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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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Hasenstab KA, Prabhakar V, Helmick R, Yildiz V, Jadcherla SR. Pharyngeal biorhythms during oral milk challenge in high-risk infants: Do they predict chronic tube feeding? Neurogastroenterol Motil 2023; 35:e14492. [PMID: 36371708 PMCID: PMC10078406 DOI: 10.1111/nmo.14492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Eating difficulties are common in high-risk neonatal intensive care unit (NICU) infants; mechanisms remain unclear. Crib-side pharyngo-esophageal motility testing is utilized to assess contiguous swallowing physiology, and cross-system interplay with cardio-respiratory rhythms. Aims were to: (1) identify whether distinct pharyngeal rhythms exist during oral milk challenge (OMC), and (2) develop a chronic tube feeding risk prediction model in high-risk infants. METHODS Symptomatic NICU infants (N = 56, 29.7 ± 3.7 weeks birth gestation) underwent pharyngo-esophageal manometry with OMC at 40.9 ± 2.5 weeks postmenstrual age (PMA). Exploratory cluster data analysis (partitioning around k-medoids) was performed to identify patient groups using pharyngeal contractile rhythm data (solitary swallows and swallows within bursts). Subsequently, (a) pharyngeal-esophageal, cardio-respiratory, and eating method characteristics were compared among patient groups using linear mixed models, and (b) chronic tube feeding prediction model was created using linear regression. RESULTS Three distinct patient groups were identified with validity score of 0.6, and termed sparse (high frequency of solitary swallows), intermediate, or robust (high swallow rate within bursts). Robust group infants had: lesser pharyngeal and esophageal variability, greater deglutition apnea, pharyngeal activity, and esophageal activity (all p < 0.05), but less frequent heart rate decreases (p < 0.05) with improved clinical outcomes (milk transfer rate, p < 0.001, and independent oral feeding at discharge, p < 0.03). Chronic tube feeding risk = -11.37 + (0.22 × PMA) + (-0.73 × bronchopulmonary dysplasia) + (1.46 × intermediate group) + (2.57 × sparse group). CONCLUSIONS Robust pharyngeal rhythm may be an ideal neurosensorimotor biomarker of independent oral feeding. Differential maturation of cranial nerve-mediated excitatory and inhibitory components involving foregut, airway, and cardiac rhythms distinguishes the physiologic and pathophysiologic basis of swallowing and cardio-respiratory adaptation.
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Affiliation(s)
- Kathryn A Hasenstab
- Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Varsha Prabhakar
- Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Roseanna Helmick
- Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Vedat Yildiz
- Biostatistics Resource at Nationwide Children's Hospital (BRANCH), Columbus, Ohio, USA.,Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Sudarshan R Jadcherla
- Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Division of Neonatology, Pediatric Gastroenterology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, 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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Alshaikh B, Yusuf K, Dressler-Mund D, Mehrem AA, Augustine S, Bodani J, Yoon E, Shah P. Rates and Determinants of Home Nasogastric Tube Feeding in Infants Born Very Preterm. J Pediatr 2022; 246:26-33.e2. [PMID: 35301017 DOI: 10.1016/j.jpeds.2022.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine rates and determinants of home nasogastric (NG)-tube feeding at hospital discharge in a cohort of very preterm infants within the Canadian Neonatal Network (CNN). STUDY DESIGN This was a population-based cohort study of infants born <33 weeks of gestation and admitted to neonatal intensive care units (NICUs) participating in the CNN between January 1, 2010, and December 31, 2018. We excluded infants who had major congenital anomalies, required gastrostomy-tube, or were discharged to non-CNN facilities. Multivariable logistic regression analysis was used to identify independent determinants of home NG-tube feeding at hospital discharge. RESULTS Among the 13 232 infants born very preterm during the study period, 333 (2.5%) were discharged home to receive NG-tube feeding. Rates of home NG-tube feeding varied across Canadian NICUs, from 0% to 12%. Determinants of home NG-tube feeding were gestational age (aOR 0.94 per each gestational week increase, 95% CI 0.88-0.99); duration of mechanical ventilation (aOR 1.02 per each day increase, 95% CI 1.01-1.02); high illness severity at birth (aOR 1.32, 95% CI 1.01-1.74); small for gestational age (aOR 2.06, 95% CI 1.52-2.78); male sex (aOR 0.61, 95% CI 0.49-0.77); severe brain injury (aOR 1.60, 95% CI 1.10-2.32); and bronchopulmonary dysplasia (aOR 2.22, 95% CI 1.67-2.94). CONCLUSIONS Rates of home NG-tube feeding varied widely between Canadian NICUs. Higher gestational age and male sex reduced the odds of discharge home to receive NG-tube feeding; and in contrast small for gestational age, severe brain injury, prolonged duration on mechanical ventilation and bronchopulmonary dysplasia increased the odds.
