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

Deesha D. Mago-Shah; William F. Malcolm; Rachel G. Greenberg; Ricki F. Goldstein

doi:10.1055/s-0040-1709497

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2021; 38(S 01): e207-e214
DOI: 10.1055/s-0040-1709497

Original Article

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

Deesha D. Mago-Shah

¹Division of Neonatology, Department of Pediatrics, Duke University Hospital, Durham, North Carolina

,

William F. Malcolm

¹Division of Neonatology, Department of Pediatrics, Duke University Hospital, Durham, North Carolina

,

Rachel G. Greenberg

¹Division of Neonatology, Department of Pediatrics, Duke University Hospital, Durham, North Carolina

²Duke Clinical Research Institute, Durham, North Carolina

,

Ricki F. Goldstein

³Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, Kentucky

› Institutsangaben

Abstract

Objective The aim of this study is to evaluate the feasibility, safety, and efficacy of discharge with supplemental nasogastric tube (NGT) feeds in medically complex infants.

Study Design Cohort study of 400 infants enrolled in the Transitional Medical Home (TMH) program at Duke University Level IV neonatal intensive care unit from January 2013 to 2017.

Results Among 400 infants enrolled in the TMH, 57 infants were discharged with an NGT. A total of 45 infants with a variety of diagnoses and comorbidities were included in final analysis. Among 45 infants, 5 obtained a gastrostomy tube (GT) postdischarge. Median (25–75th percentile) length of use of NGT in 40 infants was 12 days (4–37). Excluding four outliers who used NGT for ≥140 days, the median length of use was 8 days (3–24). This extrapolates to a median of 288 hospital days saved for the remaining 36 infants. There were only three emergency room visits related to parental concern for incorrect NGT placement. There was no statistically significant difference in percent oral feeding predischarge or growth in first month postdischarge between infants who orally fed versus those who obtained GTs.

Conclusion Discharge with supplemental NGT feeds is safe and feasible utilizing a standardized protocol and close postdischarge follow-up. This practice can decrease length of stay and prevent need for GT.

Key Points

Discharge with nasogastric tube (NGT) supplementation is safe.
Discharge with NGT supplementation decreases cost.
Discharge with NGT can decrease neonatal intensive care unit length of stay.
Medical home model facilitates safe discharge.

Keywords

infant - newborn - premature - feeding problem - nasogastric tube - gastrostomy tube - medical home

Volltext

Referenzen

References
1 Eichenwald EC, Blackwell M, Lloyd JS, Tran T, Wilker RE, Richardson DK. Inter-neonatal intensive care unit variation in discharge timing: influence of apnea and feeding management. Pediatrics 2001; 108 (04) 928-933
2 Warren MG, Do B, Das A. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Gastrostomy tube feeding in extremely low birthweight infants: frequency, associated comorbidities, and long-term outcomes. J Pediatr 2019; 214: 41-46.e5
3 Lau C. Development of infant oral feeding skills: what do we know?. Am J Clin Nutr 2016; 103 (02) 616S-621S
4 Edwards L, Cotten CM, Smith PB. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development. Inadequate oral feeding as a barrier to discharge in moderately preterm infants. J Perinatol 2019; 39 (09) 1219-1228
5 Jadcherla SR, Wang M, Vijayapal AS, Leuthner SR. Impact of prematurity and comorbidities on feeding milestones in neonates: a retrospective study. J Perinatol 2010; 30 (03) 201-208
6 Greene NH, Greenberg RG, O'Brien SM. et al. Variation in gastrostomy tube placement in premature infants in the United States. Am J Perinatol 2019; 36 (12) 1243-1249
7 Collins CT, Makrides M, McPhee AJ. Early discharge with home support of gavage feeding for stable preterm infants who have not established full oral feeds. Cochrane Database Syst Rev 2015; (07) CD003743
8 Williams SL, Popowics NM, Tadesse DG, Poindexter BB, Merhar SL. Tube feeding outcomes of infants in a Level IV NICU. J Perinatol 2019; 39 (10) 1406-1410
9 White BR, Ermarth A, Thomas D, Arguinchona O, Presson AP, Ling CY. Creation of a standard model for tube feeding at neonatal intensive care unit discharge. JPEN J Parenter Enteral Nutr 2020; 44 (03) 491-499
10 American Academy of Pediatrics Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate. Pediatrics 2008; 122 (05) 1119-1126
11 Khalil ST, Uhing MR, Duesing L, Visotcky A, Tarima S, Nghiem-Rao TH. Outcomes of infants with home tube feeding: comparing nasogastric vs gastrostomy tubes. JPEN J Parenter Enteral Nutr 2017; 41 (08) 1380-1385
12 Avritscher EBC, Mosquera RA, Tyson JE. et al. posttrial sustainability and scalability of the benefits of a medical home for high-risk children with medical complexity. J Pediatr 2019; 206: 232-239.e3
13 Ahnfeldt AM, Stanchev H, Jørgensen HL, Greisen G. Age and weight at final discharge from an early discharge programme for stable but tube-fed preterm infants. Acta Paediatr 2015; 104 (04) 377-383
14 Vohr B, McGowan E, Keszler L. et al. Impact of a transition home program on rehospitalization rates of preterm infants. J Pediatr 2017; 181: 86-92.e1
15 Liu Y, McGowan E, Tucker R, Glasgow L, Kluckman M, Vohr B. Transition home plus program reduces medicaid spending and health care use for high-risk infants admitted to the neonatal intensive care unit for 5 or more days. J Pediatr 2018; 200: 91-97.e3
16 Jensen EA, Dysart K, Gantz MG. et al. The diagnosis of bronchopulmonary dysplasia in very preterm infants. an evidence-based approach. Am J Respir Crit Care Med 2019; 200 (06) 751-759
17 Trembath A, Hornik CP, Clark R, Smith PB, Daniels J, Laughon M. ; Best Pharmaceuticals for Children Act—Pediatric Trials Network. Comparative effectiveness of surfactant preparations in premature infants. J Pediatr 2013; 163 (04) 955-60.e1
18 Ermarth A, Thomas D, Ling CY, Cardullo A, White BR. Effective tube weaning and predictive clinical characteristics of NICU patients with feeding dysfunction. J Parenter Enteral Nutr 2020; 44 (05) 920-927
19 Shaker CS. Infant-guided, co-regulated feeding in the neonatal intensive care unit. Part i: theoretical underpinnings for neuroprotection and safety. Semin Speech Lang 2017; 38 (02) 96-105
20 White BR, Zhang C, Presson AP, Friddle K, DiGeronimo R. Prevalence and outcomes for assisted home feeding in medically complex neonates. J Pediatr Surg 2019; 54 (03) 465-470
21 Wilder RT, Flick RP, Sprung J. et al. Early exposure to anesthesia and learning disabilities in a population-based birth cohort. Anesthesiology 2009; 110 (04) 796-804