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Mitchell MB, Callans K, Erdei C, Patrizi S, Fiechtner L, Kelleher C, Goldstein AM, Lerou P, Turcu R, Fracchia M, Radano M, Dodrill P, Sorbo J, Hersh C, Warren M, Hartnick C. Multi-institutional quality improvement algorithm for home nasogastric tube care for neonates. Int J Pediatr Otorhinolaryngol 2024; 185:112083. [PMID: 39217866 DOI: 10.1016/j.ijporl.2024.112083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/25/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND High-risk neonates continuing to need enteral nutrition, but otherwise medically ready for discharge home from the NICU, are often offered ongoing hospitalization for nasogastric tube (NGT) feeding, versus discharge after placement of gastrostomy tube. Our group developed an interdisciplinary algorithm to support a third option-discharge home with enteral nutrition via NGT. Our objective was to develop a cross-institutional and interdisciplinary pathway to optimize outcomes for neonates discharged with NGTs. METHODS A program to support home NGT feeding use was created, "Passport Home Program," based upon feedback from parents, nurses, speech-language pathologists, otolaryngologists, and neonatal intensivists, amongst others, spanning four hospitals across our health system. RESULTS Standardized educational materials for caregivers of neonates requiring ongoing NGT feeding on discharge were created and consist of an in-hospital curriculum with specific competency thresholds, including demonstrating NGT replacement and confirmation with pH test strips. A discharge kit, including a QR code for a video reviewing safe techniques for home NGT placement, is distributed, along with support staff contact information. Members of an emergency department were trained in neonatal NGT replacement in case of issues after business hours. Each patient is followed in a dedicated outpatient multi-disciplinary clinic. DISCUSSION This is an interdisciplinary and multi-institutional effort to standardize a pathway for neonates discharged home from the NICU with NGTs. This has the potential to lead to earlier discharge, better outcomes for patients and families, as well as lower costs. This best practice algorithm serves as an example pathway applicable across fields of medicine.
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Affiliation(s)
- Margaret B Mitchell
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Kevin Callans
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear, Boston, MA, USA
| | - Carmina Erdei
- Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
| | - Siliva Patrizi
- Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA; Department of Neonatology, Newton-Wellesley Hospital, Boston, MA, USA
| | - Lauren Fiechtner
- Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Mass General for Children, Boston, MA, USA
| | - Cassandra Kelleher
- Harvard Medical School, Boston, MA, USA; Department of Pediatric Surgery, Mass General for Children, Boston, MA, USA
| | - Allan M Goldstein
- Harvard Medical School, Boston, MA, USA; Department of Pediatric Surgery, Mass General for Children, Boston, MA, USA
| | - Paul Lerou
- Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Mass General for Children, Boston, MA, USA
| | - Rodica Turcu
- Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Mass General for Children, Boston, MA, USA
| | - Mary Fracchia
- Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Mass General for Children, Boston, MA, USA
| | - Marcella Radano
- Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Mass General for Children, Boston, MA, USA
| | - Pamela Dodrill
- Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
| | - Jessica Sorbo
- Department of Pediatrics, Mass General for Children, Boston, MA, USA; Pediatric Aerodigestive Center, Massachusetts General Hospital, Boston, MA, USA
| | - Cheryl Hersh
- Department of Pediatrics, Mass General for Children, Boston, MA, USA; Pediatric Aerodigestive Center, Massachusetts General Hospital, Boston, MA, USA
| | - Mollie Warren
- Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA.
| | - Christopher Hartnick
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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2
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Bourque SL, Murthy K, Grover TR, Berman L, Riddle S. Cutting into the NICU: Improvements in Outcomes for Neonates with Surgical Conditions. Neoreviews 2024; 25:e634-e647. [PMID: 39349417 DOI: 10.1542/neo.25-10-e634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/04/2024] [Accepted: 06/03/2024] [Indexed: 10/02/2024]
Abstract
The Children's Hospitals Neonatal Consortium (CHNC), established in 2010, seeks to improve care for infants with medically and surgically complex conditions who are cared for in level IV regional children's hospital NICUs across North America. Through patient-level individual data collection, comparative benchmarking, and multicenter quality improvement work, CHNC has contributed to knowledge and improved outcomes, leveraging novel collaborations between and across institutions. Focusing on antenatal and inpatient care for infants with surgical conditions including congenital diaphragmatic hernia, gastroschisis, and necrotizing enterocolitis, we summarize the progress made in these infants' care. We highlight the ways in which CHNC has enabled multidisciplinary and multicenter collaborations through the facilitation of diagnosis-specific focus groups, which enable comparative observations of outcomes through quality improvement and research initiatives. Finally, we review the importance of postbirth hospitalization needs of these infants and the application of telemedicine in this population.
