1
|
Enteral tube feeding selection at NICU discharge and resource utilization. J Perinatol 2022; 43:647-652. [PMID: 36435925 DOI: 10.1038/s41372-022-01566-4] [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: 05/24/2022] [Revised: 11/05/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate resource utilization in infants discharged with different forms of feeding access. STUDY DESIGN Retrospective chart review of neonates discharged from 2012 to 2018. Data were collected from the medical record and relevant outcomes were compared. RESULTS 300 patients were sampled. 196 (65%) were discharged on NG feeds, 95 (32%) via GT, and 9 gastrojejunal (GJ 3%). NG-fed infants discharged sooner (mean DOL: NG = 85.4 vs GT = 122.8, p < 0.001). More GT/GJ patients required emergency department (ED) visits for tube complications (GT = 61 vs GJ = 7 vs NG = 42, p < 0.001) and more frequently (mean visits: GT = 1.63 ± 2.33 vs GJ = 4.22 ± 4.44 vs NG = 0.48 ± 1.40, p < 0.001). However, 44 (24%) of the patients discharged on NG later had a GT placed. CONCLUSIONS Many patients discharged from the NICU can be supported with NG feeds. This may shorten hospital stays and decrease ED visits but select patients will later merit surgical tube placement.
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Berman L, Baird R, Sant'Anna A, Rosen R, Petrini M, Cellucci M, Fuchs L, Costa J, Lester J, Stevens J, Morrow M, Jaszczyszyn D, Amaral J, Goldin A. Gastrostomy Tube Use in Pediatrics: A Systematic Review. Pediatrics 2022; 149:186999. [PMID: 35514122 DOI: 10.1542/peds.2021-055213] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Despite frequency of gastrostomy placement procedures in children, there remains considerable variability in preoperative work-up and procedural technique of gastrostomy placement and a paucity of literature regarding patient-centric outcomes. OBJECTIVES This review summarizes existing literature and provides consensus-driven guidelines for patients throughout the enteral access decision-making process. DATA SOURCES PubMed, Google Scholar, Medline, and Scopus. STUDY SELECTION Included studies were identified through a combination of the search terms "gastrostomy," "g-tube," and "tube feeding" in children. DATA EXTRACTION Relevant data, level of evidence, and risk of bias were extracted from included articles to guide formulation of consensus summaries of the evidence. Meta-analysis was conducted when data afforded a quantitative analysis. EVIDENCE REVIEW Four themes were explored: preoperative nasogastric feeding tube trials, decision-making surrounding enteral access, the role of preoperative imaging, and gastrostomy insertion techniques. Guidelines were generated after evidence review with multidisciplinary stakeholder involvement adhering to GRADE methodology. RESULTS Nearly 900 publications were reviewed, with 58 influencing final recommendations. In total, 17 recommendations are provided, including: (1) tTrial of home nasogastric feeding is safe and should be strongly considered before gastrostomy placement, especially for patients who are likely to learn to eat by mouth; (2) rRoutine contrast studies are not indicated before gastrostomy placement; and (3) lLaparoscopic placement is associated with the best safety profile. LIMITATIONS Recommendations were generated almost exclusively from observational studies and expert opinion, with few studies describing direct comparisons between GT placement and prolonged nasogastric feeding tube trial. CONCLUSIONS Additional patient- and family-centric evidence is needed to understand critical aspects of decision-making surrounding surgically placed enteral access devices for children.
