgroup of at-risk patients for whom alternative weaning strategies may need to be considered.

Weight loss during ambulatory tube weaning: don’t put the feeds back up

“…Long-term enteral feeding has substantial social and healthcare costs, but it is hard to develop expertise in managing tube dependency, as it presents relatively rarely in most centres. Our earlier study6 and a recent larger case series using a similar outpatient feed reduction regime by Dipasquale et al 3 showed that children could be safely tube weaned. In this new series, we consider the role weight loss plays in how long the process takes.…”

“…We successfully weaned 90% of children, compared with 70% in Dipasquale et al's series, where 11% of wean attempts feeds were restarted because of rapid weight loss. 3 The association of weight loss with initially higher BMI has not been reported before, but in another case series, children who failed to stop feeds had markedly higher BMI at baseline (+1 SD), compared with those successfully weaned (−0.41). 16 Thus, there is a risk that high initial weight loss will lead to termination of the weaning process before children have lost enough of their surplus weight to develop an interest in food.…”

“…While the wean duration was longer in boys, as found in another study,15 and in children with developmental delay, much the strongest predictors were the number of weight loss periods and whether feeds had been increased (figure 1). We successfully weaned 90% of children, compared with 70% in Dipasquale et al ’s series, where 11% of wean attempts feeds were restarted because of rapid weight loss 3. The association of weight loss with initially higher BMI has not been reported before, but in another case series, children who failed to stop feeds had markedly higher BMI at baseline (+1 SD), compared with those successfully weaned (−0.41) 16.…”

“…Most descriptions in the literature are of inpatient programmes, with feeds being withdrawn over a matter of days 2. There have been fewer descriptions of slower, outpatient tube weaning programmes,3–5 although these will be more feasible in most settings. The clinic described in this paper was set up within a large National Health Service children’s hospital in the UK (www.nhsggc.org.uk/rhcfeedingclinic) to provide an outpatient multidisciplinary tube weaning service 6–8.…”

Mealtime Support: A Pilot Case Series study of an Effective, Cost-saving Outpatient Hunger-Based Feeding Program for Tube Dependency

“…Other established feeding programs include the following: the Newborn Individualized Developmental Care & Assessment Program (NIDCAP) ( 4 ). The Sequential Oral sensory (SOS) Approach to Feeding ( 5 ), the Satter Eating Competence Model ( 6 ), and programs worldwide in places such as Austria ( 7 ), the United States ( 8 ), the Netherlands ( 9 ), and France ( 10 ). Many programs consist of intensive outpatient or even two to three weeklong inpatient stays.…”