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Affiliation(s)
- Belal Alshaikh
- Neonatal Nutrition and Gastroenterology Program, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Kamran Yusuf
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Donna Dressler-Mund
- Occupational Therapy, Alberta Children's Hospital, Alberta Health Services, Calgary, Alberta, Canada
| | - Ayman Abou Mehrem
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sajit Augustine
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Section of Neonatology, Windsor Regional Hospital, Windsor, Ontario, Canada
| | - Jaya Bodani
- Department of Pediatrics, Regina General Hospital, Regina and College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Eugene Yoon
- Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Prakesh Shah
- Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada; Departments of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
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Finding a New Normal: Maternal Experiences Transitioning to Home From the Neonatal Intensive Care Unit Caring for Technology-Dependent Infants. Adv Neonatal Care 2022; 22:E2-E12. [PMID: 35113827 DOI: 10.1097/anc.0000000000000850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infants discharged from the neonatal intensive care unit (NICU) dependent on medical technology (eg, respiratory or nutritional support) are a growing vulnerable population. These infants are medically fragile, prone to emergency department visits and readmissions, and require increased caregiver demands at home. The experiences of their maternal caregiver's after NICU discharge however, are not well understood. PURPOSE This qualitative descriptive study addressed this knowledge gap by interviewing mothers of technology-dependent infants about their experience during their first 2 weeks transitioning to home from the NICU. This is a critical period in which mothers must first assume advanced caretaking responsibilities in the home. METHODS Eight mothers participated in semistructured audio-recorded interviews via the Web conferencing system Zoom and completed demographic questionnaires. RESULTS Five themes emerged from the data that described essential features of the mothers' transition to home: (a) needing coordinated discharge care; (b) establishing a routine; (c) being an advocate; (d) having a support system; and (e) finding normalcy. An additional important finding of this study was the presence of maternal posttraumatic stress and postpartum depression. IMPLICATIONS FOR PRACTICE Results highlight the importance of providing mothers hands-on practice opportunities and identifying social support and home healthcare options prior to discharge of technology-dependent infants. IMPLICATIONS FOR RESEARCH Future research should focus on multidisciplinary interventions targeted toward discharge preparation, transitional support, and understanding maternal psychiatric symptoms among mothers of technology-dependent infants.
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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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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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Matharu P, Cristea AI, Slaven JE, Becker S, Niehaus JZ. Feeding Outcomes for Infants with Bronchopulmonary Dysplasia Discharged on Nasogastric Feeds. Am J Perinatol 2021; 38:897-900. [PMID: 31887745 DOI: 10.1055/s-0039-3401796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE While previous studies regarding neonatal home feeding regimens have demonstrated a more favorable prognosis for nasogastric (NG) versus gastrostomy tubes (GT), institutional practices of discharge on NG feeds are varied, particularly for infants with bronchopulmonary dysplasia (BPD). Little is known regarding the risk factors for patients treated with GT postdischarge in premature infants with BPD. Our objective was to identify frequency and risk factors for treating premature infants with BPD discharged on NG feeds with GT. STUDY DESIGN In this retrospective study, we included infants born at 30 weeks' gestational age with BPD transitioning from a tertiary care center to home on NG feeds from 2010 to 2016. RESULTS Of the 86 infants included in this study, 25 (29%) underwent GT placement at a median age of 264 days postdischarge. Fourteen (56%) were able to remove the GT at a median age of 979.5 days. Infants not requiring GT placement postdischarge were found to have a significantly higher ccipitofrontal circumference (p = 0.0089) and length (p = 0.0166) at discharge compared with infants with GT. CONCLUSION NG feeding for infants with BPD appears to be a viable treatment with fewer patients (29%) requiring GT placement. Gestational age and abnormal magnetic resonance imaging results were found to have a significant association with GT placement postdischarge.