Collapse
Affiliation(s)
- Loren Berman
- Departments of Surgery.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert Baird
- Department of Pediatric General and Thoracic Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ana Sant'Anna
- Department of Pediatrics, Division of Gastroenterology and Nutrition, McGill University Health Center, Montreal, Quebec, Canada
| | - Rachel Rosen
- Aerodigestive Center, Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts
| | - Maria Petrini
- Pediatrics.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Cellucci
- Pediatrics.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lynn Fuchs
- Neonatology.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joanna Costa
- Neonatology.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jennifer Lester
- Nutrition.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jenny Stevens
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Michele Morrow
- Therapy Services, Nemours Children's Health, Wilmington, Delaware.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Joao Amaral
- Department of Diagnostic Imaging, Division of Interventional Radiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adam Goldin
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
| |
Collapse
|
4
|
Mahdi EM, Tran NN, Ourshalimian S, Sanborn S, Alquiros MT, Squillaro A, Lascano D, Herrington C, Kelley-Quon LI. Factors Impacting Long-Term Gastrostomy Tube Dependence in Infants with Congenital Heart Disease. J Surg Res 2021; 270:455-462. [PMID: 34800791 DOI: 10.1016/j.jss.2021.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/09/2021] [Accepted: 09/21/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Infants with congenital heart disease (CHD) often experience oral feeding intolerance requiring gastrostomy (GT). Complications related to GT use are common. The study aim was to identify factors associated with continued GT use at one-year. METHODS A retrospective cohort study was performed at a tertiary children's hospital using the Society of Thoracic Surgeons database and patients' electronic medical record. Infants <1-year with CHD who underwent cardiac and GT surgery between January 2014-October 2019 were identified. Patient demographics, preoperative feeding, clinical variables, and GT use at one-year was evaluated. A separate cohort discharged with a nasogastric tube (NGT) was identified for longitudinal comparisons. RESULTS Of 137 infants who received a GT, 115 (84%) continued using their GT at one-year. Factors associated with continued GT use included lower median percent of goal oral feeding before GT placement (0% IQR 0-6.5 versus 3.7% IQR 0-31), prolonged hospitalization after GT placement (36% versus 14%, P-value = 0.048), and failure to take oral feeds at discharge (69% versus 27%, P-value <0.001). There was no difference in demographics or clinical comorbidities between groups. Clinic/emergency room visits for GT complications were common (72%). Eight infants discharged with a NGT did not require GT placement. CONCLUSIONS Patients with CHD tolerating minimal oral nutrition before GT placement, prolonged hospitalization after GT, and difficulty with oral feeds at discharge were more likely to use their GT at 1-year. Outpatient NGT feeding is feasible for select infants with CHD. Efforts to optimize care for this complex, device-dependent population are warranted to minimize risks and facilitate family engagement for long-term care.
Collapse
Affiliation(s)
- Elaa M Mahdi
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Nhu N Tran
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Shadassa Ourshalimian
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Stephanie Sanborn
- Department of Clinical Nutrition and Lactation Services, Children's Hospital Los Angeles, Los Angeles, California
| | - Maria Theresa Alquiros
- Division of Cardiac Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Anthony Squillaro
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Danny Lascano
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Cynthia Herrington
- Division of Cardiac Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California.
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Abdelhadi RA, Rempel G, Sevilla W, Turner JM, Quet J, Nelson A, Rahe K, Wilhelm R, Larocque J, Guenter P. Transitioning From Nasogastric Feeding Tube to Gastrostomy Tube in Pediatric Patients: A Survey on Decision-Making and Practice. Nutr Clin Pract 2020; 36:654-664. [PMID: 33347651 DOI: 10.1002/ncp.10603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/17/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Tube feeding via nasogastric tubes (NGTs) and gastrostomy tubes (GTs) is a common practice for children unable to meet their nutrition needs by oral feeding alone. There is currently a lack of evidence-based guidance specific for the process of transitioning from an NGT to GT as a longer-term enteral access device. Uncertainty in the literature about feeding tube choices, practices, and transitions requires clinicians to draw on incomplete and sometimes conflicting evidence, personal experience, economic realities, and compassion to deliver supportive child-centered care. METHODS The ASPEN Enteral Nutrition Task Force Pediatric Work Group designed a survey to explore current practice of enteral access device safety and use among pediatric clinicians practicing in the US and Canada. The survey aimed to define time frames, parameters, and decision points to guide clinicians and families in the transition from NG to GT feeding. RESULTS 258 clinicians, 55% practicing in an inpatient setting, 17% in-home patient setting, and 28% practicing in both inpatient and outpatient setting. 22% were physicians, 42% were dietitians, 32% were nurses or advanced practice nurses, 2% were pharmacists. The most common feeding tubes used were NGTs followed by GTs. Majority of respondents indicated that they did not have a specific timeline for when an NGT should be changed to a GT. Highest ranked patient factors or clinical considerations prior to recommending changing from an NGT to a GT were exceeding the duration for temporary feeding or the need for an extended duration of tube feeding. Highest physician barriers to GT placement were the reluctance for referral from primary care doctors for GT placement. Majority of respondents reported the use of NGTs for enteral access at home and that parents were taught how to place the NGTs for home use but without consistently being taught the use of pH paper to verify NGT tip location or being provided with the pH paper to perform this task at home. CONCLUSIONS This survey is the first step to address the knowledge gap surrounding feeding tube choices by ascertaining the current standard of practice regarding enteral access devices and appropriate timing of transitioning from NGT to GT feeding. The results highlight current practice variability and concerns. Information from the survey was used to formulate a decision tree to guide the transition of NGT to GT feeding that nutrition support professionals can use to advocate for best practices in their hospital and community settings.
