Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Enteral tube feeding selection at NICU discharge and resource utilization

Journal of Perinatology volume 43, pages 647–652 (2023)Cite this article

Subjects

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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to the data being a dataset that is proprietarily owned by a single institution, as well as being stored in a secure server owned by the institution and not deidentified. However, the data are available from the corresponding author on reasonable request.

References

  1. 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. J Parenter Enter Nutr. 2020;44:491–9.

    Article  Google Scholar 

  2. Viswanathan S, Jadcherla S. Feeding and swallowing difficulties in neonates: developmental physiology and pathophysiology. Clin Perinatol. 2020;47:223–41.

    Article  PubMed  Google Scholar 

  3. Lee JH, Chang YS, Yoo HS, Ahn SY, Seo HJ, Choi SH, et al. Swallowing dysfunction in very low birth weight infants with oral feeding desaturation. World J Pediatr. 2011;7:337–43.

    Article  PubMed  Google Scholar 

  4. Crapnell TL, Rogers CE, Neil JJ, Inder TE, Woodward LJ, Pineda RG. Factors associated with feeding difficulties in the very preterm infant. Acta Paediatr. 2013;102:e539–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Lau C, Smith EO, Schanler RJ. Coordination of suck-swallow and swallow respiration in preterm infants. Acta Paediatr. 2003;92:721–7.

    Article  CAS  PubMed  Google Scholar 

  6. Mizuno K, Ueda A. Neonatal feeding performance as a predictor of neurodevelopmental outcome at 18 months. Dev Med Child Neurol. 2005;47:299–304.

    Article  PubMed  Google Scholar 

  7. Kamitsuka MD, Nervik PA, Nielsen SL, Clark RH. Incidence of nasogastric and gastrostomy tube at discharge is reduced after implementing an oral feeding protocol in premature (<30 weeks) infants. Am J Perinatol. 2017;34:606–13.

    Article  PubMed  Google Scholar 

  8. Doshi H, Shukla S, Patel S, Bhatt P, Bhatt N, Anim-Koranteng C, et al. Gastrostomy tube placement and resource use in neonatal hospitalizations with down syndrome. Hosp Pediatr. 2022;12:415–25.

    Article  PubMed  Google Scholar 

  9. Martini S, Beghetti I, Annunziata M, Aceti A, Galletti S, Ragni L, et al. Enteral nutrition in term infants with congenital heart disease: knowledge gaps and future directions to improve clinical practice. Nutrients. 2021;13:932.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lagatta JM, Uhing M, Acharya K, Lavoie J, Rholl E, Malin K, et al. 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.e32.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bhagat I, Agarwal P, Sarkar A, Dechert R, Altinok D, Chouthai N. Does severity of brain injury on magnetic resonance imaging predict short-term outcome in neonates who received therapeutic hypothermia? Am J Perinatol. 2021;10:41.

  12. Gien J, Murthy K, Pallotto EK, Brozanski B, Chicoine L, Zaniletti I, et al. Short-term weight gain velocity in infants with congenital diaphragmatic hernia (CDH). Early Hum Dev. 2017;106-107:7–12.

    Article  PubMed  Google Scholar 

  13. Greene NH, Greenberg RG, O’Brien SM, Kemper AR, Miranda ML, Clark RH, et al. Variation in gastrostomy tube placement in premature infants in the United States. Am J Perinatol. 2019;36:1243–9.

    Article  PubMed  Google Scholar 

  14. Khalil ST, Uhing MR, Duesing L, Visotcky A, Tarima S, Nghiem-Rao TH. Outcomes of infants with home tube feeding: comparing nasogastric vs gastrostomy tubes. J Parenter Enter Nutr. 2017;41:1380–5.

    Article  Google Scholar 

  15. Williams SL, Popowics NM, Tadesse DG, Poindexter BB, Merhar SL. Tube feeding outcomes of infants in a Level IV NICU. J Perinatol. 2019;39:1406–10.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Duncan TL, Ulugia J, Bucher BT. Association of gastrostomy placement on hospital readmission in premature infants. J Perinatol. 2019;39:1485–91.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ricciuto A, Baird R, Sant’Anna A. A retrospective review of enteral nutrition support practices at a tertiary pediatric hospital: A comparison of prolonged nasogastric and gastrostomy tube feeding. Clin Nutr. 2015;34:652–8.