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Affiliation(s)
- Preet Matharu
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
| | - A Ioana Cristea
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Samantha Becker
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
| | - Jason Z Niehaus
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
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Page B, Nawaz R, Haden S, Vincent C, Lee ACH. Paediatric enteral feeding at home: an analysis of patient safety incidents. Arch Dis Child 2019; 104:1174-1180. [PMID: 31201158 PMCID: PMC6900243 DOI: 10.1136/archdischild-2019-317090] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/14/2019] [Accepted: 05/18/2019] [Indexed: 12/25/2022]
Abstract
AIMS To describe the nature and causes of patient safety incidents relating to care at home for children with enteral feeding devices. METHODS We analysed incident data relating to paediatric nasogastric, gastrostomy or jejunostomy feeding at home from England and Wales' National Reporting and Learning System between August 2012 and July 2017. Manual screening by two authors identified 274 incidents which met the inclusion criteria. Each report was descriptively analysed to identify the problems in the delivery of care, the contributory factors and the patient outcome. RESULTS The most common problems in care related to equipment and devices (n=98, 28%), procedures and treatments (n=86, 24%), information, training and support needs of families (n=54, 15%), feeds (n=52, 15%) and discharge from hospital (n=31, 9%). There was a clearly stated harm to the child in 52 incidents (19%). Contributory factors included staff/service availability, communication between services and the circumstances of the family carer. CONCLUSIONS There are increasing numbers of children who require specialist medical care at home, yet little is known about safety in this context. This study identifies a range of safety concerns relating to enteral feeding which need further investigation and action. Priorities for improvement are handovers between hospital and community services, the training of family carers, the provision and expertise of services in the community, and the availability and reliability of equipment. Incident reports capture a tiny subset of the total number of adverse events occurring, meaning the scale of problems will be greater than the numbers suggest.
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Affiliation(s)
- Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Rasanat Nawaz
- Department of Experimental Psychology, University of Oxford, Oxford, UK,Oxford Academic Health Science Network, Oxford, UK
| | - Sarah Haden
- John Radcliffe Hospital, Oxford, Oxfordshire, UK
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Alex C H Lee
- Oxford Academic Health Science Network, Oxford, UK,John Radcliffe Hospital, Oxford, Oxfordshire, UK
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10
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Ermarth A, Thomas D, Ling CY, Cardullo A, White BR. Effective Tube Weaning and Predictive Clinical Characteristics of NICU Patients With Feeding Dysfunction. JPEN J Parenter Enteral Nutr 2019; 44:920-927. [DOI: 10.1002/jpen.1717] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 09/02/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Anna Ermarth
- Department of PediatricsUniversity of Utah School of Medicine Salt Lake City Utah USA
- Division of Pediatric GastroenterologyUniversity of Utah School of Medicine Salt Lake City Utah USA
| | - Debbie Thomas
- Primary Children's HospitalIntermountain Healthcare Salt Lake City Utah USA
| | - Con Yee Ling
- Department of PediatricsUniversity of Utah School of Medicine Salt Lake City Utah USA
- Division of NeonatologyUniversity of Utah School of Medicine Salt Lake City Utah USA
| | - Adam Cardullo
- Department of PediatricsUniversity of Utah School of Medicine Salt Lake City Utah USA
| | - Ben R. White
- Department of PediatricsUniversity of Utah School of Medicine Salt Lake City Utah USA
- Division of NeonatologyUniversity of Utah School of Medicine Salt Lake City Utah USA
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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 2019; 44:491-499. [PMID: 31549429 DOI: 10.1002/jpen.1718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/17/2019] [Accepted: 05/28/2019] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Benjamin R White
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.,Division of Neonatology, University of Utah, Salt Lake City, Utah, USA
| | - Anna Ermarth
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.,Division of Gastroenterology, University of Utah, Salt Lake City, Utah, USA
| | - Debbie Thomas
- Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Olivia Arguinchona
- Continuous Improvement, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Angela P Presson
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.,Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - Con Yee Ling
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.,Division of Neonatology, University of Utah, Salt Lake City, Utah, USA
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