Collapse
Affiliation(s)
- Ruba A Abdelhadi
- Gastroenterology Division, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Gina Rempel
- Department of Pediatrics & Child Health, HSC Winnipeg Shared Health, Winnipeg, Manitoba, Canada
| | - Wednesday Sevilla
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Pittsburg Medical Center (UPMC) Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Justine M Turner
- Division of Gastroenterology and Nutrition, University of Alberta, Edmonton, Alberta, Canada
| | - Julie Quet
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Audra Nelson
- Pediatric Clinical Nutrition, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Katina Rahe
- Department of Patient Care Services, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Rebecca Wilhelm
- Division of Gastroenterology, Hepatology and Nutrition Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Julie Larocque
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition (ASPEN), Silver Spring, Maryland, USA
| | | |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Warren MG, Do B, Das A, Smith PB, Adams-Chapman I, Jadcherla S, Jensen EA, Goldstein RF, Goldberg RN, Cotten CM, Bell EF, Malcolm WF. Gastrostomy Tube Feeding in Extremely Low Birthweight Infants: Frequency, Associated Comorbidities, and Long-term Outcomes. J Pediatr 2019; 214:41-46.e5. [PMID: 31427096 PMCID: PMC6815700 DOI: 10.1016/j.jpeds.2019.06.066] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/07/2019] [Accepted: 06/25/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the frequency of gastrostomy tube (GT) placement in extremely low birth weight (ELBW) infants, associated comorbidities, and long-term outcomes. STUDY DESIGN Analysis of ELBW infants from 25 centers enrolled in the National Institute of Child Health and Human Development Neonatal Research Network's Generic Database and Follow-up Registry from 2006 to 2012. Frequency of GT placement before 18-22 months, demographic and medical factors associated with GT placement, and associated long-term outcomes at 18-22 months of corrected age were described. Associations between GT placement and neonatal morbidities and long-term outcomes were assessed with logistic regression after adjustment for center and common co-variables. RESULTS Of the 4549 ELBW infants included in these analyses, 333 (7.3%) underwent GT placement; 76% had the GT placed postdischarge. Of infants with GTs, 11% had birth weights small for gestational age, 77% had bronchopulmonary dysplasia, and 29% severe intraventricular hemorrhage or periventricular leukomalacia. At follow-up, 56% of infants with a GT had weight <10th percentile, 61% had neurodevelopmental impairment (NDI), and 55% had chronic breathing problems. After adjustment, small for gestational age, bronchopulmonary dysplasia, intraventricular hemorrhage/periventricular leukomalacia, poor growth, and NDI were associated with GT placement. Thirty-two percent of infants with GTs placed were taking full oral feeds at follow-up. CONCLUSIONS GT placement is common in ELBW infants, particularly among those with severe neonatal morbidities. GT placement in this population was associated with poor growth, NDI, and chronic respiratory and feeding problems at follow-up. The frequency of GT placement postneonatal discharge indicates the need for close nutritional follow-up of ELBW infants. TRIAL REGISTRATION ClinicalTrials.gov: NCT00063063.
Collapse
Affiliation(s)
| | - Barbara Do
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD
| | - P Brian Smith
- Department of Pediatrics, Duke University, Durham, NC
| | - Ira Adams-Chapman
- Emory University School of Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA
| | | | - Erik A Jensen
- Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | | |
Collapse
|
9
|
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
| |
Collapse
|
10
|
Tube feeding outcomes of infants in a Level IV NICU. J Perinatol 2019; 39:1406-1410. [PMID: 31388118 PMCID: PMC6761028 DOI: 10.1038/s41372-019-0449-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/04/2019] [Accepted: 06/12/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND NICU patients are commonly discharged home with nasogastric (NG) or gastrostomy (G-tube) feeding, but wide practice variation exists. The objective of this study was to evaluate feeding and growth outcomes and complications in NICU patients discharged home with NG or G-tube feeding. STUDY DESIGN Retrospective cohort study of infants discharged from a Level IV NICU with an NG or G-tube who had follow up to 1 year. Clinical characteristics and outcomes were compared between groups. RESULTS The study sample included 264 infants: 140 with NG and 124 with G-tube. More infants in the G-tube group (65%) still required tube feedings 12 months post-discharge than infants in the NG group (24%). Infants in the G-tube group had more tube-related ER visits than infants in the NG group. Growth outcomes did not differ. CONCLUSION Home NG feeding may be a safe alternative to a surgically placed G-tube in select NICU patients.