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Affiliation(s)
- Stephanie L Bourque
- Department of Pediatrics, University of Colorado School of Medicine; Children's Hospital Colorado, Aurora, CO
| | - Karna Murthy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine; Ann & Robert H. Lurie Children's Hospital, Chicago, IL
| | - Theresa R Grover
- Department of Pediatrics, University of Colorado School of Medicine; Children's Hospital Colorado, Aurora, CO
| | - Loren Berman
- Nemours Children's Health, Department of Surgery, Wilmington, DE
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Stefanie Riddle
- Department of Pediatrics, University of Cincinnati School of Medicine; Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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3
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Quinn M, Banta-Wright S, Warren JB. Influences of a Remote Monitoring Program of Home Nasogastric Tube Feeds on Transition from NICU to Home. Am J Perinatol 2024. [PMID: 38889888 DOI: 10.1055/a-2347-4015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVE The transition from the neonatal intensive care unit (NICU) to the home is complex and multifaceted for families and infants, particularly those with ongoing medical needs. Our hospital utilizes a remote monitoring program called Growing @ Home (G@H) to support discharge from the NICU with continued nasogastric tube (NGT) feeds. We aim to describe the experience of the transition from NICU to home for families enrolled in G@H. STUDY DESIGN Using a semistructured interviewing technique, parents of infants discharged on G@H were interviewed at NICU discharge, at 1 month, and at 6 months after NICU discharge. Interviews were recorded and transcribed into data analysis software. Conventional content analysis was used to analyze qualitative data. Codes were assigned to describe key elements of the interviews and used to identify major themes. RESULTS Parents (n = 17) identified three major themes when discussing the effect of G@H on the transition to home. The program provided a means of escape from the NICU, allowing families to stop living split lives between their homes and the NICU. It acted as a middle ground between the restrictive yet supportive NICU environment, and the normal yet isolated home environment. G@H served as a safety net for families, providing a continued connection to the NICU for their still-fragile infants. CONCLUSION G@H utilizes telehealth to positively support the complex transition from NICU to home for families and infants discharged with NGT feeds. KEY POINTS · G@H program supported parents in their transition from NICU to home.. · G@H program provided a means of escape from the NICU.. · G@H program was a middle ground between the NICU and home.. · G@H program created a safety net after discharge.. · Follow-up with a consistent provider was essential to a positive parent experience..
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Affiliation(s)
- Megan Quinn
- Oregon Health and Science University School of Nursing, Portland, Oregon
| | | | - Jamie B Warren
- Department of Pediatrics, Oregon Health and Science University School of Medicine, Doernbecher Children's Hospital, Portland, Oregon
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4
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McBride EB, Lasarev MR, O'Connell DM, Limjoco JJ. Clinical Outcomes of Neonatal Intensive Care Unit Graduates with Bridled Nasogastric Feeding Tubes. Am J Perinatol 2024; 41:1171-1177. [PMID: 35580625 DOI: 10.1055/s-0042-1748161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of this study was to describe clinical outcomes of bridled nasogastric tube (NGT) program implementation for infants requiring assisted home feeding (AHF) to discharge from the neonatal intensive care unit (NICU). STUDY DESIGN This was a descriptive prospective analysis of a pilot cohort of infants after implementation of a bridled NGT AHF program to facilitate discharge from level III and IV NICUs from March 2019 to October 2020. RESULTS Of 29 attempts in infants, 22 infants were discharged with bridled NGTs over 18 months. Bridle placement was unsuccessful in three patients, and four bridles were removed before discharge. Bridle use ranged from 7 to 125 days, with a median duration of 37 days. Dislodgement rate was 0.69 per 100 days. Seventeen infants (77%) achieved full oral feeds, while five (23%) discharged with bridled NGTs later converted to gastrostomy tubes. CONCLUSION Implementation of a bridled NGT program is feasible for level III and IV NICUs to facilitate discharging infants who require feeding support to transition home. KEY POINTS · Bridled NGT use after NICU is typically 1 month.. · Infants have low bridle NGT dislodgement.. · Most bridled NGT NICU grads attain full oral feeds..
