Prevalence and outcomes for assisted home feeding in medically complex neonates

White, Benjamin R; Zhang, Chong; Presson, Angela P.; Friddle, Kim; DiGeronimo, Robert

doi:10.1016/j.jpedsurg.2018.05.020

Cited by 13 publications

(24 citation statements)

References 24 publications

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“…Exclusion criteria included death prior to discharge, transfer to another institution, discharge on transpyloric feeds, discharge on parenteral nutrition without supplemental tube feeds, discharge for palliative care, and LOS <2 days. Infants discharged on HEN were compared with those discharged on full oral feeds, and both groups were compared with a previously described cohort of infants discharged from January 2013 to December 2015 . Data from the preintervention cohort were gathered retrospectively from the Intermountain Healthcare electronic medical record (EMR), and identical exclusion criteria were used.…”

Section: Methodsmentioning

confidence: 99%

“…Infants discharged on HEN were compared with those discharged on full oral feeds, and both groups were compared with a previously described cohort of infants discharged from January 2013 to December 2015. 4 Data from the preintervention cohort were gathered retrospectively from the Intermountain Healthcare electronic medical record (EMR), and identical exclusion criteria were used.…”

Section: Methodsmentioning

confidence: 99%

“…Full oral feeding is generally the last milestone achieved for neonates prior to hospital discharge from the neonatal intensive care unit (NICU), but many infants have prolonged oral feeding dysfunction that extends their hospital admission . Few studies have explored the scope of this problem, but available data suggest that this group represents as much as 16%–33% of the NICU population . Prolonged NICU admission not only adds cost but also carries the risk of iatrogenic harm to the patient and emotional stress for the family …”

Section: Introductionmentioning

confidence: 99%

“…1 Few studies have explored the scope of this problem, but available data suggest that this group represents as much as 16%-33% of the NICU population. [2][3][4] Prolonged NICU admission not only adds cost but also carries the risk of iatrogenic harm to the patient and emotional stress for the family. 2 Approaches to prolonged feeding dysfunction have historically involved either continuing admission until full oral feeding is achieved or until a gastrostomy tube (GT) is placed.…”

Section: Introductionmentioning

confidence: 99%

“…5 The use of home nasogastric tube (NG) feeding can allow for earlier discharge of these infants from the NICU, and the medical literature on home NG feeds supports its safety and utility in diverse groups, including older children, infants with congenital heart disease, and neonates. 2,4,[6][7][8][9][10][11][12][13][14][15][16] Yet, this practice has not been widely adopted, and processes that effectively recognize neonates who are candidates for HEN, determine their appropriate feeding modality (NG vs GT), and inform optimal discharge timing are still lacking.…”

Section: Introductionmentioning

confidence: 99%

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

White

Ermarth

Thomas

et al. 2019

J Parenter Enteral Nutr

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

White

Ermarth

Thomas

et al. 2019

J Parenter Enteral Nutr

Self Cite

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

Ermarth

Thomas

Ling

et al. 2019

J Parenter Enteral Nutr

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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.

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Feeding, Swallowing, and Breathing in Infants and Children with BPD

Hysinger,

House

2024

Pediatric Aerodigestive Medicine

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Prevalence and outcomes for assisted home feeding in medically complex neonates

Cited by 13 publications

References 24 publications

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

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

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

Feeding, Swallowing, and Breathing in Infants and Children with BPD

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