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
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; 54:465-470. [PMID: 29937107 DOI: 10.1016/j.jpedsurg.2018.05.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/30/2018] [Accepted: 05/27/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To describe the prevalence and outcome of assisted home feeding (AHF) in medically complex neonatal intensive care unit (NICU) patients, and to identify variables associated with AHF in this population. STUDY DESIGN 1223 infants who survived to discharge from 2013 to 2015 were identified in our single-center, retrospective cohort study at a large tertiary referral NICU. Demographic and selected disease-specific variables were compared between infants discharged on full oral feeding (PO) versus AHF. RESULT 404 (33%) infants were discharged on AHF (NG = 201, GT = 186, NJ = 17). AHF neonates were born at an earlier gestational age, lower birth weight, had longer hospital admission, greater post-menstrual age at discharge, and had more associated co-morbidities compared to the PO group. CONCLUSION AHF was a frequently used and safe intervention in our large cohort of infants. LEVEL OF EVIDENCE Treatment Study Level III.
Collapse
Affiliation(s)
- Benjamin R White
- Department of Pediatrics, University of Utah, School of Medicine; Division of Neonatology, University of Utah, School of Medicine.
| | - Chong Zhang
- Department of Internal Medicine, Division of Epidemiology, University of Utah, School of Medicine
| | - Angela P Presson
- Department of Pediatrics, University of Utah, School of Medicine; Department of Internal Medicine, Division of Epidemiology, University of Utah, School of Medicine
| | - Kim Friddle
- University of Utah, College of Nursing, Salt Lake City, UT
| | - Robert DiGeronimo
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, WA
| |
Collapse
|
13
|
Postoperative feeding problems in patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals undergoing unifocalisation surgery. Cardiol Young 2018; 28:1329-1332. [PMID: 30070195 DOI: 10.1017/s1047951118001270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals are at risk for prolonged hospitalisation after unifocalisation. Feeding problems after congenital heart surgery are associated with longer hospital stay. We sought to determine the impact of baseline, intra-operative, and postoperative factors on the need for feeding tube use at the time of discharge. METHODS We included patients with the aforementioned diagnosis undergoing unifocalisation from ages 3 months to 4 years from 2010 to 2016. We excluded patients with a pre-existing feeding tube. Patients discharged with an enteric tube were included in the feeding tube group. We compared the feeding tube group with the non-feeding-tube group by univariable and multi-variable logistic regression. RESULTS Of the 56 patients studied, 41% used tube feeding. Median age and weight z-score were similar in the two groups. A chromosome 22q11 deletion was associated with the need for a feeding tube (22q11 deletion in 39% versus 15%, p=0.05). Median cardiopulmonary bypass time in the feeding tube group was longer (335 versus 244 minutes, p=0.04). Prolonged duration of mechanical ventilation was associated with feeding tube use (48 versus 3%, p=0.001). On multi-variable analysis, prolonged mechanical ventilation was associated with feeding tube use (odds ratio 10.2, 95% confidence intervals 1.6; 63.8). CONCLUSION Among patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals who were feeding by mouth before surgery, prolonged mechanical ventilation after unifocalisation surgery was associated with feeding tube use at discharge. Anticipation of feeding problems in this population and earlier feeding tube placement may reduce hospital length of stay.
Collapse
|
14
|
The development of a consensus-based nutritional pathway for infants with CHD before surgery using a modified Delphi process. Cardiol Young 2018; 28:938-948. [PMID: 29704905 PMCID: PMC5977758 DOI: 10.1017/s1047951118000549] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
UNLABELLED IntroductionDespite improvements in the medical and surgical management of infants with CHD, growth failure before surgery in many infants continues to be a significant concern. A nutritional pathway was developed, the aim of which was to provide a structured approach to nutritional care for infants with CHD awaiting surgery.Materials and methodsThe modified Delphi process was development of a nutritional pathway; initial stakeholder meeting to finalise draft guidelines and develop questions; round 1 anonymous online survey; round 2 online survey; regional cardiac conference and pathway revision; and final expert meeting and pathway finalisation. RESULTS Paediatric Dietitians from all 11 of the paediatric cardiology surgical centres in the United Kingdom contributed to the guideline development. In all, 33% of participants had 9 or more years of experience working with infants with CHD. By the end of rounds 1 and 2, 76 and 96% of participants, respectively, were in agreement with the statements. Three statements where consensus was not achieved by the end of round 2 were discussed and agreed at the final expert group meeting. CONCLUSIONS Nutrition guidelines were developed for infants with CHD awaiting surgery, using a modified Delphi process, incorporating the best available evidence and expert opinion with regard to nutritional support in this group.