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Affiliation(s)
- Elizabeth B McBride
- Division of Neonatology, Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Michael R Lasarev
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Daniel M O'Connell
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Jamie J Limjoco
- Division of Neonatology, Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
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Fisher A, Ermarth A, Ling CY, Brinker K, DuPont TL. Method of home tube feeding and 2-3-year neurodevelopmental outcome. J Perinatol 2024:10.1038/s41372-024-02013-2. [PMID: 38811755 DOI: 10.1038/s41372-024-02013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To describe the Bayley Scales of Infant Development 3rd Edition (Bayley-III) of infants discharged home receiving tube feeds. STUDY DESIGN Retrospective review of infants discharged with nasogastric or gastrostomy tube feeds and completed a Bayley-III assessment at 2-3-years of age through a neonatal follow-up program. Results were reported using descriptive statistics. RESULTS Of infants discharged with nasogastric feeds, median Bayley-III scores were in the low-average to average range, and full oral feeds were achieved in 75%. Of infants discharged with gastrostomy tube feeds, median Bayley-III scores were in the extremely low range, and full oral feeds were achieved in 36%. Our data set did not demonstrate a distinct patient demographic that correlated to the type of feeding tube at discharge. CONCLUSION Neurodevelopmental outcome at 2-3 years does not appear to be negatively impacted by the decision to discharge an infant from the NICU with home NG feedings.
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Affiliation(s)
- Allison Fisher
- Department of Pediatrics, Division of Neonatology, University of Utah, Salt Lake City, UT, USA
| | - Anna Ermarth
- Department of Pediatrics, Division of Gastroenterology, University of Utah, Salt Lake City, UT, USA
| | - Con Yee Ling
- Department of Pediatrics, Division of Neonatology, University of Utah, Salt Lake City, UT, USA
| | | | - Tara L DuPont
- Department of Pediatrics, Division of Neonatology, University of Utah, Salt Lake City, UT, USA.
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Ermarth A, Brinker K, Ostrander B. Feeding dysfunction in NICU patients with cramped synchronized movements. Early Hum Dev 2023; 187:105879. [PMID: 37875030 DOI: 10.1016/j.earlhumdev.2023.105879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/26/2023]
Abstract
Patients admitted to the neonatal intensive care unit (NICU) have higher association for neurodevelopment deficits, specifically cerebral palsy (CP). We identified patients with risk for CP using abnormal Pretchl's General Movement Assessment (GMA) and sub-category of cramped synchronized movements (CSM) and reported their feeding outcomes at discharge. Over 75 % of these patients required either nasogastric (NGT) or gastrostomy tube (GT) at discharge. Of these, 57 % weaned off their NGT or GT at home and 43 % of patients still needed a GT one year after discharge. Of those that could not wean off their NGT or GT, these patients had longer hospital stay, took lower percentage by mouth, and an older post-menstrual age at discharge. We did not find a difference in NGT or GT use between patients with IVH, ELBW, nor between their birthweight or gestation age at birth. This study provides further clinical characteristics in NICU patients who have higher risk of CP, and supports the need for skilled feeding therapy and resources both during and after NICU admission.
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Affiliation(s)
- Anna Ermarth
- University of Utah School of Medicine, Salt Lake City, UT, USA; Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, USA.
