Standardized pathway for feeding tube placement reduces unnecessary surgery and improves value of care

Devin, Courtney L.; Linden, Allison F.; Sagalow, Emily S.; Reichard, Kirk W.; Vinocur, Charles D.; Miller, Jonathan M.; Goldin, Adam B.; Berman, Loren

doi:10.1016/j.jpedsurg.2020.02.033

Cited by 11 publications

(2 citation statements)

References 25 publications

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“…We also continue to anticipate the needs of more complex patients discharged with NG feeds, like those reported in programs for medically complex infants, infants with BPD, and infants whose families or specialist providers choose to defer G tube placement for a variety of reasons. 10,19,21 A team from Cincinnati found that most infants attaining full oral feeds had done so by 60 days of age; more complex infants may be less likely progress to full oral feeds and will need consideration of G tube placement. 12 One issue hopefully unique to our study is that 3 infants who needed G tubes toward the end of the study period were unable to receive them in a timely fashion due to COVID-19 delaying elective procedures.…”

Section: Discussionmentioning

confidence: 99%

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

Lagatta

Uhing

Acharya

et al. 2021

The Journal of Pediatrics

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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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Section: Discussionmentioning

confidence: 99%

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

Lagatta

Uhing

Acharya

et al. 2021

The Journal of Pediatrics

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“…Many studies have shown the effectiveness of established guidelines for infants discharged on HNG feeds [1][2][3][4][5][6][7]. However, the criterion for such discharge varies between different NICUs.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Infants Discharged Home from the Neonatal Unit with Partial Nasogastric Feeds

Kamal,

Chandrasekar

2024

IJG

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Aim: In our previous publication, we proposed an algorithm for safely discharging infants from the neonatal intensive care unit (NICU) on partial nasogastric feeds (NGF), thus avoiding gastrostomy tube placement (GTP) for infants who were unable to take full oral feeds. This follow up study post intervention, is to determine the number of patients discharged home on partial nasogastric (NG) feeds, the effectiveness of this intervention measured by reaching full oral feeds within 3 months of discharge and parent view on this intervention and outcome. We also investigated the success of this intervention based on the main discharge diagnosis. Study Design: Retrospective single-center study of infants discharged from the NICU from June 2019 to Dec 2020. Chart review was done to determine the rate of follow-up, time of achieve full oral feeds, and discontinuation of NG tube. We calculated NICU days saved by calculating the days from discharge to reaching full oral feeds at home. Results: Patient records were available for chart review regarding their outpatient follow-up in 96%. 82% of patients reached full feeds on an average of 35 days (range 1day to 10 weeks). 10% of patients required GTP due to the need for prolonged gavage feeding. 2 records were unavailable. Infants discharged home with NG tubes saved 587 NICU days. 88% of the parents contacted over phone responded positively in their choice of NG tube instead of GTP. Conclusion: Discharge from NICU on partial NG feeds for select infants is associated with reduced NICU stay without increased post-discharge complications or increased parent satisfaction.

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Discharged on Enteral Nutrition: What Now? The Poor State of Outpatient Support for Patients on Enteral Nutrition Support

Palchaudhuri

Mccreary

Davis

et al. 2023

Curr Gastroenterol Rep

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Standardized pathway for feeding tube placement reduces unnecessary surgery and improves value of care

Cited by 11 publications

References 25 publications

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

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

Outcome of Infants Discharged Home from the Neonatal Unit with Partial Nasogastric Feeds

Discharged on Enteral Nutrition: What Now? The Poor State of Outpatient Support for Patients on Enteral Nutrition Support

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