Collapse
|
15
|
Tang D, Parker EK, Faruquie SS, Hames NL, Talbot P. Evaluation of home enteral nutrition services at public hospitals in New South Wales, Australia. Nutr Diet 2018; 76:6-13. [DOI: 10.1111/1747-0080.12420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/06/2018] [Accepted: 02/12/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Diana Tang
- School of Molecular Bioscience; University of Sydney; Sydney New South Wales Australia
| | - Elizabeth K. Parker
- Department of Dietetics and Nutrition; Westmead Hospital; Sydney New South Wales Australia
| | - Sahrish S. Faruquie
- Department of Diabetes and Endocrinology; Westmead Hospital; Sydney New South Wales Australia
| | - Nadia L. Hames
- Department of Dietetics and Nutrition; Westmead Hospital; Sydney New South Wales Australia
| | - Peter Talbot
- Department of Dietetics and Nutrition; Westmead Hospital; Sydney New South Wales Australia
| |
Collapse
|
16
|
Northington L, Lyman B, Guenter P, Irving SY, Duesing L. Current Practices in Home Management of Nasogastric Tube Placement in Pediatric Patients: A Survey of Parents and Homecare Providers. J Pediatr Nurs 2017; 33:46-53. [PMID: 28188079 DOI: 10.1016/j.pedn.2017.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 12/29/2016] [Accepted: 01/18/2017] [Indexed: 12/31/2022]
Abstract
UNLABELLED Enteral feeding tubes are used in pediatric patients to deliver nutrition, fluids or medications. The literature related to short-term feeding tube (nasogastric [NG], hereafter known as NGT, or orogastric [OGT],) use in pediatric homecare patients is sparse. This descriptive study sought to gather baseline information about these children and how their feeding tubes are managed at home. Specifically, we sought to better understand how the tubes are placed and the method(s) used for tube placement verification. Two surveys were distributed: one to parents and one to homecare providers who have direct patient contact. RESULTS Responses were obtained from 144 parents and 66 homecare providers. Over half of the children were 12months of age or younger and had a 6 Fr feeding tube. Over 75% (108) had an NGT for 1year or less. Predominantly parents replaced the NGT but a few children self-inserted their tubes. Feeding tube placement was verified by auscultation (44%) or measurement of gastric pH (25%) in the parent's survey. Twenty-six percent of parents indicated they had misplaced an NGT at least once and 35 parents described symptoms of pulmonary misplacement. The homecare provider data indicated auscultation (39%) and pH measurement of gastric contents (28%) to verify NG tube placement location. Study results confirms a need for consistency of practice among health care professionals and in parent education for those children who require NGTs at home. It is troubling that auscultation is still widely used for NGT location confirmation despite practice alerts that warn against its use.
Collapse
Affiliation(s)
- LaDonna Northington
- University of Mississippi Medical Center School of Nursing, 2500 North State Street, Jackson, MS 39216, USA.
| | - Beth Lyman
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, USA.
| | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), 8630 Fenton St. Suite 412, Silver Spring, MD 20910, USA.
| | - Sharon Y Irving
- University of Pennsylvania, School of Nursing, Claire M. Fagin Hall, 418 Curie Blvd., RM 427, Philadelphia, PA 19104, USA.
| | - Lori Duesing
- Pediatric Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| |
Collapse
|
17
|
Sevilla WMA, McElhanon B. Optimizing Transition to Home Enteral Nutrition for Pediatric Patients. Nutr Clin Pract 2016; 31:762-768. [DOI: 10.1177/0884533616673348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
| | - Barbara McElhanon
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition and the Division of Autism and Related Disorders, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
18
|
Abdelhadi RA, Rahe K, Lyman B. Pediatric Enteral Access Device Management. Nutr Clin Pract 2016; 31:748-761. [DOI: 10.1177/0884533616670640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Ruba A. Abdelhadi
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Katina Rahe
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Beth Lyman
- Nutrition Support Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| |
Collapse
|
19
|
Abdelhadi RA, Bouma S, Bairdain S, Wolff J, Legro A, Plogsted S, Guenter P, Resnick H, Slaughter-Acey JC, Corkins MR. Characteristics of Hospitalized Children With a Diagnosis of Malnutrition. JPEN J Parenter Enteral Nutr 2016; 40:623-35. [DOI: 10.1177/0148607116633800] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/21/2016] [Indexed: 12/17/2022]
Affiliation(s)
| | - Sandra Bouma
- University of Michigan C.S. Mott Children’s Hospital, Ann Arbor, Michigan, USA
| | | | - Jodi Wolff
- Rainbow Babies and Children’s Hospital, Solon, Ohio, USA
| | - Amanda Legro
- Miller Children’s and Women’s Hospital, Long Beach, California, USA
| | | | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Helaine Resnick
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Jaime C. Slaughter-Acey
- College of Nursing & Health Professions School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Mark R. Corkins
- University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | | |
Collapse
|