    Article  PubMed  Google Scholar 

  18. Collins CT, Makrides M, McPhee AJ. Early discharge with home support of gavage feeding for stable preterm infants who have not established full oral feeds. Cochrane Database Syst Rev. 2015;2015:Cd003743.

    PubMed  PubMed Central  Google Scholar 

  19. Adams-Chapman I, Bann CM, Vaucher YE, Stoll BJ. Association between feeding difficulties and language delay in preterm infants using Bayley Scales of Infant Development-Third Edition. J Pediatr. 2013;163:680–85.e681–83.

    Article  Google Scholar 

  20. Rosen D, Schneider R, Bao R, Burke P, Ceballos C, Hoffstadter-Thal K, et al. Home nasogastric feeds: feeding status and growth outcomes in a pediatric population. J Parenter Enter Nutr. 2016;40:350–4.

    Article  Google Scholar 

  21. Kumbhar SS, Plunk MR, Nikam R, Boyd KP, Thakrar PD. Complications of percutaneous gastrostomy and gastrojejunostomy tubes in children. Pediatr Radiol. 2020;50:404–14.

    Article  PubMed  Google Scholar 

  22. Refaat AM, Kotby MN. Pharyngo-esophageal complications of Ryle tube insertion in neonates: management and fate. Eur Arch Oto-Rhino-Laryngol. 2020;277:3403–6.

    Article  Google Scholar 

  23. Warren MG, Do B, Das A, Smith PB, Adams-Chapman I, Jadcherla S, et al. Gastrostomy tube feeding in extremely low birthweight infants: frequency, associated comorbidities, and long-term outcomes. J Pediatr. 2019;214:41–6.e45.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. Ponsky TA, Gasior AC, Parry J, Sharp SW, Boulanger S, Parry R, et al. Need for subsequent fundoplication after gastrostomy based on patient characteristics. J Surg Res. 2013;179:1–4.

    Article  PubMed  Google Scholar 

  26. Novotny NM, Jester AL, Ladd AP. Preoperative prediction of need for fundoplication before gastrostomy tube placement in children. J Pediatr Surg. 2009;44:173–6.

    Article  PubMed  Google Scholar 

  27. Berman L, Sharif I, Rothstein D, Hossain J, Vinocur C. Concomitant fundoplication increases morbidity of gastrostomy tube placement. J Pediatr Surg. 2015;50:1104–8.

    Article  PubMed  Google Scholar 

  28. Barnhart DC, Hall M, Mahant S, Goldin AB, Berry JG, Faix RG, et al. Effectiveness of fundoplication at the time of gastrostomy in infants with neurological impairment. JAMA Pediatr. 2013;167:911–8.

    Article  PubMed  Google Scholar 

  29. Madiwale MV, Sahai S. Nissen fundoplication: a review of complications for the pediatrician. Clin Pediatr. 2015;54:105–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Amy A. Howk

  2. Emory University, Atlanta, GA, USA

    Jordan L. Sternthal & Beatrice Connor

  3. Division of Neonatology, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, USA

    Mitali A. Pakvasa

  4. Division of Neonatology, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Sarah D. Keene

Authors
  1. Amy A. Howk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jordan L. Sternthal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mitali A. Pakvasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Beatrice Connor
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sarah D. Keene
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AAH: Drafting and revision of the manuscript. Performed analysis and interpretation of data. JLS: Performed acquisition and analysis of data. MAP: Conceptualized the design of the study. Critical manuscript revisions. BC: Performed acquisition and analysis of data. SDK: Conceptualized the design of the study. Supervised data acquisition, analysis, and interpretation. Critical manuscript revisions. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Amy A. Howk.

Ethics declarations

Competing interests

The authors declare no competing interests.

Study approval

This study protocol was reviewed and approved by the Children’s Healthcare of Atlanta Institutional Review Board, approval number STUDY00001324.

Consent to participate

The institutional review board determined that written informed consent was not required for this study.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Howk, A.A., Sternthal, J.L., Pakvasa, M.A. et al. Enteral tube feeding selection at NICU discharge and resource utilization. J Perinatol 43, 647–652 (2023). https://doi.org/10.1038/s41372-022-01566-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-022-01566-4

This article is cited by

Search

Advanced search

Quick links