Feeding Methods at Discharge Predict Long-Term Feeding and Neurodevelopmental Outcomes in Preterm Infants Referred for Gastrostomy Evaluation

Abstract

Objective To test the hypothesis that oral (PO) feeding at first neonatal intensive care unit (NICU) discharge is associated with less neurodevelopmental impairment and better feeding milestones, as compared with discharge with a gastrostomy tube (g-tube). Study design We studied outcomes for a retrospective cohort of 194 neonates < 37 weeks gestation referred for evaluation and management of feeding difficulties between July 2006–July 2012. Discharge milestones, length of hospitalization, and Bayley Scales of Infant Development scores at 18–24 months were examined. Chi-Square, Mann-Whitney U, or t-tests and multivariable logistic regression models were used. Results 60% (n=117) of infants were discharged on PO feedings; of these, 96% remained PO-fed at 1-year. The remaining 40% (n=77) were discharged on g-tube feedings; of these, 31 (40%) remained g-tube dependent, 17 (22%) became PO-fed, and 29 (38%) were on PO and g-tube feedings at one year. Infants discharged on a g-tube had lower cognitive (p<0.01), communication (p=0.03), and motor (p<0.01) composite scores. The presence of a g-tube, younger gestation, bronchopulmonary dysplasia, or intraventricular hemorrhage was significantly associated with neurodevelopmental delay. Conclusions For infants referred for feeding concerns, g-tube evaluations and feeding management, the majority did not require a g-tube. Full PO feeding at first NICU discharge was associated with superior feeding milestones and less long-term neurodevelopmental impairment, relative to full or partial g-tube feeding. Evaluation and feeding management before and after g-tube placement may improve long-term feeding and neurodevelopmental outcomes.

Differences in midterm outcomes in infants with hypoplastic left heart syndrome diagnosed with necrotizing enterocolitis: NPCQIC database analysis

“…There continued to be a significant difference in the ability to orally feed in the HLHS‐NEC infants compared with the HLHS‐nNEC infants at time of their second surgery. This is consistent with data in noncongenital heart disease patients that documented route of feeding at time of initial hospital discharge predicting long‐term feeding difficulties . As stated before, infants with congenital heart disease have underlying issues that place them at increased risk for feeding issues, but the inability to orally feed may have cognitive, communication, and motor implications in these patients .…”

“…This is consistent with data in noncongenital heart disease patients that documented route of feeding at time of initial hospital discharge predicting long-term feeding difficulties. 34 As stated before, infants with congenital heart disease have underlying issues that place them at increased risk for feeding issues, but the inability to orally feed may have cognitive, communication, and motor implications in these patients. 25,26,34 Though presence of NEC was associated with increased unadjusted odds of not being fed orally, adjusted odds ratio found that NEC was not necessarily a significant risk factor.…”

“…34 As stated before, infants with congenital heart disease have underlying issues that place them at increased risk for feeding issues, but the inability to orally feed may have cognitive, communication, and motor implications in these patients. 25,26,34 Though presence of NEC was associated with increased unadjusted odds of not being fed orally, adjusted odds ratio found that NEC was not necessarily a significant risk factor. Though it is reassuring that NEC does not seem to affect mid-term outcomes after hospital discharge, methods to reduce the incidence of NEC in this high risk population should be investigated to possibly improve the incidence of oral feeding in this patient population.…”

Respiratory outcomes after initial hospital discharge in children with ventricular shunts and bronchopulmonary dysplasia

“…Placement of gastric tubes during infancy may have been more common in the children with ventricular shunts and BPD, due in part to their greater likelihood of neurodevelopmental delay and dysphagia. A recent study found that preterm infants who needed gastric tube placement prior to discharge from the NICU, were more likely to have a severe IVH and to have neurodevelopmental delay at 18‐24 months of age . Another study evaluating children at risk for dysphagia found that aspiration, gastro‐esophageal reflux, and age one year or less were significant risk factors for subsequent pneumonia .…”

“…A recent study found that preterm infants who needed gastric tube placement prior to discharge from the NICU, were more likely to have a severe IVH and to have neurodevelopmental delay at 18-24 months of age. 18 Another study evaluating children at risk for dysphagia found that aspiration, gastroesophageal reflux, and age one year or less were significant risk factors for subsequent pneumonia. 19 It is possible that early gastric tube placement and/or Nissen fundoplication in our study population may have mitigated the potential adverse effects of dysphagia and aspiration on long-term respiratory outcomes in the VS children.…”