| | - Kristin Brinker
- Primary Children's Hospital, Intermountain Health, Salt Lake City, UT, USA
| | - Betsy Ostrander
- University of Utah School of Medicine, Salt Lake City, UT, USA; Division of Pediatric Neurology, Department of Pediatrics, USA
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Fisher C, Haag M, Douglas A, Kayhani A, Warren JB. Remote monitoring for neonates requiring continued nasogastric tube feeding: implementation, patient characteristics, and early outcomes. J Perinatol 2023; 43:1125-1130. [PMID: 37468613 DOI: 10.1038/s41372-023-01732-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/27/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Our neonatal intensive care unit utilizes remote patient monitoring to facilitate hospital discharge with nasogastric tube (NGT) feeds. Program implementation, patient characteristics, and initial outcomes are described. STUDY DESIGN Data was collected prospectively in this implementation study. Descriptive statistics define weight gain, number of NGT feed days, number of days on monitoring, and physician time spent. Patient characteristics, readmissions, and implementation details are described. RESULTS One-hundred and four babies consented to and completed data collection. Average weight gain on monitoring was 31.4 g/day (SD 10.2). Eighty-nine babies (85.6%) achieved full oral feeds while on the program, requiring a median 5 NGT feed days (IQR 2-13) and a median 15 days on monitoring (IQR 11-27). Average physician time spent was 9.1 min per day (SD 3.7). Six babies (5.8%) had unscheduled readmissions while on the program. CONCLUSION Remote monitoring programs can facilitate discharge for babies with continued NGT needs.
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Affiliation(s)
- Christina Fisher
- Department of Pediatrics, Oregon Health & Science University School of Medicine, Doernbecher Children's Hospital, Portland, OR, USA
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Meredith Haag
- Department of Pediatrics, Oregon Health & Science University School of Medicine, Doernbecher Children's Hospital, Portland, OR, USA
| | - Angela Douglas
- Department of Pediatrics, Oregon Health & Science University School of Medicine, Doernbecher Children's Hospital, Portland, OR, USA
| | | | - Jamie B Warren
- Department of Pediatrics, Oregon Health & Science University School of Medicine, Doernbecher Children's Hospital, Portland, OR, USA.
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Ahearn MA, Stephens JR, Zwemer EK, Hall M, Ahuja A, Chatterjee A, Coletti H, Fuchs J, Lewis E, Liles EA, Reade E, Sutton AG, Sweeney A, Weinberg S, Harrison WN. Characteristics and Outcomes of Children Discharged With Nasoenteral Feeding Tubes. Hosp Pediatr 2022; 12:969-980. [PMID: 36285567 DOI: 10.1542/hpeds.2022-006627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To describe the characteristics and outcomes of children discharged from the hospital with new nasoenteral tube (NET) use after acute hospitalization. METHODS Retrospective cohort study using multistate Medicaid data of children <18 years old with a claim for tube feeding supplies within 30 days after discharge from a nonbirth hospitalization between 2016 and 2019. Children with a gastrostomy tube (GT) or requiring home NET use in the 90 days before admission were excluded. Outcomes included patient characteristics and associated diagnoses, 30-day emergency department (ED-only) return visits and readmissions, and subsequent GT placement. RESULTS We identified 1815 index hospitalizations; 77.8% were patients ≤5 years of age and 81.7% had a complex chronic condition. The most common primary diagnoses associated with index hospitalization were failure to thrive (11%), malnutrition (6.8%), and acute bronchiolitis (5.9%). Thirty-day revisits were common (49%), with 26.4% experiencing an ED-only return and 30.9% hospital readmission. Revisits with a primary diagnosis code for tube displacement/dysfunction (10.7%) or pneumonia/pneumonitis (0.3%) occurred less frequently. A minority (16.9%) of patients progressed to GT placement within 6 months, 22.3% by 1 year. CONCLUSIONS Children with a variety of acute and chronic conditions are discharged from the hospital with NET feeding. All-cause 30-day revisits are common, though revisits coded for specific tube-related complications occurred less frequently. A majority of patients do not progress to GT within a year. Home NET feeding may be useful for facilitating discharge among patients unable to meet their oral nutrition goals but should be weighed against the high revisit rate.
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Affiliation(s)
- M Alex Ahearn
- Division of Hospital Pediatrics, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - John R Stephens
- Division of Hospital Pediatrics, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Eric K Zwemer
- Division of Hospital Pediatrics, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Matt Hall
- Department of Analytics, Children's Hospital Association, Overland Park, Kansas
| | - Arshiya Ahuja
- Division of Hospital Pediatrics, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Ashmita Chatterjee
- Division of Hospital Pediatrics, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Hannah Coletti
- Division of Hospital Pediatrics, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jennifer Fuchs
- Division of Hospital Pediatrics, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Emilee Lewis
- Division of Hospital Pediatrics, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - E Allen Liles
- Division of Hospital Pediatrics, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Erin Reade
- Division of Hospital Pediatrics, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Ashley G Sutton
- Division of Hospital Pediatrics, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Alison Sweeney
- Division of Hospital Pediatrics, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Steven Weinberg
- Division of Hospital Pediatrics, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Wade N Harrison
- Division of Hospital Pediatrics, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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9
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Abstract
Premature infants or infants born with complex medical problems are at increased risk of having delayed or dysfunctional oral feeding ability. These patients typically require assisted enteral nutrition in the form of a nasogastric tube (NGT) during their NICU hospitalization. Historically, once these infants overcame their initial reason(s) for admission, they were discharged from the NICU only after achieving full oral feedings or placement of a gastrostomy tube. Recent programs show that these infants can be successfully discharged from the hospital with partial NGT or gastrostomy tube feedings with the assistance of targeted predischarge education and outpatient support. Caregiver opinions have also been reported as satisfactory or higher with this approach. In this review, we discuss the current literature and outcomes in infants who are discharged with an NGT and provide evidence for safe practices, both during the NICU hospitalization, as well as in the outpatient setting.
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Affiliation(s)
- Anna Ermarth
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Con Yee Ling
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
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10
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Mago-Shah DD, Malcolm WF, Greenberg RG, Goldstein RF. Discharging Medically Complex Infants with Supplemental Nasogastric Tube Feeds: Impact on Neonatal Intensive Care Unit Length of Stay and Prevention of Gastrostomy Tubes. Am J Perinatol 2021; 38:e207-e214. [PMID: 32498094 DOI: 10.1055/s-0040-1709497] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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..
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Affiliation(s)
- Deesha D Mago-Shah
- Division of Neonatology, Department of Pediatrics, Duke University Hospital, Durham, North Carolina
| | - William F Malcolm
- Division of Neonatology, Department of Pediatrics, Duke University Hospital, Durham, North Carolina
| | - Rachel G Greenberg
- Division of Neonatology, Department of Pediatrics, Duke University Hospital, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Ricki F Goldstein
- Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, Kentucky
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11
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Lagatta JM, Uhing M, Acharya K, Lavoie J, Rholl E, Malin K, Malnory M, Leuthner J, Brousseau D. 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. J Pediatr 2021; 234:38-45.e2. [PMID: 33789159 PMCID: PMC8238833 DOI: 10.1016/j.jpeds.2021.03.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare healthcare use and parent health-related quality of life (HRQL) in 3 groups of infants whose neonatal intensive care unit (NICU) discharge was delayed by oral feedings. STUDY DESIGN This was a prospective, single-center cohort of infants in the NICU from September 2018 to March 2020. After enrollment, weekly chart review determined eligibility for home nasogastric (NG) feeds based on predetermined criteria. Actual discharge feeding decisions were at clinical discretion. At 3 months' postdischarge, we compared acute healthcare use and parental HRQL, measured by the PedsQL Family Impact Module, among infants who were NG eligible but discharged with all oral feeds, discharged with NG feeds, and discharged with gastrostomy (G) tubes. We calculated NICU days saved by home NG discharges. RESULTS Among 180 infants, 80 were orally fed, 35 used NG, and 65 used G tubes. Compared with infants who had NG-tube feedings, infants who had G-tube feedings had more gastrointestinal or tube-related readmissions and emergency encounters (unadjusted OR 3.97, 95% CI 1.3-12.7, P = .02), and orally-fed infants showed no difference in use (unadjusted OR 0.41, 95% CI 0.1-1.7, P = .225). Multivariable adjustment did not change these comparisons. Parent HRQL at 3 months did not differ between groups. Infants discharged home with NG tubes saved 1574 NICU days. CONCLUSIONS NICU discharge with NG feeds is associated with reduced NICU stay without increased postdischarge healthcare use or decreased parent HRQL, whereas G-tube feeding was associated with increased postdischarge healthcare use.
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Affiliation(s)
- Joanne M. Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Uhing
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Krishna Acharya
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Julie Lavoie
- Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Erin Rholl
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kathryn Malin
- Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Margaret Malnory
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jonathan Leuthner
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David Brousseau
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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